Laser hair reduction in the hirsute patient: A critical assessment

Hirsutism affects 5-10% of unselected women, depending on ethnicity and definition. The past two decades have seen the development of lasers for the removal of unwanted hair, using selective destruction of the hair follicle without damage to adjacent tissues. Selective photothermolysis relies on the absorption of a brief radiation pulse by specific pigmented targets, which generates and confines the heat to that selected target. In general, laser hair removal is most successful in patients with lighter skin colours and dark coloured hairs. Some studies have documented the results of laser hair removal in a controlled setting, although few have extended their observations beyond 1 year. In general, treatment with the ruby, alexandrite or diode lasers, or the use of intense pulsed light results in similar success rates, although these are somewhat lower for the neodymium: Yttrium-Aluminum-Garnet (nd: YAG) laser. Overall, laser hair removal should not be considered 'permanent', at least when considering the current data available. Repeated therapies are necessary, although complete alopoecia is rarely achieved and it is unclear at what point the maximum benefit is achieved from multiple therapies. While larger prospective, controlled, blinded and uniform studies are still needed, laser hair removal appears to be a useful adjuvant in the treatment of the hirsute patient.