Persistent hives after Laser Hair Removal Procedures
The goal of laser hair removal is to destroy hair follicles without harming surrounding tissue. Side effects of laser hair removal include burns, which may lead to hyper- or hypopigmentation, hair stimulation (paradoxical hypertrichosis), scars, or transient erythema of treated areas. Persistent hives as a side effect of laser hair removal is not something cosmetic practitioners generally counsel patients on .
Dorgham N et al. 2022
Authors of a new study describe a case of a patient who developed persistent urticaria (hives) with severe itching in the areas treated with laser hair reduction. This phenomenon has very rarely reported in the current literature.
A 30-year-old male patient with Fitzpatrick skin type III presented for hair reduction of the chest, abdomen, lower back, and posterior neck. His past medical history included recurrent sinus polyps, severe year-round environmental allergies, and dermatographism. His daily medications included fexofenadine, levocetirizine, montelukast, fluticasone propionate nasal spray and quarterly prednisone tapers for sinus polyps and allergy flares.
LASER TREAMTENT 1
The patient’s first laser treatment was with the GentleMax 755 nm alexandrite laser with an intensity of 16 J/cm2. The sites targeted were the posterior neck, abdomen, chest, and lower back. After the session, the patient immediately reported itching in the treated areas. Within 3 to 4 hour of the session, he developed a severely itchy urticarial eruption limited to the treated areas. This hive like reaction persisted for 5–6 days. The reaction was truly localized to the skin and he did not experience any oral or ocular swelling or any systemic symptoms such as shortness of breath. He did not have any relief with topical betamethasone 0.05% twice daily, diphenhydramine 25 mg daily in addition to his regular allergy treatment protocol
LASER TREATMENT 2
A few months later, the patient returned for his second treatment. This time, he pretreated with 5 days of prednisone 40 mg. The intensity of the 755 nm alexandrite laser was decreased from 16 J/cm2 to 10 J/cm2 . He again developed severe urticaria within 3–4 hours and similar to the first laser session, it lasted 5 days. The patient tried treating this reaction with a prednisone taper, fexofenadine, levocetirizine, diphenhydramine, and topical betamethasone but again there was no relief.
LASER TREATMENT 3
The patient returned back to clinic 6 weeks later for his third treatment. He reported the initiation of dupilumab treatment for sinus polyps beginning 4 weeks prior. The alexandrite laser was again used but now at an intensity of 9 J/cm2 was used. He was given 3 days of prednisone 40 mg to start following the laser treatment along with topical betamethasone 0.05%. Although he did develop symptoms again within 3–4 h following the treatment, the duration of the intensity of itching decreased to 2 days.
LASER TREATMENT 4
5 weeks later, the patient returned for his fourth treatment. He had been on dupilumab for 9 weeks at that time. He pretreated with prednisone 40 mg for 2 days prior. The alexandrite laser with intensity of 9 J/cm2 was again used – similar to session 3. Following the laser, he experienced similar symptoms for about 36–48 h and with significantly less discomfort.
Slight redness of the skin is common after laser hair removal. This patient developed a rare reaction with hives and intense itching within 3-4 hours of laser treatments. These lasted many days (5-6 days). Persistent hives is not something cosmetic practitioners generally counsel patients
In 2012, Landa et al reported 36 patients with hives after laser. 33 of 36 patients had a history of allergies and this was mostly dust mites.
The cause of this patient’s hives in this case is not clear. The authors considered various causes of what is known as physical urticaria (which includes dermatographism, delayed pressure urticaria (DPU), exercise-induced urticaria, cold urticaria, or heat urticaria) but it did not seem in this case this was likely. He had no prior history of cold urticaria which could lead to hives with the cryogen used in laser. He did have a history of dermatographism but those urticaria resolved within hours.
This case highlights a rare side effect that deserves further study. It could be that patients with a history of moderate-to-severe environmental allergies could have a small chance of persistent hives. Whether this is a 1 in 100,000 or 1 in 1000 is not clear.
Dorgham N et al. Severe persistent urticaria following laser hair reduction Noelle Dorgham MS I J Cosmet Dermatol. 2022 Sep 15.
Landa N, Corrons N, Zabalza I, Azpiazu JL. Urticaria induced by laser epilation: a clinical and histopathological study with extended follow-up in 36 patients. Lasers Surg Med. 2012;44(5):384-389. doi:10.1002/lsm.22024