Case Report: Complication Using Flashlamp Device for Laser Hair Removal

Laser Hair Removal Case Report: Complication using a Flashlamp Device.

Background

The following is a case report describing an adverse reaction during treatment with a flashlamp device. A search of the literature did not reveal any interactions between an orthodontic appliance and a flashlamp.

Report

A 12 year old female presented to our clinic with her mother requesting hair removal on the upper lip. A medical history was taken and a limited physical exam was completed. There was no supporting history or clinical evidence of hirsutism. A long discussion was held regarding the various treatment options for hair growth on the upper lip. After an extensive discussion the patient and mother desired to proceed with hair removal using a laser/light based device.

The patient had brown eyes, sandy blond hair and responded to sunlight by mostly tanning. She was assessed to be a skin type III. Hair growth was medium in density and size. Hair color was brown/black. Hair growth was noted from the corners of her mouth to the philtrum. The distribution was symmetric.

In our clinic we have two laser/light based options available for hair removal. One method is a 1064nm wavelength laser and the other is a flashlamp device. It was decided that the most efficacious and safe method for hair removal on this patient would be the flashlamp device.

Pre-treatment photographs were taken. Informed consent was obtained. The upper lip was shaved. Adhesive laser eye shields were placed. Parameters on the flashlamp device were set based on the patient’s skin type and characteristics of the hair. The following settings were used:

Filter- 640nm

Fluence- 10 J/cm²

Pulse width- 20ms

Cooling- 10 degrees centigrade

50% of the sapphire was masked to fit the area to be treated

Conservative flashlamp settings were used. This is our clinic’s standard approach with the initial treatment.

A test spot was performed on the patient’s mid volar forearm to assess her response to the parameters and to allay any anxiety about the discomfort she would feel with treatment. No skin changes were noted on the forearm after five minutes of observation. The patient did not feel any discomfort with the test spot. Treatment was then carried out on the right side of the upper lip. The patient stated immediately that she felt a sensation in her arch bar. Unbeknownst to the treating physician was that the patient had an orthodontic appliance. The appliance consisted of two bands encircling her posterior most molars connected by a wire that went from the lingual side of the bands and followed the contour of the hard palate forming a half circle. The arch bar had a tear drop shaped bend at its apex oriented at 90 degrees and pointed toward the pharynx. No skin changes were noted in the treatment area and inspection of the mouth confirmed the orthodontic hardware and no mucosal changes. At this time a piece of moistened white gauze was placed across the upper teeth. It is uncertain whether coverage was adequate over the banded molars. No skin changes on the right upper lip were noted and the patient experienced no discomfort in the area treated. Therefore the fluence was increased from 10 J/cm² to 11 J/cm². Again the patient felt a sensation in her arch bar with treatment of the left upper lip. She stated the sensation was more intense at the fluence of 11 J/cm². The patient described the sensation as an electrical shock in the bands wrapped around the posterior molars. The patient did not feel any discomfort in her upper lip. Faint erythema was noted in the area treated that resolved over five minutes. The treatment was concluded and the patient was discharged 10 minutes later without any discomfort. No mucosal skin changes were noted. Follow up exam at 1 week and subsequent phone conversations with the mother revealed no complications including visits to the patient’s orthodontist.

Discussion

The patient’s reaction to treatment and statement that she felt a shock was initially puzzling to this physician. I had not encountered this adverse reaction in my readings on flashlamp devices nor was it mentioned in the manufacturer’s literature. A literature search did not reveal case reports or potential interactions of flashlamp devices with orthodontic appliances.

Although the treating physician was aware of laser penetration and the need for dental protection with longer wavelength lasers, protection of the patient’s teeth with moistened white gauze didn’t prevent the sensation from occurring. In addition, the sensation was stronger with increased fluence.

A call was subsequently placed to the flashlamp manufacturer and the case was discussed with their clinical trainer. The trainer was unaware of this reaction occurring or being reported with the flashlamp device. The information was forwarded to a physicist employed by the manufacturer. Upon discussion it was believed that an inductive phenomenon occurred. The flashlamp creates its pulse of light in the handpiece using high amperage. This generated an electromagnetic field and the arch bar reacted like a coil through induction resulting in the patient’s discomfort and sensation of a shock.

To prevent this reaction from occurring in the future we have added additional questioning on our history to identify metal objects in the body.

4/27/06

This is a rough outline of the case report. The literature search for flashlamp interactions is not complete. Supporting information and references for the discussion is not complete. Any feedback or suggestions would be appreciated. We plan on submitting this report to Lasers in Surgery and Medicine.

John E. Carter, MD

Julianne M. Mazurek, MD