This month’s handout from New Hampshire dermatologists William Danby and his wife and colleague Lynne Margesson addresses patients’ concerns about excess hair — what’s normal and what isn’t and what they can do about it. Dr. Danby points out that what constitutes excess hair really comes down to unwanted hair, and that attitudes about body hair, especially on women, vary greatly according to current trends and geographical location Fashionable vs. Normal “Depending on fashion and their individual make up, most women consider hair on various parts of the body as undesirable and unattractive. In North America at the moment, underarm hair and leg hair are undesirable and so both are removed as a part of regular personal grooming. Most women feel that they have to remove this hair as a matter of simple cleanliness and so that they don’t look masculine. Pubic hair — indeed all body hair — is less in evidence these days, and sometimes is removed completely, regardless of sex.” Abnormal Hair Growth In the attached handout, Drs. Danby and Margesson explain how to tell the difference between normal hair growth and hirsutism, particularly the role of sex hormones. “Hirsutism refers to excessive hair growth in the areas of the body where the hair is controlled by these hormones. They explain how even minor imbalances in their 20s, 30s and 40s — as well as the onset of menopause — can lead to changes in hair growth, including thinning of scalp hair, warning that a sudden onset of hirsutism requires prompt investigation. Diagnosis They describe the blood tests for hormone levels and note that an ultrasound of the ovaries or the adrenals may be performed to determine whether they are larger than normal or if the ovaries contain cysts. Referral to an endocrinologist may be needed, they warn. Treatment Treatment, they say, depends on the cause, and they delineate the various medical therapies their doctors may prescribe. Then, of course, there’s the issue of removing the excess hair itself. “Once wiry hairs have appeared in an area, the hairs will usually persist despite medical treatment to correct the underlying problem.” Sometimes they may get a little lighter but they don’t go away and one is still left with the cosmetic problem of the excess hair. This superfluous hair can be concealed by bleaching or it can be removed with plucking, clipping, waxing, shaving, chemical depilatories, electrolysis or laser. Ongoing Care Finally Drs. Danby and Margesson remind patients that even after unwanted hair is satisfactorily removed — usually requiring 1 to 2 years of therapy with electrolysis, somewhat less for laser and IPL treatment — hormonal control measures may need to be continued indefinitely. ___________________________
HIRSUTISM
Introduction Hair — on our head it can be our crowning glory, but on our body it can embarrass and upset us. Depending on fashion and their individual make up, most women consider hair on various parts of the body as undesirable and unattractive. In North America at the moment, underarm hair and leg hair are undesirable and so both are removed as a part of regular personal grooming. Most women feel that they have to remove this hair as a matter of simple cleanliness and so that they don’t look masculine. Pubic hair, indeed all body hair, is less in evidence these days, and sometimes is removed completely, regardless of sex. There are two kinds of unwanted hair: that which is simply cosmetically unappealing and that which grows in excessive amounts or in unusual textures or in areas where it is not usually found or wanted. Cosmetic or medical, the removal options are the same. What’s Normal Normally everyone has hair all over the skin surface except on palms and soles. Most of this hair is fine “peach fuzz” and is apparent to a greater or lesser extent and coloration depending on the individual. There are marked familial and racial differences in the amount of body hair. Our sex hormones influence our hair growth in areas of our body that are susceptible. The hair on our axillae (armpits), pubic area, chest, around the mouth and chin, and on the front and top of our scalp are controlled in various ways by our sex hormones. Testing for Abnormalities Hirsutism doesn’t always imply that there is a serious hormonal malfunction but a hormonal investigation is warranted in many cases. To sort out the problem, a physical examination and a variety of tests may need to be performed. (Well-trained electrologists and aestheticians will advise clients to seek medical advice.) These blood tests measure testosterone and other reproductive (sex) hormones. Occasionally, your body’s response to the hormones that normally control the function of ovaries or adrenal glands may be measured in order to determine which of these glands is responsible for the excess production of sex hormones. An ultrasound of the ovaries or the adrenals may be performed in order to determine whether they are larger than normal or if the ovaries contain cysts. Referral to an endocrinologist may be needed. Causes Hirsutism refers to excessive hair growth in the areas of the body where the hair is controlled by these hormones. In hirsutism, tiny vellus hairs on the body surface become coarse and wiry. Sex Hormones The growth of