Low-Energy Laser for Pseudofolliculitis Barbae Reduces Pain

GRAPEVINE, TEX. — Reduced laser energy can be effective and more acceptable to patients who are being treated for pseudofolliculitis barbae, based on results from a study with 11 evaluable patients.

"Lower fluences offer hair modulation without permanent hair reduction," Dr. Rafael A. Schulze said at the annual meeting of the American Society for Laser Medicine and Surgery.

The hair follicles become smaller and weaker, and less prone to cause pseudofolliculitis barbae. Lower laser fluences also mean less conductive heating and therefore less pain. Treatment with lower energy, at less than half the power usually used for hair removal, also means that the laser device can be smaller and potentially more portable, said Dr. Schulze, a dermatologist at Brooke Army Medical Center, Fort Sam Houston, Tex.

Pseudofolliculitis barbae, caused by the curling and growth of hair follicles into adjacent skin, occurs primarily in African Americans and causes inflammatory papules and pustules. It can also cause skin discoloration, hypertrophic or keloidal scarring, and secondary infections. Standard treatments include topical steroids, chemical depilatories, electrolysis, and laser hair reduction.

Standard laser hair reduction is done with a high-fluence device, usually at a dose of 22–40 J/cm2, which delivers a total power of 940 watts at an energy level of 24 J/cm2. This approach is painful in patients with darker skin and can cause pigmentation changes, scarring, or blistering. The laser device needed to deliver this energy is large and expensive, and at least two or three treatments are usually needed, at 4- to 6-week intervals. This treatment is designed to permanently destroy hair follicles.

Dr. Schulze and his associates examined the efficacy and safety of treatment with a 1064-nm Nd:YAG StarLux laser that delivered 12 J/cm2 with a 10-mm spot size and 20-millisecond pulses, producing a total power dose of 390 watts.

The Lux handpiece contained a water-cooled sapphire window; no topical anesthesia was used.

The treatment was designed not to destroy hair follicles but to cause a slight insult in them and make the hairs weaker and smaller, said Dr. Schulze, who had no financial conflicts to disclose for this study.

The study enrolled 21 men and 1 woman with pseudofolliculitis barbae and skin type IV-VI who were scheduled to receive weekly low-fluence laser treatments for 5 weeks, followed by 4 weeks of follow-up. Their age range was 21–42 years, with an average of 24. The participants were told to continue whatever grooming methods they had used before laser treatment, including clipping their facial hair and using a chemical depilatory.

Photographs of the necks of each patient were assessed before and after treatment by a panel of 10 dermatologists, who scored the outcomes based on papule counts, dyspigmentation, cobblestone appearance, and global assessment. Thirteen of the 22 patients completed the study. Two of the 13 completers failed to follow the protocol and changed their grooming method during the study, so they were excluded from the final analysis.

Among the 11 evaluable patients, none developed pigmentation changes, crusting, blistering, or scarring.

The global efficacy assessment showed an average 83% improvement for the composite of papule number, dyspigmentation, and cobblestone appearance, a statistically significant difference, compared with baseline.

Each of the individual assessments was also significantly improved at follow-up, compared with baselines. (See box.)

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