Unwanted facial and body hair presents as a common finding in many patients, such as females with hirsutism. With advances in laser and light technology, a clinically significant reduction in hair can be achieved in patients with light skin. However, in patients with darker skin, Fitzpatrick skin types (FST) IV–VI, the higher melanin content of the skin interferes with the proposed mechanism of laser-induced selective photothermolysis, which is to target the melanin in the hair follicle to cause permanent destruction of hair bulge stem cells. Many prospective and retrospective studies have been conducted with laser and light hair-removal devices, but most exclude patients with darkly pigmented skin, considering them a high-risk group for unwanted side effects, including pigmentation changes, blisters, and crust formation. We reviewed the published literature to obtain studies that focused on hair reduction for darker skin types. The existing literature for this patient population identifies longer wavelengths as a key element of the treatment protocol and indicates neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, alexandrite, and ruby lasers as well as certain intense pulsed light sources for safe hair reduction with minimal side effects in patients with FST IV–VI, so long as energy settings and wavelengths are appropriate. Based on the findings in this review, safe and effective hair reduction for patients with FST IV–VI is achievable under proper treatment protocols and energy settings.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Maria-Angeliki G, Alexandros-Efstratios K, Dimitris R, et al. Platelet-rich plasma as a potential treatment for noncicatricial alopecias. Int J Trichol. 2015;7(2):54–63.
Gan SD, Graber EM. Laser hair removal: a review. Dermatol Surg. 2013;39(6):823–38.
Richter AL, Barrera J, Markus RF, et al. Laser skin treatment in non-Caucasian patients. Facial Plast Surg Clin North Am. 2014;22(3):439–46.
Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220(4596):524–7.
Ibrahimi OA, Avram MM, Hanke CW, et al. Laser hair removal. Dermatol Ther. 2011;24(1):94–107.
Altshuler GB, Anderson RR, Manstein D, et al. Extended theory of selective photothermolysis. Lasers Surg Med. 2001;29(5):416–32.
Battle EF Jr, Hobbs LM. Laser-assisted hair removal for darker skin types. Dermatol Ther. 2004;17(2):177–83.
Sachdeva S. Fitzpatrick skin typing: applications in dermatology. Indian J Dermatol Venereol Leprol. 2009;75(1):93–6.
Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003;101(5 Pt 1):995–1007.
Vachiramon V, McMichael AJ. Patient knowledge and attitudes on laser hair removal: a survey in people of color. J Cosmet Dermatol. 2011;10(3):197–201.
Aldraibi MS, Touma DJ, Khachemoune A. Hair removal with the 3- msec alexandrite laser in patients with skin types IV-VI: efficacy, safety, and the role of topical corticosteroids in preventing side effects. J Drugs Dermatol. 2007;6(1):60–6.
Lu SY, Lee CC, Wu YY. Hair removal by long-pulse alexandrite laser in oriental patients. Ann Plast Surg. 2001;47(4):404–11.
Schoenewolf NL, Barysch MJ, Dummer R. Intense pulsed light. Curr Probl Dermatol. 2011;42:166–72.
Vachiramon V, Brown T, McMichael AJ. Patient satisfaction and complications following laser hair removal in ethnic skin. J Drugs Dermatol. 2012;11(2):191–5.
Karn D, KC S, Timalsina M, et al. Hormonal profile and efficacy of long pulse Nd-YAG laser in treatment of hirsutism. J Nepal Health Res Counc. 2014;12(26):59–62.
Rao K, Sankar TK. Long-pulsed Nd:YAG laser-assisted hair removal in Fitzpatrick skin types IV–VI. Lasers Med Sci. 2011;26(5):623–6.
Nanda S, Bansal S. Long pulsed Nd:YAG laser with inbuilt cool sapphire tip for long term hair reduction on type- IV and V skin: a prospective analysis of 200 patients. Indian J Dermatol Venereol Leprol. 2010;76(6):677–81.
Khatri KA, Lee RA, Goldberg LJ, et al. Efficacy and safety of a 0.65 millisecond pulsed portable ND:YAG laser for hair removal. J Cosmet Laser Ther. 2009;11(1):19–24.
Fournier N. Hair removal on dark-skinned patients with pneumatic skin flattening (PSF) and a high-energy Nd:YAG laser. J Cosmet Laser Ther. 2008;10(4):210–2.
Tanzi EL, Alster TS. Long-pulsed 1064-nm Nd:YAG laser-assisted hair removal in all skin types. Dermatol Surg. 2004;30(1):13–7.
Alster TS, Bryan H, Williams CM. Long-pulsed Nd:YAG laser-assisted hair removal in pigmented skin: a clinical and histological evaluation. Arch Dermatol. 2001;137(7):885–9.
Mittal R, Sriram S, Sandhu K. Evaluation of long-pulsed 1064 nm Nd:YAG laser-assisted hair removal vs multiple treatment sessions and different hair types in indian patients. J Cutan Aesthet Surg. 2008;1(2):75–9.
Yeung CK, Shek SY, Chan HH. Hair removal with neodymium-doped yttrium aluminum garnet laser and pneumatic skin flattening in Asians. Dermatol Surg. 2010;36(11):1664–70.
