Lymphedema and Laser Hair Removal

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Lymphedema and Laser Hair Removal

Postby patoco » Sat Jun 10, 2006 5:24 pm

Lymphedema and Laser Hair Removal

Lymphedema People

http://www.lymphedemapeople.com

Originally posted 04/10/2005 by CW

Hi,

I have been trying to research Laser Hair Removal and whether it is bad to have it done on the affected limb. I can't find any information and I'm wondering if anyone out there has heard anything ? I wouldn't want to do it if it would cause any problems.

Thanks,

CW

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Reponse

Pat

Hey CW

We have a page on laser hair removal

Lymphedema and Laser Hair Removal

http://www.lymphedemapeople.com/forum/t ... PIC_ID=615

Based on what I was able to find out, I'm not sure that I would recommend it. Based on these possible complications.

What Can Be The Complications of Laser Hair Removal?

1. Itching

2. Pain, tingling, or feeling of numbness

3. Crusting/scab formation (on ingrown hairs)

4. Bruising

5. Purpura on tanned areas

6. Redness

7. Swelling

8. Infection

9. Temporary pigment change

10. Scarring

11. Blistering

Hope this help!

Pat

........

Lymphedema and Laser Hair Removal

Our Home Page: Lymphedema People

http://www.lymphedemapeople.com

================

Lymphedema and Laser Hair Removal

One of our members recently had asked is it safe for lymphedema patients to have laser hair removal. Search as I might for any dependable information, none can be found. Therefore to adequatly
present an answer, we need to understand:

1. How does the process of laser hair removal work

2. What can be the complications

3. Who should not have laser hair removal

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How Do Lasers and Intense Pulse Light Sources Remove Hair?

Laser hair removal systems gently remove unwanted hair. While dermatologic surgeons continue to research the exact science of laser hair removal, it appears that the light energy causes thermal injury to the hair follicle. This occurs because laser light is converted into heat as it passes through the skin and is absorbed in the target pigment melanin found in the hair follicle. When the temperature reaches a high enough level in a hair follicle during its active phase, the targeted hair structures are disabled, thus inhibiting hair re-growth. In clinical trials to date using a number of different lasers and intense pulsed light hair removal systems, some test sites remained hair-free for up to 2 years.

http://www.asds-net.org/Patients/FactSh ... moval.html

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What Can Be The Complications of Laser Hair Removal?

1. Itching

2. Pain, tingling, or feeling of numbness

3. Crusting/scab formation (on ingrown hairs)

4. Bruising

5. Purpura on tanned areas

6. Redness

7. Swelling

8. Infection

9. Temporary pigment change

10. Scarring

11. Blistering

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Who should not have laser hair removal

Based on the list of possible complications, I would emphatically say that laserhair removal should never be done on a limb that either has lymphedema or is at risk for lymphedema.

I would also, based on the possible complications have to say I would not recommend a lymphedema patient even having laser hair removal on non-lymphedema areas.

This is especially true in the pubic region. Any complication that caused blistering, a subsequent infection, or swelling could result in permanent genital lymphedema.

Other Contraindications: For the laser to be effective, the hair pigment must be darker than the surrounding skin pigment. If this is not the case, the treatment will not work and may have harmful complications.

Early in the evolution of the procedure, patients with Fitzpatrick skin types V and VI were not candidates, and even patients with skin types III and IV were high risk. With newer technologies, most patients can now be treated, although caution must still be exercised.

Obviously, sun tanning is contraindicated during or before treatment because the practice darkens surrounding pigment.

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Laser Hair Removal

Last Updated: May 2, 2003

Synonyms and related keywords: photothermolysis, hair removal, ruby laser, neodymium:yttrium-aluminum-garnet laser, Nd:YAG laser, hair-removing lasers, hirsutism

Author: Mounir Bashour, MD, CM, FRCS(C), Director of Ophthalmic Plastic and Reconstructive Surgery, Assistant Professor, Department of Ophthalmology, Sherbrooke University, Canada

Coauthor(s): Andrea James, MA, Director of Hairfact.com

Article on E Medicine

http://www.emedicine.com/ent/topic738.htm

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Laser hair removal

Basic facts

Some consumers have experienced permanent hair reduction, but there is limited data on how long hair reduction usually lasts, how much hair reduction is typical, and how often permanent hair reduction occurs.

