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DermMatters: No Place Like Home for New Laser Technologies


Laser technologies that allow for private treatment at home, once only available in a doctor's office, are under development for the consumer market.  While many of thee home devices offer energy outputs and in-machine safety features similar to office installations, there are some limitations.  Discomfort and frequent longer treatment times may occur, but in the hands of a well-informed patient, the treatments may complement office-based procedures.  Let Anne Chapas MD FAAD and Kendra Gail Bergstrom MD FAAD tell you the facts:
Currently available home laser hair removal can reduce dark hair on skin types I-IV, and use two common modalities: the 810 diode and intense pulsed light. Lower fluences and longer pulse widths offer a wider safety margin than settings usually used in physicians' offices. Testing for skin appropriateness is offered in several different ways for different lasers, including a built-in testing meter in newer models or an online quiz that can help consumers select an appropriate machine and initial setting. Another treatment modality uses bulk heating, which may widen treatment options for patients with dark skin or with blond or grey hairs.
810 nm diode systems Tria Diode Laser
Diode lasers for hair work at 810 nm, similar to lasers used in physicians' office such as the LightSheer. For the home laser, the manufacturer recommends treatments every 2 weeks for up to 6 months. It is only approved for body hair of the face at this time. Patients are screened for appropriate use via the Tria's built-in 'test pulse' assay on the laser head, which reads out a result of safe to use' or 'not safe'. The largest published study to date showed a mean hair reduction of 60% at 1 month, 41% at 3 months, and 33% at 12 months after every 2-week treatment in 77 appropriate users. The only observed side effect in this study was transient erythema; in appropriate patients no burns or postinflammatory changes were noted.
As with all home lasers, some limitations are noted. The Tria's spot size is much smaller than that of a typical medical office's diode laser, making it more appropriate for smaller areas than larger ones like the legs. Treatment intensity was often limited by patient discomfort.
no!no! Hair
The original no!no! Classic device was approved to use thermal heating to treat unwanted hair and single acne papules.This initial 'no!no! Classic' model is approved to treat hair on legs and body but not approved for treatment of face, breasts, or genitals. The newer no!no! Hair and no!no! 8800 later generation models are approved to treat unwanted hairs on the face and body, the only exceptions being nipples and genitals. The no!no! system in all models uses thermal heating to deliver heat to the hair shaft and destroy a target hair. Treatment of a hair follicle is intended to induce programmed cell death with bulk heating and may be comparable to the effect of electrolysis. Based on the no!no! Hair marketing materials, thermal treatment of hairs should not be color selective and can treat blond and grey hairs as well as dark hairs, and should theoretically be safe for all skin types.
The no!no! Hair treats a small area at a time and uses a rolling tip with a time sensor to ensure adequate treatment time for each area. It can be potentially time-consuming for larger skin areas. For example, the manufacturer estimates a treatment time of 30-45 minutes for legs, and some patients report times over one hour. The treatment schedule is more frequent than that of the Tria above, recommended three times weekly for 4-6 weeks.
IPL systems Like office-based IPL systems, these home units use a non-coherent light source to expose unwanted hairs. Some IPL systems are approved for treatment of skin (acne and photo aging) and others for treatment of hair; at present, no at-home systems are able to address both.
Similar to office-based IPL systems, safety measures may be needed to protect eyes from retinal damage, and these machines have developed different ways to protect a patient's eyes. Overall, the light intensity is less than that of office-based IPL. In one study of a home IPL system, no risk of optical damage at available settings based on retinal thermal damage, blue light damage, or infrared radiation damage.
Silk'n SensEpil
Silk'n SenseEpil is sold in the US directly to the consumer and by beauty supply stores such as Sephora. The product was launched in 2009 and is approved for use on the body and the lower face on or below the cheeks (ie, upper lip and chin). One appealing feature is a larger spot size, over 1 cm x 2 cm, compared to at-home diode lasers. A safety mechanism prevents firing unless the tip is in contact with skin to prevent accidental eye exposure; no eye protection is required. Treatments are recommended every 2 weeks. Lamp cartridges last approximately 750 pulses, which can be 2 to 3 treatments depending on areas treated, and are replaceable.
In one published study (Alster 2009), 20 women of skin types I-IV used Silk'n IPL for hair removal on nonfacial sites. Each site was treated three times, every two weeks, after which patients were followed for six months. All patients saw improvement in unwanted hairs compared to non-treated areas based on hair counts; the decrease in hairs ranged from 37-53% at the 6-month time point. Hair removal was most effective on leg hairs compared to arms, axillary, inguinal areas. The only side effect was transient erythema in 25% of patients.
Remington iLight Pro
This home IPL unit is approved for treatment of hair on the body only at this time. This product claims to have the fastest flash rate among home IPL systems, leading to a more rapid treatment time. The spot size is similar to the above iPulse. Safety screening was initially done by the patient, comparing their skin to an included color chart with six different skin tones. Newer models include an in-unit sensor to see whether skin is too dark to treat. Eye protection occurs with use of a contact sensor- the unit will not fire unless direct contact with skin is detected. It does have consumables: a cartridge contains 1500 pulses, after which a replacement cartridge is needed. Some Amazon.com reviewers complained that the cartridge empties after only a few treatments.
References:
1. Eadie E, Miller P, Goodman T, Moseley H. Assessment of the optical radiation hazard from a home-use intense pulsed light (IPL) source. Lasers Surg Med 2009 Sep;41(7):534-9.
2. Alster TS, Tanzi EL. Effect of a novel low-energy pulsed-light device for home-use hair removal. Dermatol Surg. 2009 Mar;35(3):483-9.
About the Authors: 
Anne Chapas MD FAAD is Director, Union Square Laser Dermatology, and Clinical Assistant Professor of Dermatology, NYU Medical Center, New York, NY; Kendra Gail Bergstrom MD FAAD is affiliated with Pacific Medical Centers, Seattle, WA
The JDD editorial staff welcomes your feedback, questions, and comments regarding at-home laser treatments for unwanted hair. Also, for more information on at-home laser treatments, please see the June issue of the JDD's News, Views, and Reviews section.

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DermMatters is a news commentary blog for dermatologists and published by the Journal of Drugs in Dermatology (JDD), a peer-reviewed, PubMed-indexed journal committed to advancing clinical knowledge and discovery in dermatology, including original articles and case reports that deliver cutting-edge clinical practice science and insights relating to methods, techniques, technologies, devices, and drug therapies in dermatology. The information on this blog is for educational purposes only. Links provided to other sites are for informational purposes only. Product images shown or brand names mentioned are intended for informational or example purposes only, whose makers may or may not be advertisers in JDD, and, again, no endorsement should be construed. The books and other media offered are intended to be for the viewers' convenience and benefit; although JDD shall receive a small referral fee from Amazon for purchases, there is no agreement or understanding between DermMatters or JDD and the authors whose books and media are displayed in the The DermMatters Library Amazon aStore. DermMatters does not accept advertising.

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