INTRODUCTION
Laser hair reduction (LHR) is a well-established modality for a wide range of medical indications, including hidradenitis suppurativa, pseudofolliculitis barbae and hirsutism.1 Traditional hair reduction treatments include shaving, plucking, waxing, chemical depilatories and electrolysis, but these treatments are tedious, painful, and not permanent.2,3 Long-term unwanted hair reduction is one of the fastest growing, nonsurgical aesthetic procedures worldwide.1,4 The available lasers for LHR operate in the red or near-infrared wavelength regions: alexandrite (755 nm), diode (800 to 940 nm), Nd:YAG lasers (1064 nm), and intense pulsed light (IPL) sources (515 to 1200 nm).LHR can be beneficial for hemodialysis patients who undergo repeated adhesive tape application and removal at their hemodialysis fistula site during hemodialysis sessions. However, there is a paucity of published literature on efficacious LHR treatments for hemodialysis patients. A review of the published literature was performed on November 13, 2017 on medical bibliographic databases PubMed, EMBASE, and Web of Science using search terms of “laser hair reduction” OR “laser hair removal”, AND “hemodialysis”. No results were found. Herein, we present a case of safe, efficacious, and well-tolerated LHR with Nd:YAG laser at a hemodialysis access site.
CASE REPORT
A 50-year-old white man (Fitzpatrick III) with end-stage renal disease (ESRD) on hemodialysis six days per week via a left arm arteriovenous fistula presented for laser hair reduction treatment of his left arm. He reported that the hair around the fistula site adhered and interfered with the tape used during hemodialysis, resulting in severe pain during tape removal. The patient’s pertinent medical history included a history of recurrent membranoproliferative glomerulonephritis (MPGN) for which he underwent kidney transplantation. He subsequently experienced transplant rejection and has been continued on oral azathioprine 100 mg nightly. Physical examination demonstrated tanned appearing skin with course dark brown-black terminal hairs on his left volar forearm adjacent to his arteriovenous fistula site and surrounding lentigines.The patient was treated using a long-pulsed 1064 nm Nd:YAG laser (Cynosure Cynergy, Westford, MA) with spot size of 7 mm, fluence of 45 J/cm2, 15% overlapping, pulse duration of 40 ms, and concomitant forced air cooling device (Zimmer Cryo 6, Irvine, CA) setting 5. Care was taken to avoid treatment of skin overlying the fistula. The patient received five treatments approximately 3 months apart for a total treatment duration of 15 months. He tolerated the procedure well without any adverse events and experienced significant hair reduction (Figure 1). The patient reported a subjective significant increase in his quality of life as he now was able to receive treatment without pain secondary to adhesive tape removal at the hemodialysis site.
