The ruby laser is effective in removing unwanted body hair. The occurrence of cutaneous side-effects such as blistering, hypopigmentation and hyperpigmentation, however, remains problematic. These side-effects are more commonly seen in patients with dark coloured skin, which partly explains the relative scarcity of information on the efficacy of ruby laser hair removal in such patients. The mechanisms of the occurrence of these side-effects are also not known. It was the aim of this study to evaluate the efficacy of ruby laser-assisted hair removal in patients with Fitzpatrick skin type V in a retrospective clinical study and to evaluate the mechanism of post-treatment pigmentary change in a prospective clinical study. The percentage reduction in hair density in patients with skin type V was assessed after a variable period following treatment with the Chromos 694 Depilation Ruby Laser, and was compared with the results of those with skin types I-IV. To study the pigmentary change and melanocyte numbers after laser irradiation, ex-vivo scalp skin and serial patient biopsies were taken and stained with S-100, dopa oxidase and Masson-Fontana methods. Laser treatment reduced melanocyte numbers as measured by DOPA stain but not by S100. Laser treatment resulted in the clearance of pigment from the epidermis on histology. Ruby laser was shown to be effective in removing unwanted hair from patients with dark coloured skin, but with a higher incidence of cutaneous side-effects. The occurrence of hypopigmentation after laser irradiation was thought to be due to the suppression of melanogenesis in the epidermis rather than to destruction of the melanocytes.