Eremia, 2000  Title: Topical anesthesia for laser hair removal:
comparison of spot sizes and 755 nm versus 800 nm wavelengths.
Authors: Eremia S, Newman N
Journal: Dermatol Surg 2000 Jul;26(7):667-9
PMID: 10886276
Affiliated institution: Cosmetic
Surgery Unit, Division of Dermatology, UCLA, Los Angeles, California
90024-6957, USA
Cited in:
BACKGROUND: The Candela alexandrite and the Coherent diode laser
systems come equipped with built-in skin cooling systems that
are designed to both protect the epidermis, allowing higher fluences,
and to alleviate discomfort. Nevertheless, pain can be a significant
problem especially with treatment of larger areas. Scatter of
the laser beam is reportedly affected by the spot size. It is
claimed that larger spot sizes are more effective at identical
fluences. OBJECTIVE: This study evaluated the effectiveness of
a topical 5% lidocaine cream (ELA-Max) to control pain and compared
pain levels at identical fluences between the 8 mm and 12 mm spot
size of the alexandrite laser and between the alexandrite and
diode laser with its 9 mm spot size. METHODS: The study was conducted
in the axillae of 12 patients. Each axilla was divided in half
for side-by-side comparison. Half of the right axilla was treated
with the alexandrite 8 mm and the other half with the 12 mm spot
size at identical fluences. The left axilla was treated at the
maximum tolerated fluences with the alexandrite 12 mm spot size
and the diode 9 mm spot size. RESULTS: At identical fluences and
other parameters, there was significantly more pain with the alexandrite
12 mm spot size than with the alexandrite 8 mm spot size, both
with or without topical anesthesia. The alexandrite laser was
significantly less painful than the diode laser both with and
without topical anesthetic. The difference was most noticeable
between the alexandrite 8 mm spot size and the diode 9 mm spot
size. Topical 5% lidocaine anesthesia was effective in reducing
pain, though not completely, for both the alexandrite and the
diode lasers. CONCLUSION: Topical 5% lidocaine cream is a simple
and effective method for reducing patient discomfort during laser
hair removal procedures, even when a skin cooling device is being
used. A larger spot size causes more pain than a smaller spot
size at identical fluences. The 800 nm diode laser causes greater
discomfort than the 755 nm alexandrite laser.
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