LASER HAIR REMOVAL FOR THE TREATMENT OF HYPERTRICHOSIS OF THE EXTERNAL EAR – CASE REPORT
Laser hair removal has rapidly gained acceptance as a noninvasive technique for long-term reduction in unwanted facial and body hair. This article presents the first published case report of laser assisted hair removal for the treatment of hypertrichosis of the pinna and external auditory canal. The laser was very effective in removing dark hairs but was less effective in managing light or grey hairs.
Keywords: laser hair removal, hypertrichosis, external auditory canal, hair
Hypertrichosis of the pinna and external auditory canal commonly occurs in older males. This is a y-linked trait whose expression increases with age1. The incidence of this condition is not known but it is not uncommonly seen in an Otolaryngological practice. Hairy canal impacts on wearing hearing aids, causing irritation by contacting the tympanic membrane, may increase the risk of cerumen impaction and possibly recurrent otitis externa. It is a frustrating and time consuming condition to treat, as the only available treatment so far has been careful trimming under direct vision. In this case presentation we present a patient with troublesome hypertrichosis of external canal who was treated with Alexandrite laser on two occasions 8 weeks a part. In other body parts this treatment has been reported to cause excellent long term hair removal in the order of 85%2,5. To our knowledge this is the first reported case of using the laser to treat ear canal hair in the literature.
Mr. C is a 72 year old gentleman who has had hypertrichosis of this external canal and pinna for many years. Recurrent cerumen impaction and blockage has led him to seek medical attention for ear toilet. He also complained of distressing scratchy noises when the hair touched his ear drum. He required 3-6 monthly visits to the senior author for hair trimming and wax removal. He had Fitzpatrick skin type 3. We have used candela Gentlelase (Candela) which contains a Alexandrite laser rod at 755 nm at fluence of 25 J/cm^sup 2^ with spot size of 8mm. The heat of the laser is controlled by using tetroflurane spray, commonly referred to as cryogen. The spray fires at the laser site on the ear for 60ms. There is a 40ms delay from the end of the cryogen application to the commencement of the laser application. Patient’s tympanic membrane and bony skin canal were protected with a moist cotton wool. Under direct vision the excessive hair follicles of the external ear canal and pinna were targeted by the laser beam. Each laser session took 15 minutes. The patient tolerated the procedure well with minimal discomfort, and was reviewed 4 months after treatment. Figures 1 and 3 are pre procedure and Figures 2 and 4 are post procedure at the 4 month review. The patient had excellent removal of all dark hairs but significant persistence of light and grey hairs.
Laser hair removal is the most efficient method of longterm hair removal currently available6. Its effectiveness and safety has been shown in many studies7. Laser light has unique properties, which allow it to be used for selective damage to hair follicles. It is monochromatic, coherent and collimated. This would allow for generation and delivery of high fluences which can interact with hair follicles.
The mechanism by which laser induces selective hair follicle are based on selective photothermolysis8. This principle predicts that selective thermal damage of a target structure will result when sufficient fluence at a wavelength, preferentially absorbed by the target is delivered during a time equal to or less than the thermal relaxation time of the target. Melanin is the natural chromophore for targeting hair follicles. There are two types of melanin in hair: eumelanin, which gives hair brown or black colour, and pheomelanin, which gives hair blonde or red colour. Several wavelengths of laser energy have been used for hair removal, from visible light to nearinfrared radiation. These lasers are usually defined by the lasing medium used to create the wavelength: Argon: 488 or 514.5 nm, Ruby: 694 nm, Alexandrite: 755 nm, Pulsed diode array: 810 nm and Nd:YAG: 1064 nm. The aim to is target the melanin and reduce the thermal impact on surrounding tissues, such as water or haemoglobin, which are more sensitive to other wavelengths.
Hair grows in cycles: anagen is the growth phase; catagen is the transition phase; and telogen is the resting phase. The laser is most effective only in the anagen phase. Because all hairs are not in anagen at any one time, laser treatment must be repeated to capture new hairs coming into anagen.
Cooling is achieved via different mechanism. In this case short cryogen spurts delivered to skin surface through an electronically controlled solenoid valve. Other methods include application of cooling gel and cooled hand piece9.
The advantages of the laser technique is the effectiveness and speed. The main disadvantage is that the laser does not remove lightly coloured white or grey hairs. This suggests that the procedure is best done in patients with dark hairs, and before the hairs turn white or grey with age. The dark hairs respond well, but the same hair will not respond once the hair colour changes with ageing. The procedure would have less benefit in a patient with predominantly lighter hairs. Other disadvantages include the cost which may be over $500, required protection of the tympanic membrane during the procedure, slight discomfort and a risk of hypo or hyper pigmentation of the skin of the ear canal. There has been no report of scarring9.
Lasers have become treatment of choice for hypertrichosis of the face and body2. This is the first case presentation in the literature to describe the use of the laser to manage troublesome hypertrichosis of the external auditory canal. The laser treatment provided a substantial improvement, and very little morbidity. It is likely to be most effective in patients with an abundance of dark hairs.
1. HAWKE M., BlNOHAM 8., STAMMBERGER H., BENJAMIN BRUCE (2002) In Diagnostic handbook of otorhinolaryngology. Dunitz Martin 1td 2nd Ed.
2. EREMIA S., LI C., NEWMAN N. Laser hair removal with alexandrite versus diode laser using four treatment sessions: I -year results. Dermatol Surg. 2001 Nov;27(11):925-9; discussion 929-30.
3. LIEW S.H. Laser hair removal: guidelines for management. Am J Clin Dermatol. 2002;3(2): 107-15.
4. LU S.Y., LEE C.C., WU Y.Y. Hair removal by long-pulse alexandrite laser in oriental patients. Ann Plast Surg. 2001 Oct; 47(4):404-11.
5. VITTORIO C.C., LEHRER M.S., (2003) Laser hair removal. Facial Plastic Surgery 2003; 19(1): 131-135.
6. TRUEB R.M. Causes and management of hypertrichosis. Am J Clin Dermatol. 2002;3(9):617-27.
7. SADICK N.S., PRlETO V.O. Dermatol Surg 2003 Jan;29(1):303; discussion 33-4
8. Dierickx, (2001) available at http://www.emedicine.com/derm/topic562.htm
9. EREMIA S., LI C.Y., UMAR S.H., NEWMAN N. Laser hair removal: long-term results with a 755 nm alexandrite laser. Dermatol Surg. 2001 Nov;27(11):920-4.
SHAHRAM SHAHIDI, MARTYN MENDELSOHN and BABAK MOINI*
Sydney ENT and Facial Day Surgery Centre,
Chatswood, New South Wales
Shahram Shahidi B.Sc. (Med.)(Hon.I), M.B., B.S., F.R.A.C.S.
Martyn Mendelsohn M.B., B.S., F.R.A.C.S.
Babak Moini* BMath, B.Ec., F.I.A.A.
*The Australian Laser Clinic
1 McLaren Street (Cnr Pacific Highway)
North Sydney, New South Wales 2060
Sydney ENT and Facial Day Surgery Centre
Unit 5/12 14 Malvern Avenue
Chatswood 2067 New South Wales
Dr Martyn Mendelsohn
Suite 4/12 – 14 Malvern Avenue
Chatswood, 2067, New South Wales
Tel: (02) 9411 4288
Fax: (02) 9904 8787
Copyright Australian Society of Otolaryngology Head & Neck Surgery Ltd. Jun 2004
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