excess hair is related to the balance of the sex hormones. Women make both male and female hormones, usually in a fine balance allowing for periods, reproduction, etc. A malfunction of this balance can result in an excess of the androgens — male hormones — and the result may be the development of coarse hair on the face, chest, lower abdomen and extremities. Occasionally women also develop acne and thinning of the scalp hair (a localized thinning like the pattern of baldness seen in men). In most women, it is a minor imbalance that results in this excess hair growth. It often begins at puberty and gets progressively more noticeable by the late 20s and into the 30s and 40s. If, however, a woman has a sudden onset of hirsutism, a prompt investigation should be carried out to find out where the hormonal abnormality lies. These androgens come from the ovary and adrenal glands, under the control of the brain’s pituitary gland. In most women there is simply an upset in the balance, but occasionally there can be a growth in one of these glands and that must be adequately investigated. Aging yields a further drop in estrogen with menopause, allowing the male hormones to do their job making hair. Drugs Some drugs can precipitate or aggravate hirsutism. They include Depo-Provera, Dilantin, cortisone, anabolic steroids and tamoxifen. Treatment of Underlying Causes Treatment of the excess hair — hirsutism — will depend on the underlying balance of hormones revealed by the medical investigation. Sometimes, suppression of the ovaries with birth control pills is the appropriate treatment if these glands are primarily responsible for the hirsutism (and there are no reasons to avoid birth control pills). If the adrenal glands are responsible for excess sex hormone production, suppression with dexamethasone may be helpful. Interference with the way testosterone affects the hair follicle may be useful in many women. Finasteride (Proscar), flutamide (Euflex), spironolactone (Aldactone) or cyproterone acetate (Androcur) are drugs which prevent or reduce testosterone action on hair growth. None of these “anti androgens” should be taken during pregnancy because they may affect the developing baby. Therefore they should be used with an acceptable form of birth control such as an oral contraceptive or following tubal ligation or hysterectomy. Not all are available in the United States. There is now a group of three male-hormone-blocking birth control pills available in the United States that can be used for hirsutism and acne. Yasmin, Yaz and the new generic Ocella (the equivalent of Yasmin) all contain drospirenone, and spironolactone; other anti-androgens can be added to these preparations once the patient is protected from pregnancy. Hair Removal Once wiry hairs have appeared in an area, the hairs will usually persist despite medical treatment to correct the underlying problem. Sometimes they may get a little lighter but they don’t go away and one is still left with the cosmetic problem of the excess hair. This superfluous hair can be concealed by bleaching or it can be removed with plucking, clipping, waxing, shaving, chemical depilatories, electrolysis or lasers. All these methods, except electrolysis and some forms of laser, have only a temporary effect and every method has advantages and disadvantages depending on the area, the hair consistency, the amount of growth and personal preference. At-Home Treatments Shaving. Shaving is the most popular way of removing unwanted hair because it is easy, quick and relatively acceptable. It can handle most of the hair in places like legs but is usually not acceptable on the face in women. There is a myth about shaving that new hair will grow in faster and thicker than before. This concept is exactly that — a myth. What actually happens is that shaving allows the regrowth of a short stubble of hairs that are less flexible than long hair and are not ‘weathered.’ These hairs, therefore, feel more ‘bristly’. Bleaching. Bleaching is a very simple method and works well for facial hair and arm hair. A homemade treatment can be prepared by making a paste of baking soda and 6% (bleaching strength) hydrogen peroxide. A few drops of household ammonia are added and the paste is applied and left on for 5 to 10 minutes. This should be done with care; avoid breathing the ammonia. Chemical depilatories are used by some women but can be irritating, frustrating and time-consuming. Plucking and waxing are quite useful but, if used extensively in areas like the inner thigh and groin, can cause ingrown hairs. With time, the hair roots become distorted and electrolysis in that area may then be difficult. Usually we recommend that you stop plucking or waxing an area 2 or 3 months prior to electrolysis. Shaving will be needed for the interval. Prescription cream. Topical eflornithine cream (Vaniqa) may be used to reduce the speed of hair growth. Professional Hair Removal Electrolysis. The gold standard for permanent and safe method of hair removal is with electrolysis. It can be used in hairs of all color, unlike laser. This electroepilation involves the application of a high frequency alternating current producing an electrical heat injury at the hair root level — thermolysis. The aim is to destroy