Description

Light at a specified wavelength is delivered from a handpiece into the skin, where it targets dark material (usually the pigment in hair).

This is intended to cause thermal and/or mechanical damage to a hair follicle while sparing surrounding tissues.

Advantages

Some consumers have experienced long-lasting hair removal or permanent hair reduction.

Considered safe if performed properly.

Useful for large areas such as backs or legs.

Regrowth can come back lighter in color or finer in texture.

Light-skinned consumers with dark hair have the best results.

Disadvantages

Long-term data on safety and effectiveness have not been accurately established.

Response rates have not been established.

Regrowth rates have not been accurately established and cannot be predicted due to numerous variables.

Generally not as effective on unpigmented (gray) hairs and red or blonde hair.

Must be used very cautiously (if at all) on darker skin tones or on consumers who tan themselves.

Improper treatment can cause burns, lesions, skin discoloration lasting several months, or patchy/patterned regrowth.

Recent data suggest other skin structures are often affected by laser irradiation, and long term effects of this constitute an unknown risk.

Requires eye protection.

Can be expensive.

Some find treatment painful.

Regulation varies by state, so inadequate controls exist to ensure competent practitioners.

Some consumers, even ideal candidates, do not respond to treatment.

Quack claims

"Painless" or "virtually painless"

While many clients tolerate laser without requiring pain relief, it's overpromise to state that treatment will be painless for all consumers.

"Permanent hair removal" or "100% permanent" or "permanent"

Some consumers experience permanent reduction of treated hair over the course of treatment, but published studies have observed that many consumers are not good candidates, and even ideal candidates with light skin and dark hair do not always respond to treatment. See the page on permanent hair reduction below.

"Guaranteed 0% regrowth"

There is no published clinical data to substantiate this sort of overpromise.

"Laser electrolysis" or "lasertrolysis"

These quack marketing terms are used to blur important distinctions between laser and electrolysis effectiveness. Laser has several advantages over electrolysis, and vice versa. Terms like these only confuse consumers.

"Light years ahead of electrolysis"

This quack marketing term suggests that laser is better than electrolysis for consumers, but this is not always the case.

http://www.hairfacts.com/methods/laser/lasermain.html

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Laser hair removal history and current issues

The new uses of lasers in the 1960s captured the imagination of both scientists and the general public. Lasers also captured the imagination of the hair removal industry, who began attempting hair removal almost as soon as dermatologists and researchers began experimenting on living tissue.

Wave 1 lasers: 1960 to 1969

The first lasers used for dermatology in the mid to late 1960's emitted a continuous wave, but this was not practical for hair removal, since the beam could not be controlled well enough to avoid collateral skin damage. The development of the Q-switch (similar to a camera shutter) allowed laser energy to be emitted in controlled pulses.

Wave 2 lasers: 1969 to present

Early laser-like devices (see photoepilators) selectively targeted individual follicles by delivering energy through a wire-thin fiberoptic probe (and later through a penlight-type device). This device was rushed to market without adequate testing of effectiveness. It was marketed illegally as painless and permanent until FDA stepped in. These devices turned out to be tedious to use, logistically difficult to maintain the probes, and ineffective for permanent hair removal.

Wave 3 lasers: 1979 to present

As with electrolysis, the early published clinical data on laser hair removal involved the successful treatment of ingrown eyelashes. [1] This led to research and even a commercial attempt at a device using an argon laser for general market hair removal. This device was rushed to market without adequate testing of effectiveness, and it turned out to be tedious to use and ineffective for permanent hair removal.

Other researchers began using lasers for dermatological procedures and found them useful for removing some kinds of tattoos and for the treatment of some kinds of vascular lesions. In some instances, it was observed that hair loss occurred in treated areas, which led to experiments in epilation in animal models and later human subjects in the early 1990's.

Wave 4 lasers: 1995 to present

In 1995, one century after the discovery of x-rays, FDA cleared the first laser for hair removal in the US, the SoftLight™ Nd:YAG by ThermoLase. [2] This device was rushed to market without adequate testing of effectiveness. It was marketed illegally as painless and permanent until FDA stepped in. It uses a carbon-based lotion as a chromophore. This lotion was rubbed into the skin following waxing, with the hope it would penetrate the follicle. The laser would then rapidly heat the carbon, causing a shock wave of energy that had the potential to damage nearby cells. This process was found to be more complicated and less effective than targeting chromophores that occur naturally in the skin.

