Predictors and prevalence of paradoxical hypertrichosis in alexandrite laser-based facial hair removal: results from a prospective clinical study

Abstract

Objective: To investigate the prevalence and identify potential contributing factors of facial paradoxical hypertrichosis (PH) following long-pulse Alexandrite LHR among Jordanian women.

Methodology: This observational, prospective study included female patients aged sixteen and above undergoing long-pulse Alexandrite laser treatment for facial hair at the Dermatology Department of King Abdullah University Hospital, Irbid, Jordan, from March 2023 to December 2024. Data on patient demographics, treatment sessions, and contributing factors such as hormonal conditions, family history, and sunblock use were collected through patient questionnaires and medical records.

Results: The study revealed a prevalence of facial PH of 16.2%, significant associations were found with irregular menstrual cycles (33.3% vs. 12.6%, P = 0.001), family history of hirsutism (27.8% vs. 13.8%, P = 0.001), and Fitzpatrick skin types III and IV (27.1% and 21.9% respectively, P = 0.001). Multiple laser sessions (6-10) increased PH risk (30.9% vs. 6.8%, P = 0.001), as did PCOS (33.3% vs. 14.1%, P < 0.001). Regular sunblock use demonstrated a protective effect (12.1% vs. 36.1%, P = 0.001). OCP use showed no significant association with PH (13.8% vs. 17.6%, P = 0.19).

Conclusion: Our findings highlight a higher-than-reported prevalence of PH following Alexandrite laser hair removal, key risk factors include PCOS, menstrual irregularities, darker skin types, and lack of sun protection. Understanding these associations can help clinicians take preventive measures, optimize patient selection, and provide better counseling to reduce the risk of paradoxical hypertrichosis and improve treatment outcomes.

Clinical trial registration: Not applicable.

Keywords: Alexandrite laser; Hirsutism; Laser hair removal; Paradoxical hypertrichosis; Polycystic ovary syndrome.