the bottom part of the hair follicle permanently so there will be no regrowth. This is time consuming, uncomfortable and expensive but, done properly, gives a very acceptable or excellent result. Serious complications are very uncommon. If there is a lot of discomfort, local anesthesia can be used. Sometimes there can be a little redness or pimple formation that subsides in 24 hours. Very rarely, there can be a little pigment change, a small area of either increased or decreased pigmentation around the hair follicle, particularly in dark skinned individuals. We insist on the purchase and use of one's own “personal probe” so there is no risk of spread of disease. Laser and Intense Pulsed Light (IPL) units offer ‘permanent hair reduction’. These units work best on fairly thick hairs that are darkly pigmented. The more pigment there is in the hair, the more destructive heat is generated by the laser or intense pulsed light, so greater hair destruction occurs. Older laser units required very light skin but newer ones, especially those with cooling attachments, can also work safely with darker skin. Topical anesthesia may be used in sensitive areas. Continued Treatment Once the hormonal balance is controlled and the hairs have been removed successfully with electrolysis or laser/IPL therapy, there is an excellent result. If, however, one just has hair removal without control of the hormonal imbalance, there will continue to be excessive/unwanted hair growth. As mentioned above, controlling the hormones alone may still leave the hair in place. Most women under good hormonal control need about 1 to 2 years of therapy with electrolysis to clear; laser and IPL may be a little faster, but the hormonal control may need to continue indefinitely.
This month’s handout from New Hampshire dermatologists William Danby and his wife and colleague Lynne Margesson addresses patients’ concerns about excess hair — what’s normal and what isn’t and what they can do about it. Dr. Danby points out that what constitutes excess hair really comes down to unwanted hair, and that attitudes about body hair, especially on women, vary greatly according to current trends and geographical location Fashionable vs. Normal “Depending on fashion and their individual make up, most women consider hair on various parts of the body as undesirable and unattractive. In North America at the moment, underarm hair and leg hair are undesirable and so both are removed as a part of regular personal grooming. Most women feel that they have to remove this hair as a matter of simple cleanliness and so that they don’t look masculine. Pubic hair — indeed all body hair — is less in evidence these days, and sometimes is removed completely, regardless of sex.” Abnormal Hair Growth In the attached handout, Drs. Danby and Margesson explain how to tell the difference between normal hair growth and hirsutism, particularly the role of sex hormones. “Hirsutism refers to excessive hair growth in the areas of the body where the hair is controlled by these hormones. They explain how even minor imbalances in their 20s, 30s and 40s — as well as the onset of menopause — can lead to changes in hair growth, including thinning of scalp hair, warning that a sudden onset of hirsutism requires prompt investigation. Diagnosis They describe the blood tests for hormone levels and note that an ultrasound of the ovaries or the adrenals may be performed to determine whether they are larger than normal or if the ovaries contain cysts. Referral to an endocrinologist may be needed, they warn. Treatment Treatment, they say, depends on the cause, and they delineate the various medical therapies their doctors may prescribe. Then, of course, there’s the issue of removing the excess hair itself. “Once wiry hairs have appeared in an area, the hairs will usually persist despite medical treatment to correct the underlying problem.” Sometimes they may get a little lighter but they don’t go away and one is still left with the cosmetic problem of the excess hair. This superfluous hair can be concealed by bleaching or it can be removed with plucking, clipping, waxing, shaving, chemical depilatories, electrolysis or laser. Ongoing Care Finally Drs. Danby and Margesson remind patients that even after unwanted hair is satisfactorily removed — usually requiring 1 to 2 years of therapy with electrolysis, somewhat less for laser and IPL treatment — hormonal control measures may need to be continued indefinitely. ___________________________
HIRSUTISM
