The BMLA was invited by the NHS Clinical Reference Group for transgender services to comment on the requirements for suitable laser depilation services. Our response to the questions raised can be downloaded below.BMLA response to Laser Depilation Services
DATE: June 2013
REF: Laser Europe 2013
Conference date: 15th – 17th May 2013
Conference Location: The Lowry, Salford
Last month, the British Medical Laser Association (BMLA) hosted Laser Europe 2013 in Salford Quays, Manchester (UK). The conference was declared a resounding success with record delegate attendance and a fantastic scientific programme. Prof. Harry Moseley (President of the BMLA) said “The conference provided a great learning & networking opportunity for all involved. The venue was stunning and this year there was a real “buzz” of excitement and enjoyment throughout the event”
The two and a half day conference included laser training courses presented by industry experts and which covered topics from Hair removal to Fractional resurfacing. The scientific programme was equally impressive with a wide variety of invited and free papers presenting research in dermatology, PDT, Biophotonics and much more. The delegates were particularly delighted with the Vasant Oswal Oration presentation by Dr. Christine Diereckx (Belgium) on Laser Dermatology – past, present and future). Other world class guest speakers included Dr. Mario Trelles (Spain), Prof. Carsten Phillips (Germany), Prof. Serge Mordon (France), Dr Martin Kassir (USA).
The annual conference dinner was a complete sell-out as delegates were invited to the famous football ground of Manchester United (old Trafford). Those attending the dinner were given exclusive access to the terraces and ample opportunity to take pictures of the iconic stadium. During the Champagne reception and following the dinner, guests were entertained with a stunning performance by conjuring and close-up magic.
Throughout the conference those attending benefited from meeting industry experts and networking with like-minded scientists and clinicians. Feedback indicated the event was a huge success with delegates commenting “Best BMLA meeting I have been to – congratulations!” and “Excellent and well organized conference”. The BMLA committee wish to extend their thanks to all those involved with organising and supporting the event, particularly the support received from the European Laser Association, commercial sponsors and of course the many enthusiastic delegates.
Photodynamic therapy (PDT) is a treatment option for some types of cancer that involves administration of a drug that is activated by light, usually from a laser. This causes cell death. The underlying scientific principles and numerous clinical studies have been published in peer-reviewed literature1 2 3. PDT can be curative. For example, in non-melanoma skin cancers, PDT has less morbidity than cryotherapy and avoids the need for skin grafts in surgical excision of large lesions. Often it is palliative where it can bring welcome symptomatic relief and precious extra months’ quality life to the patient.
PDT has several key attractions: there is minimal loss of normal tissue; PDT can be repeated in the same area as often as required; it can be used after conventional treatments have failed or as a stand-alone treatment in appropriate patients.
There are clinics providing what is sometimes called Next Generation PDT (NGPDT) or sonodynamic therapy (SDT). In general, the treatments provided do not have the necessary scientific rigour that is expected. Often the light is delivered externally and it is claimed that this reaches the tumour but light penetration to internal cancers is insufficient for effective PDT. A critical appraisal of a clinical application of SDT has been published4. This concludes that there is no convincing data that shows that treatment carried out as reported is effective in the treatment of primary tumour and multiple metastases. Without critical safety and efficacy information, it is unjustifiable to test unproven unconventional techniques and substances in patients, particularly those in terminal stages. PDT can be used effectively in the treatment and care of appropriate cancer patients The use of so-called NGPDT or SDT cannot be recommended.
Prof Harry Moseley, Hon President British Medical Laser Association; Prof Sam Eljamel, Clinical Director Scottish PDT Centre; Prof Keyvan Moghissi, Clinical Director Yorkshire Laser Centre.References
1. Moghissi K, Dixon K, Stringer M et al. Photofrin PDT for early stage oesophageal cancer: Long term results in 40 patients and literature review. Photodiagnosis and Photodynamic Therapy 2009; 6: 159-66.
2. Allison RR, Sibata C, Gay H. PDT for cancers of the head and neck. Photodiagnosis and Photodynamic Therapy 2009; 6: 1-2.
3. Morton CA, McKenna KE, Rhodes LE et al. Guidelines for topical photodynamic therapy: update. British Journal of Dermatology 2008; 159: 1245-66.
4. Huang Z, Moseley H, Bown S. Rationale of Combined PDT and SDT Modalities for Treating Cancer Patients in Terminal Stage: The Proper Use of Photosensitizer. Integrative Cancer Therapies 2010; 9: 317-9.
The Department of Health is currenty undertaking a major review of cosmetic procedures, including laser treatments. In particular, they are considering:
- The regulation and safety of products used in cosmetic interventions
- How best to ensure that the people who carry out procedures have the necessary skills and qualifications
- How to ensure that organisations have the systems in place to look after their patients both during their treatment and afterwards
- How to ensure that people considering cosmetic surgery and procedures are given the information, advice and time for reflection to make an informed choice
- What improvements are needed in dealing with complaints so they are listened to and acted upon
BMLA’s response1. What depilation interventions (laser and type of laser, IPL, electrolysis, or others) are needed to meet the needs of transpeople? This must take into account people aged 16 to end of life, with different hair and skin colours, and skin sensitivity.
Light based devices (e.g. laser and IPL) are capable of meeting the needs of the majority of transpeople.
Clinical experience suggests that fewer adverse events occur with longer wavelength infra-red lasers such as the diode and Nd:YAG in darker skin types.
People with light hair, such as blonde or grey hair, are not suited to any type of light based treatment, as the hair is not able to absorb adequate light energy. Dying the hair does not improve treatment efficacy in these cases.2. What is the duration of treatment and over what period might a beard area be cleared? An average and the range would be helpful.
For individuals with no underlying hormonal drivers of increased hair growth one would expect around 6-8 treatments to be adequate in any one area. The interval between treatments typically ranges between 4 weeks and 10 weeks. Thus, a 6 month treatment programme may be commmon, but a course lasting more than 1 year would not be unusual. Clinics should be able to offer treatments at appropriate intervals to meet patient needs.
For those individuals with hormonal imbalances contributing to hair growth such as certain medications, and for example Polycystic Ovarian Syndrome PCOS, results may be more short lived with recurrence of hair growth after a variable period of time.3. What would be the cost of such treatment?
A course of 6 treatments for facial hair removal would cost about £700. The cost may vary but should be freely available from each provider.4. How might providers of depilation interventions, with appropriate equipment, to meet the needs of transpeople be identified?
Each provider should have at least the following:
- Clinical experience in treatment of unwanted hair in different skin types at different body areas in both sexes.
- Use of one or more infra-red lasers, in order that transwomen of all skin types may be treated appropriately.
- Continued evidence of suitable training of staff in laser or IPL treatment.
- Treatments should be protocol driven with appropriate consent and patient information.
- Ideally the clinic should have outcome data appropriate for the treatment.
There are no universal standards of regulation currently available in the UK. As a minimum, the BMLA recommends the following:
- The BMLA supports the opinion of the MHRA (DB2008) which recommends that all laser and IPL users must have completed a Core of Knowledge safety course as well as specific training in the use of the laser or IPL device for depilation.
- The individual taking overall responsibility for the patient’s care should be a HCPC registered health care professional and able to demonstrate competence in the treatment provided.
- The provider should have access to a registered and suitably qualified clinician (e.g. dermatologist, plastic surgeon).
- The provider should have access to an appropriately qualified Laser Protection Advisor.
- The provider should operate within a system of clinical governance with a robust clinical incidence reporting system and complaints procedure.