Hair removal in hirsute women with normal testosterone levels: a randomized controlled trial of long-pulsed diode laser vs. intense pulsed light.

BACKGROUND: Hirsutism is a common disorder in women of reproductive age, and androgen disturbances may aggravate the condition. Limited evidence exists regarding efficacy of hair removal in this specific population and no data are available for patients with verified normal testosterone levels. OBJECTIVES: To compare efficacy and safety of intense pulsed light (IPL) vs. long-pulsed diode laser (LPDL) in a well-defined group of hirsute women with normal testosterone levels. METHODS: Thirty-one hirsute women received six allocated split-face treatments with IPL (525-1200 nm; Palomar Starlux IPL system) and LPDL (810 nm; Asclepion MeDioStar XT diode laser). Testosterone levels were measured three times during the study period. Patients with intrinsically normal or medically normalized testosterone levels throughout the study were included in efficacy assessments (n = 23). Endpoints were reduction in hair counts assessed by blinded photoevaluations at baseline and 1, 3 and 6 months after final treatment, patient-evaluated reduction in hairiness, patient satisfaction, treatment-related pain and adverse effects. RESULTS: IPL and LPDL reduced hair counts significantly, with median reductions from baseline of 77%, 53% and 40% for IPL and 68%, 60% and 34% for LDPL at 1, 3 and 6 months, respectively. At 6 months follow-up, there was no significant difference between treatments in terms of hair reduction (P = 0·427), patient assessment of hairiness (P = 0·250) and patient satisfaction (P = 0·125). Pain scores were consistently higher for IPL [median 6, interquartile range (IQR) 4-7] than LPDL (median 3, IQR 2-5) (P < 0·001). CONCLUSION: Hirsute women with normal or medically normalized testosterone levels responded equally well to IPL and LPDL treatments of facial hairiness, but the efficacy declined over 6 months.

Long-pulsed dye laser vs. intense pulsed light for the treatment of facial telangiectasias: a randomized controlled trial.

OBJECTIVE: This study aims to compare the efficacy and adverse effects of long-pulsed dye laser (LPDL) and intense pulsed light (IPL) in the treatment of facial telangiectasias. METHODS: We used intra-individual, randomized, controlled trial with split-face treatments and single-blind outcome evaluations in this study. Forty patients with symmetrically located facial telangiectasias received a series of three LPDL (V-beam, 595 nm, Candela Laser Corp.) and three IPL treatments (Ellipse Flex, PR and VL2 applicators, Danish Dermatologic Development) at 6-week intervals. Patients were evaluated 3 months after the final treatment. Outcome measures were clinical efficacy (five-point ordinal scale), pain (10-point numerical scale), adverse effects, patient satisfaction (10-point numerical scale) and preferred treatment. RESULTS: Thirty-nine of 40 patients completed the study. All but 2 patients obtained a reduction in facial telangiectasias from both IPL and LPDL treatments. Both treatments were effective with good or excellent response in 30 of 39 patients. The LPDL was superior in the overall reduction of telangiectasias by blinded photographic evaluations: Excellent clearance (75% to 100% vessel clearance) was found in 18 patients treated with LPDL (46%) and in 11 patients treated with IPL (28%) (P = 0.01). Patients experienced less pain from LPDL [4 (2-6)] than IPL treatments [7 (3-9)] (P < 0.001). No adverse effects (hypo-/hyperpigmentation or scarring) were seen from any of the treatments. Patients were satisfied with both LPDL [8 (2-10)] and IPL treatments [7 (2-10)] (P = 0.05). Twenty-five patients preferred the LPDL (64%), 8 patients preferred IPL (21%) and 6 patients had no preference (15%) (P < 0.001). CONCLUSION: This study was based on two specific types of laser and IPL equipment, which effectively clear telangiectasias; however, the most beneficial outcome was from the LPDL.

Intense pulsed light vs. long-pulsed dye laser treatment of telangiectasia after radiotherapy for breast cancer: a randomized split-lesion trial of two different treatments.

