Electrolysis For The Treatment Of Hypertrichosis And Hirsutism

Robert N. Richards M.D., F.R.C.P.(C)


Department of Medicine (Dermatology), North York General Hospital University of Toronto, Ontario, Canada

ABSTRACT

There are three electrolysis modalities. In galvanic electrolysis, a direct electric current is passed down a needle inserted into the hair follicle, destroying the follicle. In thermolysis a high frequency alternating current is passed down the needle and produces destructive heat. The blend is the third modality which combines galvanic electrolysis and thermolysis. Electrolysis satisfactorily removes hair from women and men with hypertrichosis, but women with hirsutism require concomitant hormonal management. Scarring does not occur with properly performed electrolysis.

Shaving one to five days before electrolysis greatly increases efficacy because it ensures that only growing anagen hairs are epilated. The judicious use of ice packs and the recent availability of EMLA (lidocaine/prilocaine cream) have been beneficial in reducing the sensations of electrolysis.

Key Words:
Galvanic electrolysis, thermolysis, hypertrichosis, hirsutism

Introduction

Electrolysis has been used to produce permanent hair loss since 1875, when Dr. Charles Michel first used it in St. Louis, Missouri to remove the ingrown hairs of trichiasis1. The term electrolysis is a generic term referring to the permanent removal of hair by the insertion of a needle into the hair follicle. The needle acts as a conductor to carry the appropriate current to the base of the hair follicle, and particularly to the dermal papilla.

In galvanic electrolysis a direct electric (galvanic) current is passed down the needle into the hair follicle. The current acts on tissue saline to produce sodium hydroxide, which destroys the lower hair follicle and dermal papilla. Galvanic electrolysis is the most certain method of permanent hair removal, but is slow and can require a minute or more for each hair.

In thermolysis (also called short-wave, diathermy, high radio frequency) the high frequency current passed down the needle produces heat, which destroys the base of the follicle. Thermolysis is much faster than galvanic electrolysis and requires only a few seconds. This procedure involves the generation of much higher energy for only a fraction of a second. The flash method is best used with insulated needles, which protect the upper hair follicle and restricts high energy delivery to the lower end of the follicle. The widely referenced method employed by Kligman and Peters should be referred to².

The blend method shortens treatment time. It combines galvanic electrolysis, for the localized destruction of the hair papilla, and high frequency thermolysis to shorten treatment time. In this combination, the heat produced from thermolysis increases the temperature of the sodium hydroxide produced by galvanic electrolysis. This, in turn, increases efficiency in destroying the hair follicle. The several electrolysis options outlined result in permanent hair removal, but the choice of modality depends upon the experience and preference of the operator.

Electrolysis procedures and equipment are standardized and in most jurisdictions monitored by regulators. Electrolysis is safe and scarring does not occur when properly performed by trained electrologists. Much of the scarring previously attributed to electrolysis actually resulted from inappropriate plucking and/or picking. However, if the electrolysis operator is unskilled or if the current used is too high, scarring may occur.

Hyperpigmentation may occur, especially so in patients with Skin Types III and IV, but is usually of a transient nature. Disease transmission may be of concern, but with proper regulatory standards in place, such an occurrence is minimized^2,3,4,5,6.

When to Use Electrolysis

Electrolysis can be most advantageously employed for localized areas of hair removal. The regions that are most frequently of cosmetic concern for women are the face, eyebrows, breasts, lower abdomen and inner thighs (bikini area), and the axillae. Men sometimes wish to have hair removed from between the eyebrows, around the ears, as well as in areas where ingrown hairs are a problem (the beard area) and on the upper back and shoulders.

Electrolysis is effective but often impractical for large hirsute areas such as the trunk or limbs. Hair removal in such cases can be achieved, but frequent visits are required for up to three hours a week for one or two years and few can afford the time or expense.

A woman undergoing menopausal changes may develop hairs on the chin. In most instances this may require three to six visits, lasting 15 to 30 minutes each. Further followup visits would be required over a period of months to deal with hair regrowth. One or two visits per year afterwards may be required. An individual with dense moustache hair would require more sessions over 12- 24 months. Permanent hair removal of a few unwanted hairs around the nipples would require 1 to 5 hours of electrolysis at appropriate intervals.

Rates for electrolysis vary considerably, but typical studio rates are $40.00 to $60.00 per hour.

Hypertrichosis and Hirsutism

In hypertrichosis there is little or no new hair growth and the results of electrolysis are rapidly evident. However, in dealing with hirsutism, new hair growth is continually occurring. For best results a team approach might be considered. Electrolysis could be combined with hormonal administration under the direction of an endocrinologist.

Instructing patients about good grooming and stressing that shaving is not harmful will help to maximize improvement and appearance^5,8.

Electrolysis Results

The results of electrolysis are well documented. As well, posttreatment biopsy and histopathology studies have shown its effectiveness4,6. Electrolysis may be performed on patients with varying skin types, all hair types and colours, or on most anatomic sites on the body. It does not adversely effect nevi or tattoos. Hair removal can also be carried out in the periorbital area.

Shaving one to five days prior to electrolysis greatly increases its efficacy because it ensures that only growing anagen hairs are treated. This is important because in some body areas more than 70% of the hairs may be in telogen phase, and telogen hairs do not respond satisfactorily to electrolysis^4,6.

Minimal postinflammatory erythema and occasional whealing are normal after electrolysis, but these disappear within an hour in most people. Discomfort is usually minimal and EMLA (lidocaine/prilocaine cream) and ice packs may be used⁷.

The use of electronic tweezers is not a valid option. This procedure does not produce permanent hair removal because hair is not an electric conductor.

Conclusion

Of the three modalities, galvanic electrolysis is slow and used the least. Thermolysis and the blend are probably used equally as often. Both are effective and the choice depends on operator preference and experience. There is not clear, documented difference.

The effectiveness of electrolysis is well documented^4,6, and it is most effective in dealing with hair removal from localized areas. Electrolysis is not as effective in hair removal from large hirsute areas.

References

1. Michel CE. Trichiasis and districhiasis with an improved method for their radical treatment. St. Louis Clinical Record 2:145-8 (1875).
2. Kligman AM, Peters L. Histologic changes of human hair follicles after electrolysis: a comparison of two methods. Cutis 34(2):169-76 (1984 Aug).
3. Wagner RF Jr, Tomich JM, Grande DJ. Electrolysis and thermolysis for permanent hair removal. J Am Acad Dermatol 12(3):441-9 (1985 Mar).
4. Hobbs ER, Ratz JL, James B. Electrosurgical epilation. Dermatol Clin 5(2):437-44 (1987 Apr).
5. Richards RN, Meharg GE. Electrolysis: Observations from 13 years and 140,000 hours of experience. J Am Acad Dermatol 33(4):662-6 (1995 Oct).
6. Richards RN, Meharg GE. Cosmetic And Medical Electrolysis And Temporary Hair Removal. 2nd Edition. Toronto: Medric Ltd (1997).
7. Wagner RF, Flores CA, Argo LF. A double blind placebo controlled study of a 5% lidocaine/prilocaine cream (EMLA) for topical anesthesia during thermolysis. J Dermatol Surg Oncol 20(2):148-50 (1994 Feb).
8. Richards RN, McKenzie MA, Meharg GE. Electroepilation (electrolysis) in hirsutism. 35,000 hours’ experience on the face and neck. J Am Acad Dermatol 15(4 Pt. 1): 693-7 (1986 Oct).
9. Richards RN, Uy M, Meharg GE. Temporary hair removal in patients with hirsutism: a clinical study. Cutis 45(3):199-202 (1990 Mar).