Paradoxical Hypertrichosis and Black Skin - When laser triggers more hair growth
Laser hair removal is a fantastic invention but there is a rare hair growth side effect you need to be aware of.
Like extensive foundation shades, great sunscreens and afro-textured extensions, laser hair removal has come a long way for darker skin tones. Thanks to the beauty and technological advancements that have been made in recent years, laser hair removal is so much more accessible with gentler and inclusive lasers including Nd: Yag and Diode.
However, there is such a thing called paradoxical hypertrichosis - whilst rare it is a significant side effect of laser hair removal in darker skin tones. Before panic ensues note that laser is a safe and expert-recommended treatment for fading hyperpigmentation, improving uneven skin tone as well and reducing unwanted hair – so don’t instantly run to cancel any appointments that you already had in your calendar. It’s just in some instances that laser hair removal can multiply hair growth instead of reducing it. But, to dive deeper into the topic we have BSD Practitioners Dr Ingrid Wilson and Dr Stefanie Williams (Consultant Dermatologist) to share their insights into paradoxical hypertrichosis and its adverse effects on Black skin darker skin tones.
What is Paradoxical Hypertrichosis?
Paradoxical Hypertrichosis, or PH for short, is when, “energy-based treatments which include laser or IPL (intense pulsed light) can mean some individuals (uncommonly) can end up with more hair, or coarser hair, or a combination of both post-treatments,” explains Dr Williams. Also – it’s not a condition that happens all over the body – paradoxical hypertrichosis only appears on the face (sideburns, cheeks, upper lips, and chin) and neck for women and the upper torso (back, shoulders and chest) for men.
What causes Paradoxical Hypertrichosis – how does it alter the hair follicle in Black skin?
The exact cause of paradoxical hypertrichosis is still unknown. But experts have narrowed the likely cause down to is how the heat from laser devices is delivered to the skin, causing an almost reversed effect. “PH is thought to be related to an inflammatory response in the skin,” says Dr Williams. Therefore, as the laser device targets the skin, “the heat delivered to nearby hair follicles kick starts and stimulates the hair growth cycle,” adds Dr Wilson. So, instead of the hair follicle starting with coarser hair and almost becoming light peach fuzz (often affiliated with a laser hair removal journey), the hair becomes thicker. The total opposite to the hair removal cycle.
Why is Paradoxical Hypertrichosis more common in Black skin vs. other skin tones?
First things first, it’s essential to highlight that PH, in general, occurs anywhere from 0.6%-10% of all who undergo laser hair treatments (as mentioned by Dr Williams). But, in Black skin tones in particular, “it is thought to be between 0.6%-5.1%,” explains Dr Wilson.
The reason for this is that one – Black individuals naturally have thicker and darker hair, and two – some may also have underlying hormone conditions that can increase the chances of experiencing PH. “The risk of paradoxical hypertrichosis is higher in those with darker skin, especially in women with PCOS (polycystic ovarian syndrome, a hormonal imbalance with elevated levels of male hormones, androgens),” says Dr Williams. Not only PCOS (National Institute of Health say approximately 5 million Black women in the US alone are affected by PCOS) but other conditions including NCAH (nonclassical congenital adrenal hyperplasia), Cushing’s syndrome and Androgen-secreting illnesses have shown a significant link to PH due to the alternate nature of hormonal behaviour in the body.
What does Paradoxical Hypertrichosis look like on Black Skin?
Due to the hair growing back, there are instances that it will grow back thicker, coarser and darker than before, therefore, much more visible on Black skin.
Is there any way to avoid Paradoxical Hypertrichosis?
Unfortunately not, however, “there are some measures that can lower the risk of paradoxical hypertrichosis - such as certified practitioners ensuring the energy from the device isn’t too low or too high. Another point is to only treat thick hair .vs. very light hair, especially on the face and neck due to having the highest risk of paradoxical hypertrichosis,” says Dr Williams. “Another way of lowering the risk of PH is to pre-treat (before laser) and co-treat (in between sessions) with Vaniqa prescriptive cream that slows down hair growth in the follicles (hair roots). It contains eflornithine 11.5% and should only be administered by a medical expert.”
Also make sure you only use practitioners who are qualified and experienced in laser hair removal who are able to take your full medical history into consideration.
What are the treatment options for improving Paradoxical Hypertrichosis?
If you start to experience or have experienced paradoxical hypertrichosis all is not lost. It may seem counterintuitive but experts often recommend sticking to your course of laser treatments because the technology can eventually remedy it. For Dr Williams, “usually the solution is more laser treatments, but with a higher energy, ideally in combination with eflornithine cream.”
Are there alternative hair removal options experts recommend?
According to Dr Williams, any laser device can in theory cause paradoxical hypertrichosis because no type of laser is 100% safe in this respect. Therefore, if you want to try an alternative hair removal the best option would be electrolysis, “it does take longer, but the results are permanent,” recommends Dr Wilson. (Though do be mindful as there is a risk of hyperpigmentation!)
Of course, non-energy-based hair removal methods such as epilation and shaving are also options to be considered.
Paradoxical Hypertrichosis is rare but can happen, and as recommended before any laser and light treatments, a patch test is essential. We also recommend paying closer attention to your skin when you undergo any laser treatments and keeping a photo diary to track any potential issues.