The device was sold to physicians and treatments were offered in a chain of proprietary clinics called Spa Thira, primarily in affluent communities. Consumers basically paid to be guinea pigs. By the time a medical paper appeared in 1997 which observed full regrowth of all hair [3], consumers had already spent hundreds of thousands of dollars on treatments. They quickly shifted their marketing strategy away from permanent hair removal to a "hair-management strategy," but word was beginning to get out.

In 1998 a class action suit was brought against the company by a consumer alleging ThermoLase "advertised SoftLight laser hair removal as long lasting with the knowledge that such treatments did not achieve that result." [4] ThermoLase quietly settled out of court later that year. In 1999, following other lawsuits and an annual loss of over $41 million, they began closing or selling their spas. [5] In 2000, with the stock down 92% from its high, ThermoLase was folded back into its parent company, which no longer manufactures or markets SoftLight in the U.S.

Wave 5 lasers: 1997 to present

In 1997 FDA cleared several types of devices that target melanin in the hair (see also flashlamps). As with the earlier devices, these devices were rushed to market without adequate testing of effectiveness.

Incremental improvements in equipment since 1997, such as more ergonomically-designed handpieces and methods of epidermal cooling, have made treatment generally more tolerable and reduced the likelihood of some side effects. The publication of clinical observations have also led to more optimized treatment parameters, but understanding of lasers and their long-term effects on hair and other skin structures is still in the early stages.

Current laser consumer issues: "A big problem brewing"

This quote is taken from a letter by Rox Anderson M.D., one of the major figures in medical laser research. He has written extensively on lasers in dermatology [6] and in hair removal in particular. I have quoted extensively from his comments below:

"Unfortunately, there is relatively little good, hypothesis-driven research on lasers in dermatology. These studies are expensive and slow to perform, analyze, present, and publish. The laser companies are quick to promote their new devices and procedures, even before efficacy and safety are well established, and before a specific FDA clearance is given."

"Self-promotion is also common among laser practitioners, especially after laying out a small fortune for some new device. In the long run, their reputations (and ours) will suffer. Fooling the public into buying something of little value, is a very old trick."

"Hippocrates knew this when making his famous oath... Does "first, do no harm'' extend to a prospective patient's bank account? Does it include the loss of trust suffered after receiving a series of costly, ineffective treatments? The answer is, yes."

"When poorly researched before use on patients, cosmetic lasers or anything else are no different than the infamous patent medicines of the 19th century... But, what can be done about the decrepit standards for quality of introducing new aesthetic laser applications?... Specifically, I think companies should find it difficult to get a "general'' [FDA] 510k clearance and then sell a device for some specific, unproven new procedure."

"But the problem lies mainly with us, the professionals. We should simply refuse to believe infomercials over peer-reviewed studies." [7]

Lack of consensus about effectiveness

Recent medical overviews of laser hair removal present widely differing opinions regarding the status. Some view it as "a promising but still faltering medical field," while others proclaim it's "beyond the experimental stage." [9] Some other examples:

"From this review of the literature, we conclude that laser hair removal does not at the moment have a permanent or convincing long-lasting effectiveness." [10]

"During the last few years the fast development of different laser and laser-like systems for photoepilation and their one-sided representation in media has led to confusion among physicians and patients." [11]

"Aggressive marketing of [lasers] has contributed to their popularity among patients and physicians. However, significant controversy and confusion surrounds this field... Although the field of optical hair removal is still in its infancy, initial reports of long-term efficacy are encouraging." [12]

"As the field develops, a better sense of the effectiveness of laser hair removal will evolve and reasonable expectations will be determined." [13]

"Although the amount of unwanted hair in a treated area can be effectively diminished, it is unclear if complete elimination of unwanted hair from any anatomic area can be achieved with any of the existing systems... There are very little published data on most of the lasers... The optimal treatment parameters, which may vary with anatomic site and skin type, have not been clearly established for any of the systems." [14]

Optimizing treatment

Because lasers were rushed to market without a full understanding of their capabilities and limitations, it's vital that researchers, practitioners, and consumers continue to make their experiences known to the public.

