Lasers for Reduction of Unwanted Hair in Skin of Color: A Systematic Review and Meta‐analysis

摘要： Light-based therapies are one of the most effective and widely used strategies for removal of undesired hair, with a broadly favorable safety profile. However, subjects with pigmented skin are found to be more prone to laser-related adverse events. While prolonged pulse-width and longer treatment duration were proposed to minimize adverse events, the optimal treatment option among available phototherapy modalities—long-pulsed (Nd: YAG), pulsed diode, and alexandrite lasers as well as intense pulsed light (IPL)—remains unclear, particularly for skin of color. To determine superiority in terms of effectiveness and tolerability, we conducted a systematic review of literature on different types of in-office laser and IPL for hair removal in subjects with Fitzpatrick skin types III-VI. The meta-analysis was performed using Review Manager (RevMan) version 5.3 and included 12 eligible comparative trials (9 randomized controlled trials and 3 quasi-randomized). In terms of hair count reduction, pooled effect estimates for long-pulsed ND:YAG laser (OR 0.26, 95% CI [0.1, 0.78]) and diode laser (SMD -0.11, 95% CI [-0.62, 0.39) were not statistically significant from those of IPL; in contrast, alexandrite laser was found to be superior to IPL in reducing hair count (SMD -1.7, 95% CI [-2.6, -0.78]. In terms of adverse events, the pooled effect estimates favoured long‐pulsed Nd: YAG laser to IPL with respect to post-inflammatory hyperpigmentation (OR 0.26, 95% CI [0.1, 0.78]). However, both pulsed diode and alexandrite lasers exhibited a comparable safety profile to IPL, despite higher pain scores with lasers. In conclusion, this systematic review suggests that treatment outcomes for different in-office laser devices and IPL in subjects with skin type III-VI are broadly similar; nevertheless, we observed a trend toward greater hair reduction following laser therapy compared to IPL.