According to a recent case report by Assistant Professor of Medicine (dermatology) Azzam Alkhalifah a young female patient who had never had vitiligo, experienced patches appearing after undergoing Alexandrite laser hair removal (LHR). Whilst these patches were treated successfully with NB-UVB, the patient then experienced a re-occurrence of vitiligo patches following a second laser hair removal session 4 years later. The new patches only appeared on areas that received the laser treatment[i].
This made me think about other types of hair removal, and the potential dangers that people living with vitiligo might not be aware of. It’s a common question that people ask us, so this article is written based on my personal research, to help share what I learnt about vitiligo and hair removal techniques.
Understanding vitiligo and the Koebner phenomenon
Understanding and learning more about vitiligo is key to protecting and caring for your skin. Not many people are aware that vitiligo is a condition that that is affected by something called the Koebner phenomenon. This phenomenon is hugely important to learn about when understanding how environment factors can trigger vitiligo.
Simply put, the Koebner phenomenon refers to the fact that when skin is injured, rubbed, or damaged in some way, new vitiligo patches can be triggered. This injury could be chemically induced, from using harmful cosmetics or cleaning agents, or physically induced from scrubs, blades, or lasers.
Different types of hair removal and their dangers
The best way to keep yourself safe is to understand how different kinds of hair removal work, and then evaluate the level of risk involved in each. I’ve summarised some popular hair removal techniques below:
Laser hair removal uses light and heat to remove hair. When the process is started, the intensity of the heat is lower as the hairs are thick and dark, therefor less energy is needed to target these hairs. However, as you progress the targeted hairs become lighter and finer, and so need more energy to remove. Too much heat applied to the skin can cause damage and potentially trigger the Koebner phenomenon described above. It has also been suggested that those with darker skin tone more susceptible to tissue injury during laser hair removal due to the presence of a high amount of melanin. Melanin absorbs energy from the laser, which results in heat generation[ii]
Waxing is also not without risk. Waxing is actually a form of physical exfoliation, removing the top layers of the skin along with hair. This results in the area of skin becoming temporarily more susceptible to sun damage, which in turn can cause further irritation, inflammation and damage.
Hair removal creams, also known as Depilatory Creams, work by weakening each strand of hair, allowing you to then wipe the hair away. The active ingredient in these creams is thioglycolic acid and calcium hydroxide, which work together to break down the hair. The dangers of these creams is that when they come into contact with the skin they can cause chemical burns, which become more severe the longer the cream is left on for. As with the other forms of hair removal, this can trigger the Koebner phenomenon.
From what I discovered, shaving is generally considered to be the saver option of hair removal. But even with saving, regular shaving or shaving too closely can lead to excessive exfoliation, irritation, and peeling. Some shaving forms can also irritate the skin or leave it dry and damaged feeling, so it’s really important to pick the right shaver and use foams and balms that are kind to your skin.
Keeping yourself safe
Whilst it feels as though hair removal is fraught with danger, there are measures we can all take to try and keep ourselves safe:
- Speak to your dermatologist, they can give you personalise advice on which solution might be less risky for you and your skin.
- If you are considering waxing or laser treatments, then do your homework and go to a reputable beautician. Try to find someone who has an awareness of the condition and can talk to you about the risks. Make sure they are aware of your vitiligo patches, and when your vitiligo was last active. If you know certain things (such as sunlight) trigger your vitiligo, then be sure to share this with your beautician.
- Make sure that for whatever technique you try, that you do a patch test, this can help you ascertain if something might irritate you. Ideally to the test on a less exposed area, so that if a new patch is triggered it has less of an impact for you.
- Be extremely cautious if your vitiligo is ‘active’. If you have had new patches appear recently then this increases your chances of skin damage triggering more patches.
- Keep a diary of anything you try, it can help you establish if there are specific removal techniques or chemicals that you are more sensitive to.
A word from our dermatologist
Regarding hair removal, the problem here is that something like laser hair removal might induce some trauma to the skin, even if mild, and that might set off some depigmentation. Other forms of hair removal such as creams might cause some irritation that could have the same effect. Shaving might be less traumatic but is not so acceptable. So the answer is that any of the commonly used methods could be risky. If you are considering hair removal then, it might be an idea to try which ever methods you decide on a non-visible part of the body and wait a few weeks to see if there has been any adverse effect. However, there is no guarantee here that something might develop later or that a more visible part of the body such as the face might behave in a different way. An adverse effect will be more likely if the vitiligo is in an active phase but might occur even if it is not.
If you have any further questions or concerns about this topic, then please contact our team: email@example.com
[i] A Case Report of Vitiligo Induced by Alexandrite Hair Removal Laser, A Alkhalifah https://pubmed.ncbi.nlm.nih.gov/35082612/
[ii] Nelson JS, Majaron B, Kelly KM. Active skin cooling in conjunction with laser dermatologic surgery.Semin Cutan Med Surg.19: 253-266 (2000).