ARE EXCESSIVE HAIR spoiling your looks?

In recent times, with over exposure given by media to beauty queens, there I tremendous importance being given to looks. Excessive hair is a cause of concern more particularly at unwanted sites. Due to its negative impact excessive hair or  hirsutism is often called ‘Hair raising problem’.

Now excessive hair can be due to

1.    Ovarian source.

Polycystic ovarian disease - ovarian tumours  (PCOD).

2.    Adrenal source

Adrenal hyperplasia (late onset congenital)

3.    Drug induced

Corticosteroids, some progesterones, penicillamine, cyclosporine, anabolic steroids    etc.

4.   Idiopathic

5.   Thyroid disorders

5      Familial Hirsute

6      Family  History - Racial background plays a role.

Usually the distressing sites are upper lip, chin, neck, sides of face, presternal area, around the  areola of breast, upper & lower back, upper inner thighs, upper pubic triangle. Dermatologists, gynaecologists and endocologists are closely involved in this care. A combined integrated approach is required.

 Tests required   

                         Free testosterone,  DHEAS.

                         FSH, LH (for ovarian cause)

                         Serum prolactin.

                           TSH (For thyroid)

                          Ultrasound  lower abdomen for the ovaries.

Treatment

Drug treatment is given whenever indicated like oral contraceptives, spironolactone, antiandrogens like cyproterone acetate etc.

Physical therapy

Drug treatment prevents further hair from coming. For hair which are already present the therapy of choice is lasers.

The various lasers available  are:

 Q switched ND Yag laser

Diode laser

Ruby laser

Alexandrite laser.

Laser epilation selectively targets melanin in the hair bulb. The hair reduction is achieved in around 7 sittings, 4-6 weeks apart initially and  then later on about 2-3 months apart. Transient erythema & discomfort may occur but that passes off. Patients should be told to avoid plucking, waxing and electrolysis 4-6 weeks prior to laser treatment. The effects with laser are long lasting and patients with realistic expectations can really benefit. Rather than spending lacs in beauty parlors over the years, few sittings of laser though may sound expensive initially are usually cost effective eventually. Unlike the technique employed with electrolysis, which treats only one hair at a time, lasers allow for the simultaneous treatment of many hairs with a single pulse of light, so that relatively large areas of involvement, such as the legs, chest or back, can be treated quickly.The fairer the patient, the coarser the hair, the better the results.

Actually ladies are bothered about coarse hair and not that much about the fine vellus hair  which give the impression of bleached hair. Specifically, areas characterized by thinner skin (eg, axillae) are more responsive to laser treatment than those with thicker skin (eg, chin and legs). On the face,the lateral sides of upper lip and sides of chin respond less as compared to other areas.The effect on under arm hair is so dramatic that in about 3-4 sittings most of the hair go away and one is free of repeated shaving or using painful depilatory procedures. The unpleasant odour in this region is appreciably decreased after hair removal and one can wear cut sleeves without any hassles.

Recently eflornithine is another topical medication added to the armamentarium. It starts its effect in 6-8 weeks, delays hair growth but can cause acne, pseudofolliculitis, stinging & burning at the local site. The frequency of application is twice a day and it is to be applied 12 hrs apart.

    Carry Home Pearls

1.    ND YAG laser  for hair removal is the most sought after treatment  under the guidance of an expert laser therapist.

2.    Over the counter products for hair removal are not always safe.

3.    Setting proper expectations is the ‘Key factor’.

4.    Hirsutism is treatable and not curable and that is good enough.

5.    Sometimes superficial browning of skin can occur with laser, which falls off in 3-4 days time. Do not be alarmed as this occurs in order to give proper fluence for hair removal.  

(The Author is Prof. & Head, Deptt of Skin & V.D. DMC & H, Ludhiana.)