Abstract

Background

Unwanted hair growth is a therapeutic challenge and considerable resources are spent to achieve a hair‐free appearance. Epilation with laser devices (alexandrite, diode, neodymium:YAG, and ruby lasers) and intense pulsed light are commonly used although the long‐term effect is uncertain.

Objectives

To assess the effects of epilation with lasers and light sources.

Search methods

We searched the Cochrane Skin Group's Specialised Register in February 2004; MEDLINE (from 1966) and EMBASE (from 1980) in April 2005. We searched reference lists of collected trials and contacted trial authors.

Selection criteria

Randomised controlled trials of laser or photoepilation.

Data collection and analysis

Primary outcomes were objective reduction in hair counts, adverse effects and subjective reduction in hairiness. Secondary outcomes were participants´ satisfaction and personal observations such as softer, finer, or paler hairs. Two authors independently extracted data and assessed trial quality.

Main results

We included eleven randomised controlled trials involving 444 people, none of which were of high methodological quality. A large number of trials were excluded, mainly because of their non‐randomised design. The randomisation procedures were either unclear or inadequate, using coin tossing, alternation, drawing lots or cards, or open tables of random numbers. The interventions and outcomes were too heterogeneous to be entered in a meta‐analysis. Most trials examined a short‐term effect up to six months after final treatment. There appeared to be a short‐term effect of approximately 50% hair reduction with alexandrite and diode lasers up to six months after treatment, whereas little evidence was obtained for an effect of intense pulsed light, neodymium:YAG or ruby lasers. Long‐term hair removal was not documented with any treatment. Pain, skin redness, swelling, burned hairs and pigmentary changes were infrequently reported adverse effects.

Authors' conclusions

Some treatments lead to temporary short‐term hair removal. High quality research is needed on the effect of laser and photoepilation.

Author(s)

Merete Haedersdal, Peter C Gøtzsche

Abstract

Plain language summary

Unwanted hair removal by laser systems and intense pulsed light sources

Unwanted hair growth is a challenge and considerable resources are spent to achieve a hair‐free appearance. Hair removal with laser devices (alexandrite, diode, neodymium:YAG, and ruby lasers) and intense pulsed light are widespread methods for hair removal although the long‐term effect is uncertain.

Eleven randomised controlled trials were included in the review, none of which were of high quality. A large number of trials were excluded, mainly because of their non‐randomised designs. There appeared to be a short‐term effect of approximately 50% hair reduction with alexandrite and diode lasers up to six months after treatment, whereas there was little evidence for an effect with intense pulsed light, neodymium:YAG or ruby lasers. Long‐term hair removal was not recorded for any treatment. Infrequently reported adverse effects were pain, skin redness, swelling, burned hairs and pigmentary changes.

Author(s)

Merete Haedersdal, Peter C Gøtzsche

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

Despite the enormous amount of resources involved in hair removal with lasers and intense pulsed light (IPL), there are no randomised trials that have shown a long‐term effect of these interventions. There appeared to be a short‐term effect of approximately 50% hair reduction with alexandrite and diode lasers up to six months after treatment, whereas little evidence was obtained for an effect of intense pulsed light, neodymium:YAG or ruby lasers. Long‐term hair removal was not obtained with any treatment. Pain, skin redness, swelling, burned hairs and pigmentary changes were infrequently reported adverse effects.

Implications for research 

There is a need for high‐quality trials of laser and photoepilation. Particularly needed are trials with long‐term evaluations, trials evaluating the efficacy of lasers and IPL versus untreated control groups and trials comparing the efficacy of laser and IPL treatments. The importance of individual participant characteristics remains to be answered and trials are also required in specific populations such as hirsute women with and without endocrine dysfunction. Such trials could provide a more rational approach to the treatment strategy of unwanted hair growth and, hopefully, optimise the cost‐benefits associated with the treatments and result in realistic expectations from affected people.

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