Bioactive Proteolytic Enzymes Chymotrypsin and Papain as Adjuvants to Laser Hair Removal: Reducing the Risk of Paradoxical Hypertrichosis in Women with Facial Hirsutism

Paradoxical hypertrichosis is an adverse effect of photo-epilation, involving the induction of hair growth within treated or adjacent non-treated areas. Given the significant psychosocial burden associated with facial hair growth in women, effective adjunctive strategies to mitigate this phenomenon are required. Chymotrypsin and papain are bioactive proteolytic enzymes whose activity has been associated with structural alterations in hair follicle components. This study investigated the effect of combining Alexandrite laser with enzyme-assisted hair removal compared with laser alone on the occurrence of paradoxical hypertrichosis. The outcome was assessed by recording the number of laser pulses performed per treatment session. Fifty-nine adult Greek women with facial hirsutism were allocated into two groups: Group I (Laser + Enzymes, n = 30), treated with Alexandrite laser (755 nm) combined with iontophoretic delivery of aqueous chymotrypsin and papain solutions, and Group II (Laser, n = 29), treated with laser alone. After 10 sessions, the combined intervention resulted in a significantly greater change in laser pulse counts compared with laser alone (−18.53 ± 16.31 vs. +1.68 ± 9.61, p < 0.005). This finding suggests that adjunctive iontophoresis of bioactive proteolytic enzymes is associated with reduced laser pulse requirements, which may be considered in the clinical management of paradoxical hypertrichosis in women with facial hirsutism. Larger studies with extended follow-up are warranted.