Skin cooling continues to be improved, [15, 16, 17] as does pain management [18, 19], although the risks of side effects have not been eliminated. Following a consumer death in 2000 due to a combination of pain medications prior to laser hair removal, [20] I have put together an overview of hair removal pain management. [21]

Standardizing terminology and performance standards

With everyone offering up arbitrary definitions in published data [22, 23, 24] and even on websites like this, it's very confusing for consumers to judge long-term effectiveness and safety. In addition, FDA currently has no performance standard for epilators. They simply accept or reject definitions submitted by each manufacturer. This has led to multiple standards for what is permanent, which also confuses consumers. [25] If FDA is going to regulate labeling regarding use of the term "permanent," there needs to be industry consensus on what this means, preferably a year or more follow-up with several hundred subjects participating in controlled multi-center studies.

Who gets to use laser?

The biggest issue at the time of this writing is who will control the use of this technology. Physicians, electrologists, and beauticians have all staked their claims, and it's being left to each state to decide. [26] As expected, one survey showed that physicians feel they should maintain control of the device, and some non-physicians have stated they are qualified to own and operate lasers. [27]

As with x-ray 100 years earlier, use of dermatological lasers is in danger of being rapidly debased into a cosmetic procedure. Self-proclaimed "laserologists" have set up "training institutes" for beauticians and other non-physicians. Some even offer laser hair removal treatments to consumers without direct medical supervision.

There is currently a legislative push in some areas to make lasers available for purchase to non-physicians, proposed by those who stand to gain financially. Some argue this will make laser hair removal more widely available and drive down prices for consumers. Some consumer activists (including myself) have concerns that the likelihood of injury and quackery will increase if these devices are widely available to non-physicians. For instance, several of the parties pushing to make laser available to non-physicians in Florida are contributors, members and/or moderators of non-recommended promotional site Kitty's Consumer Beware. [28]

As with Dr. Anderson, Christian Raulin, M.D., another pioneering laser researcher, states the issue of laser training is "a serious problem." He notes: "Anyone, including healers, hair stylists, tattoo artists, and cosmeticians, can buy lasers and then advertise for their services. There are no legal requirements for training, no quality control measures, no official quality standards or guidelines... We must demand the extensive scientific evaluation of new and existing systems; objective and trustworthy marketing by laser manufacturer; well-founded training for laser operators; and legislation which restricts the use of lasers to physicians alone. [29]

Pushing for more published data

As always, the best hope for consumers comes is that researchers and physicians continue to make their findings known in peer-reviewed journals. This is the only way to combat the hype rampant in the mainstream press, the manufacturer and practitioner promotional materials, and in the unreliable anecdotal reports from consumers, as discussed in my section on recommended and non-recommended information sources.

http://www.hairfacts.com/methods/laser/ ... story.html

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Laser general medical data

General observations

There are very few well-designed long-term laser hair removal studies.

Results vary widely and are not accurately predictable at this time.

Some laser hair removal consumers have permanent reduction in the size and color of hairs.

In some consumers, this is a dramatic improvement.

This result is most likely in light-skinned, dark-haired "ideal" candidates.

Even "ideal" candidates do not always respond to treatment.

Despite promotional claims, there is not enough published comparative data to determine if one type of laser targeting melanin is more effective than other types.

Cooling the skin can reduce pain and side effects.

Skin discoloration which can last several months can occur in 1% to 10% of patients, with a higher likelihood in darker skin.

Consumers must avoid sun before and after treatment to reduce the risk of discoloration.

Consumers who have realistic expectations about laser hair removal are often satisfied.

Why clinical data should be given the most weight

Promotional material from manufacturers and practitioners is often unreliable

As noted by pioneering laser researcher Christian Raulin, M.D.: "Laser companies, tattoo and cosmetic studios as well as self-proclaimed "laser institutes" promote their work with full-page advertisements in newspapers and lifestyle magazines... It is not uncommon for the industry to advertise newly developed lasers for which the efficacy has not been determined by means of objective, randomized trials. When a laser is first marketed, there are thus no dependable data available from studies; instead, physicians must rely upon the often unfounded claims from the advertising literature." [1]

Personal experiences of consumers are unreliable

While consumer experiences are very important in determining what treatment is like and general satisfaction, it's very difficult to assess quantitative effectiveness based on one or a few consumers. As I discuss in my section on Vaniqa, one-third of patients using a placebo were judged by physicians to have improvement or even marked improvement, and that was under controlled clinical conditions. There are simply too many variables between individuals to determine if one person's result will predict your own results.