Introduction Hair — on our head it can be our crowning glory, but on our body it can embarrass and upset us. Depending on fashion and their individual make up, most women consider hair on various parts of the body as undesirable and unattractive. In North America at the moment, underarm hair and leg hair are undesirable and so both are removed as a part of regular personal grooming. Most women feel that they have to remove this hair as a matter of simple cleanliness and so that they don’t look masculine. Pubic hair, indeed all body hair, is less in evidence these days, and sometimes is removed completely, regardless of sex. There are two kinds of unwanted hair: that which is simply cosmetically unappealing and that which grows in excessive amounts or in unusual textures or in areas where it is not usually found or wanted. Cosmetic or medical, the removal options are the same. What’s Normal Normally everyone has hair all over the skin surface except on palms and soles. Most of this hair is fine “peach fuzz” and is apparent to a greater or lesser extent and coloration depending on the individual. There are marked familial and racial differences in the amount of body hair. Our sex hormones influence our hair growth in areas of our body that are susceptible. The hair on our axillae (armpits), pubic area, chest, around the mouth and chin, and on the front and top of our scalp are controlled in various ways by our sex hormones. Testing for Abnormalities Hirsutism doesn’t always imply that there is a serious hormonal malfunction but a hormonal investigation is warranted in many cases. To sort out the problem, a physical examination and a variety of tests may need to be performed. (Well-trained electrologists and aestheticians will advise clients to seek medical advice.) These blood tests measure testosterone and other reproductive (sex) hormones. Occasionally, your body’s response to the hormones that normally control the function of ovaries or adrenal glands may be measured in order to determine which of these glands is responsible for the excess production of sex hormones. An ultrasound of the ovaries or the adrenals may be performed in order to determine whether they are larger than normal or if the ovaries contain cysts. Referral to an endocrinologist may be needed. Causes Hirsutism refers to excessive hair growth in the areas of the body where the hair is controlled by these hormones. In hirsutism, tiny vellus hairs on the body surface become coarse and wiry. Sex Hormones The growth of excess hair is related to the balance of the sex hormones. Women make both male and female hormones, usually in a fine balance allowing for periods, reproduction, etc. A malfunction of this balance can result in an excess of the androgens — male hormones — and the result may be the development of coarse hair on the face, chest, lower abdomen and extremities. Occasionally women also develop acne and thinning of the scalp hair (a localized thinning like the pattern of baldness seen in men). In most women, it is a minor imbalance that results in this excess hair growth. It often begins at puberty and gets progressively more noticeable by the late 20s and into the 30s and 40s. If, however, a woman has a sudden onset of hirsutism, a prompt investigation should be carried out to find out where the hormonal abnormality lies. These androgens come from the ovary and adrenal glands, under the control of the brain’s pituitary gland. In most women there is simply an upset in the balance, but occasionally there can be a growth in one of these glands and that must be adequately investigated. Aging yields a further drop in estrogen with menopause, allowing the male hormones to do their job making hair. Drugs Some drugs can precipitate or aggravate hirsutism. They include Depo-Provera, Dilantin, cortisone, anabolic steroids and tamoxifen. Treatment of Underlying Causes Treatment of the excess hair — hirsutism — will depend on the underlying balance of hormones revealed by the medical investigation. Sometimes, suppression of the ovaries with birth control pills is the appropriate treatment if these glands are primarily responsible for the hirsutism (and there are no reasons to avoid birth control pills). If the adrenal glands are responsible for excess sex hormone production, suppression with dexamethasone may be helpful. Interference with the way testosterone affects the hair follicle may be useful in many women. Finasteride (Proscar), flutamide (Euflex), spironolactone (Aldactone) or cyproterone acetate (Androcur) are drugs which prevent or reduce testosterone action on hair growth. None of these “anti androgens” should be taken during pregnancy because they may affect the developing baby. Therefore they should be used with an acceptable form of birth control such as an oral contraceptive or following tubal ligation or hysterectomy. Not all are available in the United States. There is now a group of three male-hormone-blocking birth control pills available in the United States that can be used for hirsutism and acne. Yasmin, Yaz and the new generic Ocella (the equivalent of Yasmin) all contain drospirenone, and spironolactone; other anti-androgens can be added to these preparations once the patient is protected from pregnancy. Hair Removal Once wiry hairs have appeared in an area, the hairs will usually persist despite medical treatment to correct the underlying problem. Sometimes they may get a little lighter but they don’t go away and one is still left with the cosmetic problem of the excess hair. This superfluous hair can be concealed by bleaching or it can be removed with plucking, clipping, waxing, shaving, chemical depilatories, electrolysis or lasers. All these methods, except electrolysis and some forms of laser, have only a temporary effect and every method has advantages and disadvantages depending on the area, the hair consistency, the amount of growth and personal preference. At-Home Treatments Shaving. Shaving is the most popular way of removing unwanted hair because it is easy, quick and relatively acceptable. It can handle most of the hair in places like legs but is usually not acceptable on the face in women. There is a myth about shaving that new hair will grow in faster and thicker than before. This concept is exactly that — a myth. What actually happens is that shaving allows the regrowth of a short stubble of hairs that are less flexible than long hair and are not ‘weathered.’ These hairs, therefore, feel more ‘bristly’. Bleaching. Bleaching is a very simple method and works well for facial hair and arm hair. A homemade treatment can be prepared by making a paste of baking soda and 6% (bleaching strength) hydrogen peroxide. A few drops of household ammonia are added and the paste is applied and left on for 5 to 10 minutes. This should be done with care; avoid breathing the ammonia. Chemical depilatories are used by some women but can be irritating, frustrating and time-consuming. Plucking and waxing are quite useful but, if used extensively in areas like the inner thigh and groin, can cause ingrown hairs. With time, the hair roots become distorted and electrolysis in that area may then be difficult. Usually we recommend that you stop plucking or waxing an area 2 or 3 months prior to electrolysis. Shaving will be needed for the interval. Prescription cream. Topical eflornithine cream (Vaniqa) may be used to reduce the speed of hair growth. Professional Hair Removal Electrolysis. The gold standard for permanent and safe method of hair removal is with electrolysis. It can be used in hairs of all color, unlike laser. This electroepilation involves the application of a high frequency alternating current producing an electrical heat injury at the hair root level — thermolysis. The aim is to destroy the bottom part of the hair follicle permanently so there will be no regrowth. This is time consuming, uncomfortable and expensive but, done properly, gives a very acceptable or excellent result. Serious complications are very uncommon. If there is a lot of discomfort, local anesthesia can be used. Sometimes there can be a little redness or pimple formation that subsides in 24 hours. Very rarely, there can be a little pigment change, a small area of either increased or decreased pigmentation around the hair follicle, particularly in dark skinned individuals. We insist on the purchase and use of one's own “personal probe” so there is no risk of spread of disease. Laser and Intense Pulsed Light (IPL) units offer ‘permanent hair reduction’. These units work best on fairly thick hairs that are darkly pigmented. The more pigment there is in the hair, the more destructive heat is generated by the laser or intense pulsed light, so greater hair destruction occurs. Older laser units required very light skin but newer ones, especially those with cooling attachments, can also work safely with darker skin. Topical anesthesia may be used in sensitive areas. Continued Treatment Once the hormonal balance is controlled and the hairs have been removed successfully with electrolysis or laser/IPL therapy, there is an excellent result. If, however, one just has hair removal without control of the hormonal imbalance, there will continue to be excessive/unwanted hair growth. As mentioned above, controlling the hormones alone may still leave the hair in place. Most women under good hormonal control need about 1 to 2 years of therapy with electrolysis to clear; laser and IPL may be a little faster, but the hormonal control may need to continue indefinitely.
This month’s handout from New Hampshire dermatologists William Danby and his wife and colleague Lynne Margesson addresses patients’ concerns about excess hair — what’s normal and what isn’t and what they can do about it. Dr. Danby points out that what constitutes excess hair really comes down to unwanted hair, and that attitudes about body hair, especially on women, vary greatly according to current trends and geographical location Fashionable vs. Normal “Depending on fashion and their individual make up, most women consider hair on various parts of the body as undesirable and unattractive. In North America at the moment, underarm hair and leg hair are undesirable and so both are removed as a part of regular personal grooming. Most women feel that they have to remove this hair as a matter of simple cleanliness and so that they don’t look masculine. Pubic hair — indeed all body hair — is less in evidence these days, and sometimes is removed completely, regardless of sex.” Abnormal Hair Growth In the attached handout, Drs. Danby and Margesson explain how to tell the difference between normal hair growth and hirsutism, particularly the role of sex hormones. “Hirsutism refers to excessive hair growth in the areas of the body where the hair is controlled by these hormones. They explain how even minor imbalances in their 20s, 30s and 40s — as well as the onset of menopause — can lead to changes in hair growth, including thinning of scalp hair, warning that a sudden onset of hirsutism requires prompt investigation. Diagnosis They describe the blood tests for hormone levels and note that an ultrasound of the ovaries or the adrenals may be performed to determine whether they are larger than normal or if the ovaries contain cysts. Referral to an