Hair Removal

September 13, 2011

Excessive growth of facial or body hair (hirsutism) in women can be profoundly distressing, and is often perceived as loss of femininity. The psychological ramifications of excess hair growth in women cannot be overstated. Hirsutism is defined as the presence of excess hair growth in a male distribution including the chin, sideburns, and above the upper lip.

The diagnosis of hirsutism is somewhat subjective and there is clearly a cultural bias to what is perceived as “normal.” The vast majority of female patients diagnosed with hirsutism have no underlying hormonal abnormality and have female relatives with similar hair growth. However, hirsutism may sometimes be a serious harbinger of underlying disease. If the hair growth is very significant or sudden in onset, or if there are other symptoms suggesting increased levels of male hormones (such as deepening of the voice, increased muscle mass, menstrual irregularities, decrease in breast size, or increase in genital size), then ovarian or adrenal abnormalities should be ruled out through laboratory testing. Occasionally women demonstrate increased hair growth in a distribution that is not solely in a male pattern, and this condition is referred to as hypertrichosis. This pattern of growth may be caused by certain drugs and inherited diseases.

Since male hormones (androgens) cause hirsutism, a common first-line approach to reduce the amount of hair is treatment with drugs that reduce levels of androgens. Combination oral contraceptives and antiandrogen drugs such as spironolactone (a mild water pill) are often used for this purpose.

Mechanical methods of hair removal are commonly used in women with varying degrees of undesirable hair growth. Depilatory creams and shaving remove hair at the surface of the skin, cutting the hair shaft by chemical or physical means, respectively. In contrast, tweezing or waxing removes hair from the root resulting in a longer delay in regrowth. Regardless of depth of the hair removal, all of these represent short-term hair removal methods that have the advantage of rapid results and the disadvantage of rapid regrowth. Electrolysis provides a more permanent form of hair removal by destroying the regenerative portion of the hair follicle with an electric current. Because a small needle must be introduced into the hair follicle, there is some discomfort associated with the procedure that can be minimized by using topical anesthetic beforehand. The most common side effects associated with the procedure are altered pigmentation, infection, and scarring. The success rate is highly dependent on the technical skill of the individual performing the procedure.

Lasers and other light-assisted methods are increasingly popular ways to remove hair that use the principle of selective photothermolysis. Varying wavelengths of light are used to target various skin or hair follicle substances, producing permanent hair reduction in a safe and effective manner. Currently, the more popular hair removal lasers target the pigment-producing cells in the hair, and for this reason, are most effective among patients with darker hair and lighter skin. Further research is needed to determine how permanently hair is removed with lasers.

One of the newest methods of hair removal is eflornithine cream. Its active ingredient blocks an enzyme ornithine decarboxylase that plays a critical role in the hair growth cycle. Rather than removing the hair, it slows its growth and therefore complements physical methods of hair removal by reducing the frequency of treatments. Side effects are mild and include treatment site discomfort and irritation.

Suggested Reading

  • Dierickx, C. C. (2000). Hair removal by lasers and intense pulsed light sources. Seminars in Cutaneous Medicine and Surgery, 19(4), 267-275.
  • Mercurio, M. G. (2001). Hirsutism: Diagnosis and management. Journal of Gender-Specific Medicine, 4(2), 29-34.
  • Moghetti, P., Tosi, F., Tosti, A., et al. (2000). Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: A randomized, double blind, placebo-controlled trial. Journal of Clinical Endocrinology Metabolism, 85(1), 89-94.
  • Wendelin, D. S., Pope, D. N., & Mallory, S. B. (2003). Hypertrichosis. Journal of the American Academy of Dermatology, 48, 161-179.

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