Consumers are better served when they follow the advice of Whitney Tope, M.D. and Maria Hordinsky, M.D.: "Look for studies incorporating rigorous design to produce believable data and conclusions." [2]

Echoing Tope and Hordinsky, laser researcher Sharyn Laughlin recently stated:

"It appears that the laser industry and the clinical arena of epilation are being driven by market forces and economic factors, with a minimum of consideration given to evidence-based medicine. The majority of clinical trials and peer-reviewed reports do not address the issues of permanence or specific dose-response relationships..."

"There are few comparative data to allow physicians and their patients to make rational choices... Patients deserve to know the precise benefits and limitations of the particular system to be used in relation to whether their expectation is for temporary or permanent epilation." [3]

Dr. Raulin adds: "Well-founded scientific studies are no longer the basis for the wide-spread use of lasers. Careful clinical assessment cannot occur under such conditions, and the absolute opposite of the Hippocratic Oath to do no damage can easily be achieved." [1]

Rox Anderson, M.D., one of the pioneers in the field of laser dermatology agrees "there is a big problem brewing":

"Unfortunately, there is relatively little good, hypothesis-driven research on lasers in dermatology. These studies are expensive and slow to perform, analyze, present, and publish. The laser companies are quick to promote their new devices and procedures, even before efficacy and safety are well established, and before a specific FDA clearance is given..."

"When poorly researched before use on patients, cosmetic lasers or anything else are no different than the infamous patent medicines of the 19th century... But the problem lies mainly with us, the professionals. We should simply refuse to believe infomercials over peer-reviewed studies... Those industry salesmen who can't support their claims well, should be tolerated only as village idiots. In short, the patients are ours, and we should make better patient care the only real bottom line." [4]

This has been my point since 1995. Luckily, a few researchers have continued to publish rigorous long-term studies.

Published clinical data by type

If you are researching a specific model of laser and don't know what type it is, ask the practitioner or check this list

Nd:YAG clinical data

Ruby clinical data

Alexandrite clinical data

Diode clinical data

(see also Flash lamp Photoepilator Argon laser)

References

Raulin C, Greve B, Raulin S. Ethical considerations concerning laser medicine. Lasers in Surgery and Medicine 28:100-101 (2001).
Tope WD, Hordinsky MK. A hair's breadth closer? Archives of Dermatology. 1998 Jul;134(7):867-9.

Laughlin SA, Dudley DK Long-term Hair removal using a 3-millesecond alexandrite laser. Journal of Cutaneous Medicine and Surgery. 2000 Apr;4(2):83-88.

Anderson RR. Response to "Letter to the Editor.'' Lasers in Surgery and Medicine 28:102 (2001).

Please see hairfacts.com for a current list of available lasers.
= recommended only for in-depth researchers
= may be worth ordering
= strongly recommended

General articles/overviews
Anderson (1981): A good overview on theories in the optics of human skin and laser interactions.

Anderson (1983): One of the earliest articles about the concept of selective thermolysis, the theory behind laser hair removal.

Wagner (1998): Survey found only 6% of dermatologists thought independent non-physician laser practitioners should be allowed to practice.

Chernoff (1997): A pretty good synopsis of hair physiology, with a very brief discussion on Nd:YAG and ruby lasers.

Bargman (1999): A point-counterpoint article discussing advantages of laser hair removal, with a companion piece on electrolysis (Richards 1999)

Comparative data (hair removal)
Nanni (1998): A practical review for Q-switched Nd:YAG, ruby and alexandrite lasers.

Nanni (1999): A comparison of side effects for Q-switched Nd:YAG, ruby and alexandrite lasers.

Comparative data (other applications)
Rosenbach (1997): A comparison of Q-switched alexandrite and Nd:YAG lasers for nevi removals

See this link for further information:

http://www.hairfacts.com/medpubs/lasermed.html

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Pub-Med List of Related Articles

http://www.ncbi.nlm.nih.gov/entrez/quer ... d=11149607
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