endocrinologist may be needed, they warn. Treatment Treatment, they say, depends on the cause, and they delineate the various medical therapies their doctors may prescribe. Then, of course, there’s the issue of removing the excess hair itself. “Once wiry hairs have appeared in an area, the hairs will usually persist despite medical treatment to correct the underlying problem.” Sometimes they may get a little lighter but they don’t go away and one is still left with the cosmetic problem of the excess hair. This superfluous hair can be concealed by bleaching or it can be removed with plucking, clipping, waxing, shaving, chemical depilatories, electrolysis or laser. Ongoing Care Finally Drs. Danby and Margesson remind patients that even after unwanted hair is satisfactorily removed — usually requiring 1 to 2 years of therapy with electrolysis, somewhat less for laser and IPL treatment — hormonal control measures may need to be continued indefinitely. ___________________________
HIRSUTISM
Introduction Hair — on our head it can be our crowning glory, but on our body it can embarrass and upset us. Depending on fashion and their individual make up, most women consider hair on various parts of the body as undesirable and unattractive. In North America at the moment, underarm hair and leg hair are undesirable and so both are removed as a part of regular personal grooming. Most women feel that they have to remove this hair as a matter of simple cleanliness and so that they don’t look masculine. Pubic hair, indeed all body hair, is less in evidence these days, and sometimes is removed completely, regardless of sex. There are two kinds of unwanted hair: that which is simply cosmetically unappealing and that which grows in excessive amounts or in unusual textures or in areas where it is not usually found or wanted. Cosmetic or medical, the removal options are the same. What’s Normal Normally everyone has hair all over the skin surface except on palms and soles. Most of this hair is fine “peach fuzz” and is apparent to a greater or lesser extent and coloration depending on the individual. There are marked familial and racial differences in the amount of body hair. Our sex hormones influence our hair growth in areas of our body that are susceptible. The hair on our axillae (armpits), pubic area, chest, around the mouth and chin, and on the front and top of our scalp are controlled in various ways by our sex hormones. Testing for Abnormalities Hirsutism doesn’t always imply that there is a serious hormonal malfunction but a hormonal investigation is warranted in many cases. To sort out the problem, a physical examination and a variety of tests may need to be performed. (Well-trained electrologists and aestheticians will advise clients to seek medical advice.) These blood tests measure testosterone and other reproductive (sex) hormones. Occasionally, your body’s response to the hormones that normally control the function of ovaries or adrenal glands may be measured in order to determine which of these glands is responsible for the excess production of sex hormones. An ultrasound of the ovaries or the adrenals may be performed in order to determine whether they are larger than normal or if the ovaries contain cysts. Referral to an endocrinologist may be needed. Causes Hirsutism refers to excessive hair growth in the areas of the body where the hair is controlled by these hormones. In hirsutism, tiny vellus hairs on the body surface become coarse and wiry. Sex Hormones The growth of excess hair is related to the balance of the sex hormones. Women make both male and female hormones, usually in a fine balance allowing for periods, reproduction, etc. A malfunction of this balance can result in an excess of the androgens — male hormones — and the result may be the development of coarse hair on the face, chest, lower abdomen and extremities. Occasionally women also develop acne and thinning of the scalp hair (a localized thinning like the pattern of baldness seen in men). In most women, it is a minor imbalance that results in this excess hair growth. It often begins at puberty and gets progressively more noticeable by the late 20s and into the 30s and 40s. If, however, a woman has a sudden onset of hirsutism, a prompt investigation should be carried out to find out where the hormonal abnormality lies. These androgens come from the ovary and adrenal glands, under the control of the brain’s pituitary gland. In most women there is simply an upset in the balance, but occasionally there can be a growth in one of these glands and that must be adequately investigated. Aging yields a further drop in estrogen with menopause, allowing the male hormones to do their job making hair. Drugs Some drugs can precipitate or aggravate hirsutism. They include Depo-Provera, Dilantin, cortisone, anabolic steroids and tamoxifen. Treatment of Underlying Causes Treatment of the excess hair — hirsutism — will depend on the underlying balance of hormones revealed by the medical investigation. Sometimes, suppression of the ovaries with birth control pills is the appropriate treatment if these glands are primarily responsible for the hirsutism (and there are no reasons to avoid birth control pills). If the adrenal glands are responsible for excess