Hirsutism is usually defined as excess terminal hair in a woman that occurs in a male pattern. Usually, this clinical condition is reported by females mostly secondary to some underlying medical pathology¹. There could be multiple systemic conditions related to hirsutism, and managing them may decrease the facial growth of hair growth of affected individuals. Still, mostly local intervention has been required to remove or minimize the unwanted hair on the face ². Various local and systemic therapies have been in practice for this clinical condition ³.

Various modalities have been researched and used in clinical practice to manage unwanted hair of the face related to hirsutism. IPL can be one of them. Intense first night IPL was commercially launched as a medical device in 1994⁴. In the following years, multiple technical modifications allowed an easier handling, increased safety, and widened the spectrum of potential indications. IPL devices use flash lamps and computer-controlled capacitor banks to generate pulsed polychromatic high-intensity light. Electrical energy stored in the capacitor bank is passed through Xenon gas within a gas-discharge lamp so that bright light is emitted. Thus, electrical energy is converted into optical energy.

This study is determined to review the use of IPL in the treatment of hair removal in hirsutism patients in the setting of a Bangladeshi medical centre.

This study was conducted at the Department of Burn and Plastic Surgery of Dhaka National Medical College Hospital in collaboration with the Skin and VD department of the same Hospital, from January 2022 to June 2024. As the treatment was offered to a selective number of patients, the study was conducted as a case series, and all the cases that were managed with IPL laser were included in the study. The non-probability consecutive sampling technique was used to gather samples for this study after proper informed consent.

Inclusion criteria: Female patients, who were the ages between 15 to 55 years old, and were diagnosed by a dermatologist as a case of Hirsutism, were included in the study.

Exclusion Criteria: Pregnant or lactating women, women with a tendency to develop hypertrophic scar/ keloid, photosensitivity, pigmentation, or any other adverse effects of previous such therapy, those with white hair, and those who underwent any form of treatment for the disease in the previous year were excluded.

Baseline Investigations were carried out beforehand, including the hormonal profile. IPL was performed standard protocol with a Fluence of 30 J/cm^{2 5}. A total of 5 sessions were done one month apart, and hair reduction was measured by counting the number of hair follicles in a 1 cm² area of the face. The 1st measurements were taken before the first session, and the second one at the beginning of 3rd session, and the final one after one month of the fifth or last session. All the results were recorded by both the patients and the researchers. Expert categorized based on reduction in the hair count⁶. Less than 25%, 25 -50%, 50 -75% >75%. Patients rated their satisfaction from 0 to 10, and > 6 as sufficient satisfaction for the procedure⁶.

All statistical analysis was performed using Statistics Package for Social Sciences version 24.0 (SPSS-24.0), Microsoft Word, and Excel.

In the study, the age range is about 15-55 years, with 27.31 mean age; 15% of patients have>75% hair reduction, and 32% have <25%. Among all participants, 68% experienced mild to moderate side effects, while 62% reported a good level of satisfaction.

Table-I showed that side effects were seen in 60% of patients. Among all side effects, transient erythema (38%) and moderate pain (41.6%) were the most commonly experienced by the patients.

Table-I: Characteristics of Study Participants (n=100)

Hair Reduction at the end of three Sessions

Table-II showed that hair reduction, adverse effects and patient satisfaction were effective and tolerable.

Table-II: Outcome of various Variables Studied in the final Analysis (n=100)

FIGUER(s) of CASE (before and after IPL):

Hirsutism is one of the most stressful conditions for women, particularly for the younger age group. It can be idiopathic or can occur as a part of multiple metabolic or endocrine syndromes. Behboodi Moghadem et al. in 2018 conducted a detailed review. They concluded that no matter which tool is used, overall quality of life has been affected in many ways if the patient has been suffering from a condition that gives rise to unwanted hair on the face ⁷. Alizadeh et al. 2017 conducted an interesting study in this regard where they instead of reducing hair growth as the outcome, they studied the overall quality of life after the laser treatment of Hirsutism. They concluded that laser therapy improves hirsutism and enhances the quality of life in such women⁸. Multiple treatment options have been available for managing hirsutism but the evidence is little for the best choice of our women. in this aspect we planned to review the efficacies of intense pulse light IPL in removing unwanted facial hair at the plastic surgery department of Dhaka National medical college hospital in collaboration with the skin and VD department.

Shrimal et al in 2017 concluded that the IPL-755nm is safe and effective in managing idiopathic facial Hirsutism⁹. Though our study had a smaller sample size, we found similar results.

In 2011, Nilforoushzadeh et al. conducted a trial and compared the Diode and Alexandrite lasers to manage hirsutism. They concluded that overall efficacy and patient satisfaction were significantly different in both groups ¹⁰. Though our study was not comparative, we found that patient satisfaction was quite significant in IPL treatment (62%).

The common side effects of our patients were transient erythema, skin irritation, and long-standing hyperpigmentation. Thaysen-Peterson et al in 2017¹¹. and Zaleskavet et al. in 2018 also summarized that common adverse effects of laser and IPL treatment include transient erythema, mild to moderate local pain, hyperpigmentation, skin irritation, skin burns, and skin hypersensitivity¹².

Although there are some disadvantages of IPL like, inconsistence of emitted spectrum, weight of handpiece, large spot size, I'll focused light, requirement of gel application, direct contact of handpiece to the skin, the advantages of IPL are more, like lower purchase price, high skin coverage rate, high versatility, robust technology etc¹³.

The study draws its results from 100 patients, which may not fully capture the diversity of patient demographics that could benefit from IPL treatment for hirsutism. Another limitation is the lack of long-term follow-up, along with a significant patient dropout rate. Future studies with improved long-term follow-up and addressing these limitations may generate better results.

Our study revealed that use of IPL has been effective and tolerable in managing unwanted facial hair in women suffering from hirsutism. 

Conflict of Interest: None.
Acknowledgement:  Prof. Dr. Sayeed Ahmed Siddiky Sir; Professor and Chief Consultant, Cosmetic Surgery Centre Ltd, Dhaka, Bangladesh for his brilliant support throughout the publication journey.

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