The use of lasers for hair removal carries a certain level of potential risk related to dermal side effects, and has certain limitations for treating darker skin or lighter hair. These risks and limitations get further amplified when treatments need to administered to one’s face. The risk of causing a permanent or long-lasting dermal effect, such as scarring or pigmentary change is highly dependent on the laser dose used, and the subject’s skin type. We have investigated the effect of a relatively low-dose diode laser treatment on the upper-lip hair in a split-body test using eflornithine cream (Vaniqa) on one side and the placebo cream on the contralateral side. The study was carried out as a randomized, double-blind, placebo – control test on 16 women with upper-lip hair. An 810 nm diode laser system (SLP 1000, Palomar Medical Technologies, Burlington, MA) was used with parameter settings of 90 W, 50 ms pulse and 12 mm aperture that translated to a low 4 J/cm2 skin exposure. Subjects were treated with the laser once every week for 8 weeks, and the Vaniqa and placebo cream applications were made twice daily for 12 weeks. There was a three-month follow-up period after the last Vaniqa treatment. Efficacy response to this low laser dose (fluence) was highly variable among subjects. The denser, darker coarser hair responded well to the laser treatment, with or without the concomitant treatment with Vaniqa (Fig. 20.1). On the other hand, sparser, less pigmented, or thinner hair had responses that ranged from a moderate effect to no response at all from the laser treatment alone. Addition of Vaniqa made a dramatic difference in providing hair reduction benefits for subjects who were either poor or nonresponders to the laser treatment. As shown in Fig. 20.2 (left side), the subject treated with the placebo cream and laser combination had no response, even after the eight-weekly
Baseline
treatments. The lack of efficacy is probably related to the suboptimal low-fluence used for the thinner, finer hair. However, a combination treatment with Vaniqa and the same laser dose resulted in a complete clearance of terminal hair and a significant reduction in the finer vellus like hair on the contra lateral right side of the subject (Fig. 20.2). For consumers where only a low laser dose can be safely used, the combination can make the difference between an effective treatment and a satisfied consumer, against a complete lack of efficacy and a highly dissatisfied consumer.
A manuscript with the detailed study design and the results is being prepared for a future publication.
In the past decade, lasers and IPL systems have become increasingly popular for hair removal or permanent hair reduction. However, their market penetration still remains very
Baseline
Placebo Vaniqa
low, at about 1%. There are multiple factors that have contributed to their low acceptability including expense, inconvenience, efficacy limitations, and skin safety risks. The efficacy and safety issues become particularly important when treating the facial areas. Nonuniformity of hair types and pigmentation, and possibly an androgenic hormonal involvement makes the facial hair more resistant to laser treatment. Further, the sensitivity around the beauty aspect of the face prevents one from using laser fluences higher than what a subject can comfortably tolerate, because of the risk of causing dermal damage such as blistering, scarring or permanent pigmentary changes. The use of hair – growth reduction chemical technologies in combination with a laser or IPL system provides an opportunity for enhanced effectiveness. The efficacy synergy demonstrated for the combination of Vaniqa and a laser system represents an opportunity for overcoming limitations of either technologies alone, and meeting the threshold of consumer satisfaction for facial hair removal.