Human Anatomy & Physiology

Contraindications for Pulsed Light Hair Removal
by Andrew Thompson (2008, revised 2011, revised 2012)

The contents of this page form part of the induction process I use to train therapists.  I've placed this information in the public domain in the hope of improving the tragically poor level of staff education in the Australian hair removal industry.

Depilatory Creams & Sprays
Depilatory creams and sprays dissolve hair with keratinocytes, ie chemicals designed to kill keratin.  Keratinocytes are non-discriminatory and kill the keratin in skin as well as hair.  Minimal use of depilatory creams is enough to permanently damage the skin, and therefore their use is a definite contraindication to treatment for fear of the risk of scarring.  Clients who have used these products must wait six weeks from use before receiving a Pulsed Light or Laser treatment.

Recent Waxing, Plucking, or Sugaring
Light-based hair removal requires a hair root to target.  During waxing, plucking, or sugaring, the hair root is pulled out of the shaft.  If a client has recently had hair removal using one of these methods, they need to wait a minimum of two weeks for the hair root to regrow.

Contagious Skin Diseases or Disorders
Some skin diseases are not easily detectable, and a therapist can only rely on client honesty.  If a client discloses that they have a skin disease, and it is one that the therapist does not consider a contraindication to treatment, the following precautions must be taken:

• Extra care must be taken to clean equipment with alcohol during and after treatment;
• Gloves must be worn at all time;
• All surfaces must be wiped down thoroughly with alcohol afterwards;
• Metal instruments must be sterilised in Microshield.

Herpes 1 & 2
The concerns for Herpes is the same as other contagious skin diseases, however due to the heat caused during a treatment, it is your Duty of Care to inform the client that the treatment may cause an outbreak.

Visible Skin Trauma
If someone presents with visible skin trauma, the area is to be avoided.

Lesions, Sores, and Open Wounds
If someone presents with lesions, sores or open wounds, the area is to be avoided.

Post-Surgical Scarring
Pulsed Light or Laser treatments of any kind will have a softening effect on scarring, however scars must be fully healed and closed.  If any moisture or trauma is present, do not perform a treatment over the area.

Genuine Keloid or Hypertrophic Scarring
Clients who are genuinely prone to keloid or hypertrophic scarring must be thoroughly informed that there is a risk of skin trauma resultant from Pulsed Light or Laser, and that it is their decision if they go ahead with the treatment. Thorough notes should be kept on the details of the discussion between therapist and client.

Moles, Freckles, Skin Marks, and Sunspots
Pulsed Light and laser do not operate in the UV part of the light spectrum, and there is no evidence to suggest that such treatments can cause skin cancer or change the properties of a skin mark to make it cancerous.  The primary concern with skin marks is ethical.  It is not a therapist's place to diagnose any of the above skin conditions.  It is however, a therapist's Duty of Care to tell the client if they notice a condition that may be suspicious.

It is a therapist's Duty of Care to inform the client that any marks in the treated area may fade, and thus make it more difficult for a GP to diagnose. When clients go to their GP for skin checkups, they should state that they have undergone a light-based treatment so that the doctor looks a little harder.

• Raised Moles (black or red): Work around the mole. Do not go over it;
• Sunspots and freckles: Not contraindicated, however they may darken for a few weeks then lighten;
• Skin Tags: Not contraindicated, however be careful when shaving the area.

Sunburn
Skin showing signs of redness from sun or solarium exposure must not be treated with any form of hair removal until the skin calms down again.  Usually this will take a week or two at the minimum, and up to several months where the skin has tanned significantly. 

If the client has a residual tan, this will affect their skin typing, and must be taken into account before performing a Pulsed Light or Laser treatment.

Epilepsy or Seizures Caused by Flashing Light
Epilepsy and other types of seizures caused by flashing light are a contraindication for Pulsed Light or Laser, unless the client's GP provides a letter of authorisation.  When treating a client with epilepsy or seizures induced by flashing light, they must wear fully opaque 'swimming goggle' eye protection to block out 100% of light, preferably with a cotton pad beneath each lens to ensure client comfort and for added protection.

Pregnancy & Breastfeeding
While there is no medical evidence to suggest that a Pulsed Light or Laser treatment can harm an unborn child, there is abundant evidence that the massive fluctuations in hormone levels during pregnancy and breastfeeding make any attempts to remove hair fruitless.  For ethical and client safety reasons, a therapist should not perform a light-based treatment until breastfeeding has ended and hormone levels have begun to settle again.

