Contraindications for Lasers

Contraindications for IPL and Laser Hair Removal: 

Unfortunately, Hair Removal treatments are generally perceived by the public to be simple beauty treatments.  They are not.

Hair Removal Contraindications:

• Depilatory Creams & Sprays
• Suntan or Fake Tan
• Natural Pigmentation
• Recent Waxing, Plucking, or Sugaring
• Contagious Skin Diseases or Disorders
• Herpes 1 & 2
• Visible Skin Trauma
• Lesions, Sores, and Open Wounds
• Post-Surgical Scarring
• Keloid or Hypertrophic Scarring
• Moles, Freckles, Skin Marks
• Sunburn
• Epilepsy or Seizures Caused by Flashing Light
• Pregnancy & Breastfeeding
• Polycystic Ovarian Syndrome (PCOS)
• Hormone Supplementing Medications
• Hirsutism
• Tattoos, Permanent Makeup, or Implants
• Contraindicated Implants:
• Non-contraindicated Implants.
• Photo-Sensitising Topical Creams, Natural Supplements, or Oral Medication.
• Black Garments
• Pain

Serious burns and other problems can occur if the client withholds information or if the therapist is insufficiently experienced.

For that reason, it is vital that you read through this list of known contraindications to better prepare you for your laser or IPL hair removal treatment.

Depilatory creams and sprays dissolve hair with keratinocytes, ie chemicals designed to kill keratin. Keratinocytes are non-discriminatory and kill the keratin in skin as well as hair. Minimal use of depilatory creams is enough to permanently damage the skin, and therefore their use is a definite contraindication to treatment for fear of the risk of scarring. Clients who have used these products must wait six weeks from use before receiving a Pulsed Light or Laser treatment.

This is not to be confused with natural skin pigmentation, eg Mediterranean or Asian skins.  Tans, whether caused by the sun, spray tans, or tanning moisturisers, place the melanin in the skin in an unnatural ‘excited’ state. Since pulsed light and laser target melanin, this places the skin at risk of becoming an accidental target. This can lead to burns or pigment marks, and generally, ineffective treatments.

Secondly, excited skin is temporary. This means that the next time the client comes for treatment, their skin may be a different shade. This creates the need for experimenting with different filters from one treatment to the next, which basically requires the therapist to make a ‘best guess’ at which filters to use each time. Continuity is extremely important to compare the results from one treatment to the next, and tanning ruins this.

When can a client tan? Fake tanning is fine after treatments, assuming that any residual heat has subsided. Clients should not use spray tans or tanning moisturisers for two weeks prior to next treatment, and any remnants should be completely exfoliated.

Clients must not get real suntans or use solariums for the entire duration of their course of treatments and for one month after their final treatment.

Where a client has a naturally darker complexion, eg they are of Mediterranean, Asian, Arab, or Indian complexion, they usually fall into a skin-type category of 4 or 5.

Unlike tanning, and assuming that the hair removal equipment is of even beauty-grade standard, natural pigmentation in the 4 to 5 scale should not be a contraindication to treatment. Where a client who falls into this category has a tan in addition to their natural pigment, then they must lose their tan first so their skin returns to its normal state.

As a general rule of thumb, a category 4 client should receive a treatment using an 80% filter with no more than 50 Joules energy. A category 4 client will find a 100% filter at maximum 40 Joules most beneficial.

At any point during the course of treatments, if results appear to slow, DO NOT increase energy or decrease filters – Instead, use multiple shots of the area at the lower setting. This will ensure that extra heat goes to the hair bulb without compromising the integrity of the skin.

The same applies to treating genital skin on Caucasian clients, ie the labia, scrotum, and anal areas, which are invariably darker than surrounding skin on white-skinned people.

Light-based hair removal requires a hair root to target. During waxing, plucking, or sugaring, the hair root is pulled out of the shaft. If a client has recently had hair removal using one of these methods, they need to wait a minimum of two weeks for the hair root to regrow.

Some skin diseases are not easily detectable, and a therapist can only rely on client honesty. If a client discloses that they have a skin disease, and it is one that the therapist does not consider a contraindication to treatment, the following precautions must be taken:

→ Extra care must be taken to clean equipment with alcohol during and after treatment;

→ Gloves must be worn at all time;

→ All surfaces must be wiped down thoroughly with alcohol afterwards;

→ Metal instruments must be sterilised in Microshield.

The concerns for Herpes is the same as other contagious skin diseases, however due to the heat caused during a treatment, it is your Duty of Care to inform the client that the treatment may cause an outbreak.

If someone presents with visible skin trauma, the area is to be avoided.

If someone presents with lesions, sores or open wounds, the area is to be avoided.

Pulsed Light or Laser treatments of any kind will have a softening effect on scarring, however scars must be fully healed and closed. If any moisture or trauma is present, do not perform a treatment over the area.

Clients who are genuinely prone to keloid or hypertrophic scarring must be thoroughly informed that there is a risk of skin trauma resultant from Pulsed Light or Laser, and that it is their decision if they go ahead with the treatment. Thorough notes should be kept on the details of the discussion between therapist and client.

Pulsed Light and laser do not operate in the UV part of the light spectrum, and there is no evidence to suggest that such treatments can cause skin cancer or change the properties of a skin mark to make it cancerous. The primary concern with skin marks is ethical. It is not a therapist’s place to diagnose any of the above skin conditions. It is however, a therapist’s Duty of Care to tell the client if they notice a condition that may be suspicious.