BACKGROUND: Chronic radiodermatitis is a common sequela of treatment for breast cancer and potentially a psychologically distressing factor for the affected women. OBJECTIVES: To evaluate the efficacy and adverse effects of treatments with a long-pulsed dye laser (LPDL) vs. intense pulsed light (IPL) in a randomized split-lesion trial. METHODS: Thirteen female volunteers with radiodermatitis and Fitzpatrick skin types II-III were included in the study. Subjects received a series of three treatments at 6-week intervals with half-lesion LPDL (V-beam Perfecta, 595 nm) and half-lesion IPL (Ellipse Flex); the interventions were randomly assigned to left/right or upper/lower halves. Primary end-points were reduction in telangiectasia, patient satisfaction and preferred treatment. Secondary end-points were pain and adverse effects. Efficacy was registered by blinded photographic evaluations 3 months after the final treatment. RESULTS: Eleven patients completed the study. Telangiectasia cleared with both treatments but the efficacy of LPDL was superior. Blinded photographic evaluations showed median vessel clearances of 90% (LPDL) and 50% (IPL) (P = 0.01). LPDL treatments were associated with lower pain scores than IPL treatments [median visual analogue scale (VAS) score 4.3 and 6.0, respectively, P < 0.01]. Patients were slightly more satisfied with LPDL (median VAS score 8) than IPL treatments (median VAS score 7; P < 0.05) and more preferred LPDL (n = 9) to IPL (n = 2) (P < 0.01). Two patients withdrew from the study because of hypopigmentation of the IPL treated areas, which slowly repigmented within 1 year. CONCLUSIONS: This study was based on two specific laser and IPL devices, and found the LPDL treatment to be advantageous compared with IPL due to superior vessel clearance and less pain.

Decreased bone mineral density in patients with pustulosis palmaris et plantaris.

BACKGROUND: Focal skeletal changes in patients with pustulosis palmaris et plantaris (PPP) are known to occur in a minority of patients. It is unknown whether these changes are unique events or whether they merely represent more progressed cases. OBJECTIVE: The study was undertaken in order to investigate possible diffuse bone changes in patients with PPP. METHODS: Bone mineral density (BMD) and biochemical markers of bone turnover were studied in 18 female patients and 18 age-matched controls. RESULTS: A significant correlation was found between lower-forearm BMD and disease duration (< 0.05). With increasing age, patients had significantly lower values than controls for both forearm and spine BMD (p < 0.005); patients who had PPP for more than 2 years had significantly reduced forearm BMD (19.8%; 95% CI: 5.6-32.8%) and spine BMD (17.4%; 95% CI: 0.9-33.8%). No significant differences were observed in biochemical markers of bone turnover, physical activity or body mass index between patients and controls. The proportion of smokers among patients was four times higher than among controls (p < 0.0005). No significant dose effect was found between number of pack-years and BMD. CONCLUSION: Although we cannot exclude that prolonged use of topical steroids under occlusion is a confounding factor, the study suggests that PPP patients have decreased BMD due to primary pathogenic events, and that osteoporosis may be an additional problem for these patients.

Ectopic pregnancies in Greenland 1981-1990 verified by histology.

From 1981 to 1990 503 cases of ectopic pregnancy (EP) among Greenlandic females were confirmed by histologic examination. The yearly number more than tripled from 26 in 1981 to 89 in 1990. When correction for age distribution and the total number of conceptions were made the increase in incidence rates for the population age 15-44 as a whole, was statistically significant. The rate of EP/100,000 females increased from 223 in 1981 to 581 in 1990 (slope 34/yr, p < 0.01, degrees of freedom 8, t = 4.996). EP/100 pregnancies increased from 2.08 in 1981 to 4.51 in 1990 (slope 0.22/yr., p < 0.01, degrees of freedom 8, t = 4.784). However, we did not find a significant increase in rates for females aged 15-24 years. Possible etiological factors behind the high and increasing incidence are discussed. The incidence rates of ectopic pregnancy in Greenland found in this study are among the highest ever reported.