Barolet D. Low fluence-high repetition rate diode laser hair removal 12-month evaluation: reducing pain and risks while keeping clinical efficacy. Lasers Surg Med. 2012;44(4):277–81.
Royo J, Urdiales F, Moreno J, et al. Six-month follow-up multicenter prospective study of 368 patients, phototypes III to V, on epilation efficacy using an 810-nm diode laser at low fluence. Lasers Med Sci. 2011;26(2):247–55.
Wheeland RG. Simulated consumer use of a battery-powered, hand-held, portable diode laser (810 nm) for hair removal: a safety, efficacy and ease-of-use study. Lasers Surg Med. 2007;39(6):476–93.
Hussain M, Suwanchinda A, Charuwichtratana S, et al. A new long pulsed 940 nm diode laser used for hair removal in Asian skin types. J Cosmet Laser Ther. 2003;5(2):97–100.
Greppi I. Diode laser hair removal of the black patient. Lasers Surg Med. 2001;28(2):150–5.
Adrian RM, Shay KP. 800 nanometer diode laser hair removal in African American patients: a clinical and histologic study. J Cutan Laser Ther. 2000;2(4):183–90.
Campos VB, Dierickx CC, Farinelli WA, et al. Hair removal with an 800-nm pulsed diode laser. J Am Acad Dermatol. 2000;43(3):442–7.
Kutlubay Z. Alexandrite laser hair removal results in 2359 patients: a Turkish experience. J Cosmet Laser Ther. 2009;11(2):85–93.
Garcia C, Alamoudi H, Nakib M, et al. Alexandrite laser hair removal is safe for Fitzpatrick skin types IV–VI. Dermatol Surg. 2000;26(2):130–4.
Elman M, Klein A, Slatkine M. Dark skin tissue reaction in laser assisted hair removal with a long-pulse ruby laser. J Cutan Laser Ther. 2000;2(1):17–20.
Liew SH, Grobbelaar A, Gault D, et al. Hair removal using the ruby laser: clinical efficacy in Fitzpatrick skin types I–V and histological changes in epidermal melanocytes. Br J Dermatol. 1999;140(6):1105–9.
Trelles MA, Ash C, Town G. Clinical and microscopic evaluation of long-term (6 months) epilation effects of the ipulse personal home-use intense pulsed light (IPL) device. J Eur Acad Dermatol Venereol. 2014;28(2):160–8.
Mohanan S, Basheerahmed P, Priyavathani R, et al. New intense pulse light device with square pulse technology for hirsutism in Indian patients: a pilot study. J Cosmet Laser Ther. 2012;14(1):14–7.
Feng YM, Zhou ZC, Gold MH. Hair removal using a new intense pulsed light source in Chinese patients. J Cosmet Laser Ther. 2009;11(2):94–7.
El Bedewi AF. Hair removal with intense pulsed light. Lasers Med Sci. 2004;19(1):48–51.
Ismail SA. Long-pulsed Nd:YAG laser vs. intense pulsed light for hair removal in dark skin: a randomized controlled trial. Br J Dermatol. 2012;166(2):317–21.
Goh CL. Comparative study on a single treatment response to long pulse Nd:YAG lasers and intense pulse light therapy for hair removal on skin type IV to VI: is longer wavelengths lasers preferred over shorter wavelengths lights for assisted hair removal. J Dermatol Treat. 2003;14(4):243–7.
Bouzari N, Tabatabai H, Abbasi Z, et al. Laser hair removal: comparison of long-pulsed Nd:YAG, long-pulsed alexandrite, and long-pulsed diode lasers. Dermatol Surg. 2004;30(4 Pt 1):498–502.
Galadari I. Comparative evaluation of different hair removal lasers in skin types IV, V, and VI. Int J Dermatol. 2003;42(1):68–70.
Puri N. Comparative study of diode laser versus neodymium-yttrium aluminum: garnet laser versus intense pulsed light for the treatment of hirsutism. J Cutan Aesthet Surg. 2015;8(2):97–101.
Chan HH, Ying SY, Ho WS, et al. An in vivo study comparing the efficacy and complications of diode laser and long-pulsed Nd:YAG laser in hair removal in Chinese patients. Dermatol Surg. 2001;27(11):950–4.
Rampen FH, Fleuren BA, de Boo TM, et al. Unreliability of self-reported burning tendency and tanning ability. Arch Dermatol. 1988;124(6):885–8.
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6):869–71.
Freedberg IM, Eisen AZ, Wolff K, et al., editors. Fitzpatrick’s dermatology in general medicine. 5th ed. New York: McGraw-Hill Professional; 1999.
Conflict of interest
RAF, MP, AEE, ASA, and KN have no conflicts of interest.
No funding was received for the preparation of this review.
About this article
Cite this article
Fayne, R.A., Perper, M., Eber, A.E. et al. Laser and Light Treatments for Hair Reduction in Fitzpatrick Skin Types IV–VI: A Comprehensive Review of the Literature. Am J Clin Dermatol 19, 237–252 (2018). https://doi.org/10.1007/s40257-017-0316-7