sex hormone production, suppression with dexamethasone may be helpful. Interference with the way testosterone affects the hair follicle may be useful in many women. Finasteride (Proscar), flutamide (Euflex), spironolactone (Aldactone) or cyproterone acetate (Androcur) are drugs which prevent or reduce testosterone action on hair growth. None of these “anti androgens” should be taken during pregnancy because they may affect the developing baby. Therefore they should be used with an acceptable form of birth control such as an oral contraceptive or following tubal ligation or hysterectomy. Not all are available in the United States. There is now a group of three male-hormone-blocking birth control pills available in the United States that can be used for hirsutism and acne. Yasmin, Yaz and the new generic Ocella (the equivalent of Yasmin) all contain drospirenone, and spironolactone; other anti-androgens can be added to these preparations once the patient is protected from pregnancy. Hair Removal Once wiry hairs have appeared in an area, the hairs will usually persist despite medical treatment to correct the underlying problem. Sometimes they may get a little lighter but they don’t go away and one is still left with the cosmetic problem of the excess hair. This superfluous hair can be concealed by bleaching or it can be removed with plucking, clipping, waxing, shaving, chemical depilatories, electrolysis or lasers. All these methods, except electrolysis and some forms of laser, have only a temporary effect and every method has advantages and disadvantages depending on the area, the hair consistency, the amount of growth and personal preference. At-Home Treatments Shaving. Shaving is the most popular way of removing unwanted hair because it is easy, quick and relatively acceptable. It can handle most of the hair in places like legs but is usually not acceptable on the face in women. There is a myth about shaving that new hair will grow in faster and thicker than before. This concept is exactly that — a myth. What actually happens is that shaving allows the regrowth of a short stubble of hairs that are less flexible than long hair and are not ‘weathered.’ These hairs, therefore, feel more ‘bristly’. Bleaching. Bleaching is a very simple method and works well for facial hair and arm hair. A homemade treatment can be prepared by making a paste of baking soda and 6% (bleaching strength) hydrogen peroxide. A few drops of household ammonia are added and the paste is applied and left on for 5 to 10 minutes. This should be done with care; avoid breathing the ammonia. Chemical depilatories are used by some women but can be irritating, frustrating and time-consuming. Plucking and waxing are quite useful but, if used extensively in areas like the inner thigh and groin, can cause ingrown hairs. With time, the hair roots become distorted and electrolysis in that area may then be difficult. Usually we recommend that you stop plucking or waxing an area 2 or 3 months prior to electrolysis. Shaving will be needed for the interval. Prescription cream. Topical eflornithine cream (Vaniqa) may be used to reduce the speed of hair growth. Professional Hair Removal Electrolysis. The gold standard for permanent and safe method of hair removal is with electrolysis. It can be used in hairs of all color, unlike laser. This electroepilation involves the application of a high frequency alternating current producing an electrical heat injury at the hair root level — thermolysis. The aim is to destroy the bottom part of the hair follicle permanently so there will be no regrowth. This is time consuming, uncomfortable and expensive but, done properly, gives a very acceptable or excellent result. Serious complications are very uncommon. If there is a lot of discomfort, local anesthesia can be used. Sometimes there can be a little redness or pimple formation that subsides in 24 hours. Very rarely, there can be a little pigment change, a small area of either increased or decreased pigmentation around the hair follicle, particularly in dark skinned individuals. We insist on the purchase and use of one's own “personal probe” so there is no risk of spread of disease. Laser and Intense Pulsed Light (IPL) units offer ‘permanent hair reduction’. These units work best on fairly thick hairs that are darkly pigmented. The more pigment there is in the hair, the more destructive heat is generated by the laser or intense pulsed light, so greater hair destruction occurs. Older laser units required very light skin but newer ones, especially those with cooling attachments, can also work safely with darker skin. Topical anesthesia may be used in sensitive areas. Continued Treatment Once the hormonal balance is controlled and the hairs have been removed successfully with electrolysis or laser/IPL therapy, there is an excellent result. If, however, one just has hair removal without control of the hormonal imbalance, there will continue to be excessive/unwanted hair growth. As mentioned above, controlling the hormones alone may still leave the hair in place. Most women under good hormonal control need about 1 to 2 years of therapy with electrolysis to clear; laser and IPL may be a little faster, but the hormonal control may need to continue indefinitely.
