Contra-actions and adverse reactions in laser hair removal

Contra-action or adverse reaction?

A contra-action is an expected, temporary response. That includes redness and tenderness, and itching, mild irritation, swelling or tingling, which normally settle within 48 hours. Treated hairs can keep shedding for up to 21 days.

An adverse reaction is a skin response recognised as more than expected. That's a judgement, not a checklist. Once you judge something to be more than expected, your adverse reaction procedure starts, not "let's see how it looks tomorrow". The most common failure isn't the wrong call. It's the right call made too late.

Six signs that mean stop treatment now

A good endpoint is one likely to give a good result without an excessive reaction, with the client's pain tolerance taken into account. If you see any of these during treatment, the BMLA guidelines say the treatment must be aborted:

• Skin turning whitish, grey or darker
• Redness in the shape of the beam or applicator head
• Extreme or merging redness across the area
• Bruising
• Discomfort the client can't tolerate
• Merging swelling around the follicles, or generalised swelling

Stop first, then decide. Never adjust settings while still firing. Aborted means aborted, not "I'll just finish the other side".

When reactions tend to appear

Typically two to four hours after treatment, excessive redness, blistering, excessive swelling, or inflammation and itching can appear in skin that looked fine when the client left. Over the following days you may see scabbing or scaling, pigment changes, bruising, prolonged swelling or infection, and, rarely, scarring. Scarring usually follows a chain of blistering or heavy scaling, often with infection, so managing the earlier links well reduces the risk. That's why written aftercare and a clear way to contact you matter.

What to do in the room

• Stop, and say so.
• Keep the skin clean and reassure the client honestly and calmly.
• Cool the skin for at least 10 to 20 minutes, with no aloe vera or other topical product at this stage. If it looks like a burn, follow UK burns first aid: cool running water, or a cool wet compress where running water isn't practical, for 20 minutes. Never use ice, creams, oils or butter, and never burst a blister.
• Observe, then photograph with the client's consent. If they decline, record that.
• Apply a non-stick burns dressing if needed, following your first aid protocol, and keep in contact once the client is home.

A serious burn means referral to a medical practitioner without delay, with the treatment details. Under NHS advice, a burn that's very large or deep, or on the face, genitals or buttocks, needs A&E or 999. For eye exposure, the BMLA guidelines say a full examination by an ophthalmologist must happen as soon as possible and in any case within 24 hours. Sudden loss of vision or severe eye pain means A&E or 999 straight away, and the client must be accompanied and must not drive. Outside the UK, follow local guidance and use your local emergency services.

Aftercare, scope and records

The BMLA guidelines mention a topical steroid cream for severe, merging and persistent redness. But a steroid is a medicine, and recommending one is usually outside a technician's scope, so know your clinic's position. If it isn't within your scope, refer to a pharmacist, GP or prescriber. For any blistering, crusting or burn, start your adverse reaction procedure and refer for medical assessment.

Afterwards:

• Record a detailed account in the client's notes and the adverse incidents log
• Send photographs and paperwork to the clinic manager within 24 hours
• Arrange follow-up, ideally within 48 hours
• Review your settings and check the device for any sign of a fault
• Only re-treat once the area has fully healed, and always repeat the patch test

Learn it properly: Contra-actions and Adverse Reactions

Contra-actions and Adverse Reactions is a 16-minute online masterclass for laser technicians and for clinics training their teams. It covers contra-actions versus adverse reactions, good endpoints and abort signs, when reactions appear, immediate management and burns first aid, later reactions, serious burns and eye exposure, and records, re-treatment and the client conversation.

• 16-minute video masterclass
• Short quiz at the end
• Certificate of completion for every learner who passes
• £25