Polycystic Ovarian Syndrome (PCOS)
Refer to PCOS versus Light-Based Hair Removal page.

Hormone Supplementing Medications
Predominantly women, but also people undergoing gender reassignment, take hormone supplements such as HRT and thyroid medications to moderate their levels of various sex hormones. This has a direct effect on hair growth.

If the client's medication is regulating their hormones satisfactorily, then Pulsed Light or Laser should prove beneficial.  If the medication is not regulating their hormones satisfactorily, the client needs to speak to their GP about adjusting their dose before we can do a treatment.

Hirsutism
Hirsutism occurs in women who present with male hair growth patterns.  There are two types of hirsutism: genetic and hormonal, and they are easy to differentiate.

A simple question - "Does your mum, grandmother, or any or your aunts have facial hair?"  If yes, then the hirsutism is genetic.

If there is no family history of hirsutism, then the condition is most likely hormonal.  Genetic Hirsutism is not a contraindication, but it should be treated as male hair.  Hormonal Hirsutism will generally have an underlying cause that may be remedied with medical intervention.

If Hirsutism is present, therapists have a Duty of Care to inform clients that results will in all probability take longer.

Tattoos, Permanent Makeup, or Implants
Do not go over any areas where there are tattoos, permanent makeup, or contraindicated implants.

Contraindicated Implants:

• Depo Provera, a method of birth control often referred to as "the stick";
• Lap Bands.
  
  In the case of Depo Provera, this only applies to treatments near the implant, eg Underarms or Upper Arms.  I have asked the manufacturers to confirm or contradict my assertions based on internal statistics, and at time of writing, am waiting for a reply.  However, during 2010-2011 before this policy was put into place, five out of five girls who received under arm hair removal treatments AND had the stick implant as their only form of birth control, AND had never had pregnancy scares with it before, all fell pregnant within a month of receiving the treatment.  Subsequent discussions with a number of GPs about the possibility of Pulsed Light temporarily disabling the implant, gave me enough doubt to enact this policy.  In short, a client with the stick may received a treatment anywhere but in the upper arm, breast, or underarm region.  For all other areas, they must be informed of the potential risk of falling pregnant, and the therapist must record fully in their notes the details of the discussion.

Non-contraindicated Implants:

• Breast implants;
• Pacemakers.

Photo-Sensitising Topical Creams, Natural Supplements, or Oral Medication

• Citrus Essential Oils: Oils taken from the rind of Orange, Lemon, Mandarin, Lime, and Bergamot are highly photo-sensitising and if used in pure form, will cause skin to burn if exposed too long to light.  The client needs to wash off the oil and leave the skin 24 hours to return to normal;
  
• St John’s Wort, Accutane, Prescribed Retin-A: If the client has used any of these medications for up to 1 month, they need to cease use and come back in a month.  If the client has used any of these for over a month, then they need to cease use and leave any Pulsed Light or Laser treatments for 3 (three) months.
  
  In the case of Retin-A (also called Retinol or Concentrated Vitamin A) or St John's Wort, we are only concerned with creams that have been prescribed by a GP, Naturopath, or Dermatologist.  Over the counter products are very low dose and largely ineffective, and are not considered a contraindication to treatment.
  
• Doxycycline, Tetracycline, and Minomycin.
  
  The above compounds are most common in powerful antibiotics, and their use causes the skin to become photo-sensitive.  Drugs containing these compounds are usually prescribed when normal antibiotics don't do the trick, or to fight an ongoing condition, or even in conjunction with skin creams where a bacterial infection is present.  Tetracycline is also a common compound in anti-malaria medication, and clients may not be aware.  Always ask if they have gone overseas recently and if they have taken malaria meds of any form.  If yes, Google the product and search for its ingredients and contraindications.

Black Garments
Light attracts to areas of darkness, and particularly in the case of nylon or polyester underwear and bras, pulsed light can melt the fabric onto the skin if accidental contact occurs.  If working near these areas, have the client remove the garment and cover themselves with a towel instead.

Pain
While minimal discomfort is desirable during a pulsed light treatment, pain is a definite contraindication.  Pain presents in various ways, including excessive sweating and body language, and it is the therapist’s duty to observe how a client reacts during treatment and to constantly check that they are comfortable. If pain is evident, whether the client says so or not, the setting must be reduced to a comfortable level, or else risk buring the skin.

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