It is a therapist’s Duty of Care to inform the client that any marks in the treated area may fade, and thus make it more difficult for a GP to diagnose. When clients go to their GP for skin checkups, they should state that they have undergone a light-based treatment so that the doctor looks a little harder.

→ Raised Moles (black or red): Work around the mole. Do not go over it;

→ Sunspots and freckles: Not contraindicated, however they may darken for a few weeks then lighten;

→ Skin Tags: Not contraindicated, however be careful when shaving the area.

Skin showing signs of redness from sun or solarium exposure must not be treated with any form of hair removal until the skin calms down again. Usually this will take a week or two at the minimum, and up to several months where the skin has tanned significantly.

If the client has a residual tan, this will affect their skin typing, and must be taken into account before performing a Pulsed Light or Laser treatment.

Epilepsy and other types of seizures caused by flashing light are a contraindication for Pulsed Light or Laser, unless the client’s GP provides a letter of authorisation. When treating a client with epilepsy or seizures induced by flashing light, they must wear fully opaque ‘swimming goggle’ eye protection to block out 100% of light, preferably with a cotton pad beneath each lens to ensure client comfort and for added protection.

While there is no medical evidence to suggest that a Pulsed Light or Laser treatment can harm an unborn child, there is abundant evidence that the massive fluctuations in hormone levels during pregnancy and breastfeeding make any attempts to remove hair fruitless. For ethical and client safety reasons, a therapist should not perform a light-based treatment until breastfeeding has ended and hormone levels have begun to settle again.

Refer to PCOS versus Hair Removal Treatments.

Predominantly women, but also people undergoing gender reassignment, take hormone supplements such as HRT and thyroid medications to moderate their levels of various sex hormones. This has a direct effect on hair growth.

If the client’s medication is regulating their hormones satisfactorily, then Pulsed Light or Laser should prove beneficial. If the medication is not regulating their hormones satisfactorily, the client needs to speak to their GP about adjusting their dose before we can do a treatment.

Hirsutism occurs in women who present with male hair growth patterns. There are two types of hirsutism: genetic and hormonal, and they are easy to differentiate.

A simple question – “Does your mum, grandmother, or any or your aunts have facial hair?” If yes, then the hirsutism is genetic.

If there is no family history of hirsutism, then the condition is most likely hormonal. Genetic Hirsutism is not a contraindication, but it should be treated as male hair. Hormonal Hirsutism will generally have an underlying cause that may be remedied with medical intervention.

If Hirsutism is present, therapists have a Duty of Care to inform clients that results will in all probability take longer.

Do not go over any areas where there are tattoos, permanent makeup, or contraindicated implants.

→ Depo Provera, a method of birth control often referred to as “the stick”;

→ Lap Bands.

In the case of Depo Provera, this only applies to treatments near the implant, eg Underarms or Upper Arms. I have asked the manufacturers to confirm or contradict my assertions based on internal statistics, and at time of writing, am waiting for a reply. However, during 2010-2011 before I listed this as contraindicative, five out of five girls in my care who received under arm hair removal treatments AND had the stick implant as their only form of birth control, AND had never had pregnancy scares with it before, all fell pregnant within a month of receiving the treatment. Subsequent discussions with a number of GPs about the possibility of IPL or Laser temporarily disabling the implant, gave me enough doubt to enact this policy. In short, a client with the stick may received a treatment anywhere but in the upper arm, breast, or underarm region. For all other areas, they must be informed of the potential risk of falling pregnant, and the therapist must record fully in their notes the details of the discussion.

→ Breast implants;

→ Pacemakers.

→ Citrus Essential Oils:  Oils taken from the rind of Orange, Lemon, Mandarin, Lime, and Bergamot are highly photo-sensitising and if used in pure form, will cause skin to burn if exposed too long to light. The client needs to wash off the oil and leave the skin 24 hours to return to normal;

→ St John’s Wort, Accutane, Prescribed Retin-A:  If the client has used any of these medications for up to 1 month, they need to cease use and come back in a month. If the client has used any of these for over a month, then they need to cease use and leave any Pulsed Light or Laser treatments for 3 (three) months.

In the case of Retin-A (also called Retinol or Concentrated Vitamin A) or St John’s Wort, we are only concerned with creams that have been prescribed by a GP, Naturopath, or Dermatologist. Over the counter products are very low dose and largely ineffective, and are not considered a contraindication to treatment.

→ Doxycycline, Tetracycline, and Minomycin:  These compounds are most common in powerful antibiotics, and their use causes the skin to become photo-sensitive. Drugs containing these compounds are usually prescribed when normal antibiotics don’t do the trick, or to fight an ongoing condition, or even in conjunction with skin creams where a bacterial infection is present. Tetracycline is also a common compound in anti-malaria medication, and clients may not be aware. Always ask if they have gone overseas recently and if they have taken malaria meds of any form. If yes, Google the product and search for its ingredients and contraindications.

Light attracts to areas of darkness, and particularly in the case of nylon or polyester underwear and bras, pulsed light can melt the fabric onto the skin if accidental contact occurs. If working near these areas, have the client remove the garment and cover themselves with a towel instead.

While a small amount of mild discomfort is desirable during a pulsed light treatment, pain is a definite contraindication.  Pain presents in various ways, including excessive sweating and body language, and it is the therapist’s duty to observe how a client reacts during treatment and to constantly check that they are comfortable.  If pain is evident, whether the client says so or not, the setting must be reduced to a comfortable level, or else risk buring the skin.