CUSTOM DERMATOLOGY SEARCH:
Excessive Facial Hair
J. Shapiro, MD, FRCPC and H. Lui, MD, FRCPC
Excessive facial hair in women, or hirsutism, is a common problem that may be caused by androgen overproduction, increased sensitivity to circulating androgens, or other metabolic and endocrine disorders. Approximately 80% of women are affected by the presence of excessive hair growth in areas usually recognized as places where male secondary sexual characteristics occur. This can be a source of distress, leading to anxiety, depression and a reduced quality of life.
It is very important to determine the etiology of this condition. Diagnostic evaluation of the potentially hirsute patient first involves confirmation of the presence of hirsutism and then exclusion of associated or etiological abnormalities and disorders. Investigate or rule out underlying conditions that produce excess androgens using tests such as:
Hair Removal Techniques
Current methods for removing unwanted hair include plucking, waxing (including the sugar forms), depilatories, shaving, electrolysis,
laser, intense pulsed light (IPL), and eflornithine 13.9% cream. All these methods are temporary with the time of regrowth ranging
from a few days to a few months. Short of surgical removal of the hair follicle, the only permanent treatment is electrolysis. However,
the practice of electrolysis lacks standardization. For hirsutism associated with Polycystic Ovary Syndrome (PCOS), treatments include
oral contraceptive pills or antiandrogens, such as spironolactone, flutamide and finasteride.
Women and Hirsutism
Women who have hirsutism will need to be evaluated to rule out causes of elevated androgens. PCOS needs to be excluded if there are suspicious clinical features. Medications such as spironolactone and oral contraceptives, e.g., cyproterone acetate + ethinyl estradiol, can be of value.
Ornithine Decarboxylase (ODC)
ODC is an enzyme that has been associated with the prolongation of the anagen or growth phase of the hair. Thus, when ODC is
decreased, the length of time the hair is in the growth phase is also reduced.
Eflornithine 13.9% cream can slow hair growth and thus reduce the frequency of the need for hair removal by other means, such as lasers and IPL treatments. Studies have shown that the two processes can be started simultaneously, and eflornithine treatment can continue right through laser treatments. [Dawber RP. Curr Med Res Opin 21(8):1227-34 (2005 Aug).] Treatment should be undertaken using combination therapy to possibly include:
Paradoxical hypertrichosis has, however, been reported in a small number of patients receiving laser or IPL treatment for excess hair removal. [Alajlan A, et al. J Am Acad Dermatol 53(1):85-8 (2005 Jul).]
Hirsutism can cause embarrassment and lead to anxiety and depression. There are a limited number of treatments available that vary in efficacy, degree of discomfort and cost. It is very important to make sure that the patient is aware of all the available treatment modalities, since no one method is effective for all patients or body locations, and results from therapy may not always be satisfactory.
This article has been adapted from an article by Drs. Shapiro and Lui to be published in the November 2005 issue of Skin Therapy LetterŪ.
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Last modified: Wednesday, 06-Aug-2014 12:25:30 MDT