Published: July 08, 2009 09:59 am      

Treatments available for unwanted hair

DEAR DR. MONA: What can I do about my facial hair? No matter how I treat it, it persists. — Melissa

DEAR MELISSA: Unwanted hair is an issue many women deal with. Hair growth goes through color changes and distribution changes according to hormonal and genetic factors.

Until puberty the hair on the body is fine and has no color (vellus hair), but when sexual maturation takes place, androgens (male hormones present in both men and women) change hair color in some areas of the body leading to coarse and curly hair (terminal hair).

An abundance of unwanted hair in women is called hirsutism. This could be due to either increased androgen levels or increased hair follicle sensitivity to androgens.

Fifty percent of women with overgrowth of hair have elevated androgen levels due to, perhaps, polycystic ovary syndrome (PCOS), Cushing’s syndrome, congenital adrenal hyperplasia, or certain medications. PCOS is the most common reason for hirsutism. However, many women with overgrowth of hair have normal cycles and no hormonal imbalances; this is called idiopathic hirsutism and could possibly be related to ethnicity (Mediterranean, Middle Eastern, South Asian).

To get rid of unwanted hair, a good medical history and physical examination with blood tests to check hormone levels is needed. An ultrasound exam to check the ovaries, or CT scans or x-rays to evaluate the adrenal glands may be ordered. Once a cause is identified the appropriate treatment can begin.

You may be aware of many options for hair removal, from plucking to waxing to using whatever you can to pull those hairs, but nothing will work if the underlying cause is not addressed. So if you have excess hair due to a hormonal imbalance this must be treated in conjunction or any fix you choose will be only temporary. If increased androgens are the problem, treatment with oral contraceptive pills, anti-androgens (aldactone), or the use of the topical cream (vaniqa) takes about a month or so to begin to notice some improvement. If and when treatment is discontinued, the hair growth returns to the pretreatment levels. This is the reason your underlying cause should be determined.

In addition to medical treatment, other treatments are available to deal with the unwanted hair. These include shaving, clipping the hair, waxing and electrolysis in which a needle is placed into the hair follicle and electricity is used to damage the follicle. This is painful, tenuous, causes skin color changes and, in some cases, scarring.

Laser hair removal is a medical procedure that uses an intense concentrated beam of light accompanied by heat to destroy unwanted hair follicles permanently and instantly. The hair most receptive to this treatment is usually colored (containing melanin-not blonde hairs) and in the rapid growing phase. Slow growing follicles or dormant follicles are not affected and therefore, multiple treatments are needed to control hair growth.

Patients may choose to have their armpits, legs, chin, upper lip and bikini lines treated, but it is possible to remove hair from any part of the body. The treatment session may last from a few minutes to hours based on the area being treated. It is possible to have hair-free periods after several sessions of treatment (usually 4-6) but some periodic touch-ups may be needed. Patients can experience a 20-90 percent reduction of unwanted hair. If the treatment seems unsuccessful, it may be due to a failure to have the underlying etiology for this problem diagnosed.

Laser hair treatment does not work on white, light brown or red hair, and blond hair. It works well on patients with dark hair. The skin type is also very important since lighter skin responds better than darker skin.

Laser hair removal has some risks and it important to understand them and go to a qualified physician in order to avoid some of the issues. Risks can include darkening of the skin (temporary) or loss of the pigmentation, blistering or scarring (rare), scabbing (temporary), incomplete hair removal or growth of finer hair close to the hair removed.

The FDA has recently approved some home devices for hair removal which will give good results but not as effective as the ones provided by the specialists. However, this could be a good way to complement and maintain the hair removal treatments done at the office.

Having pictures taken before and after treatment is important to follow the progress of hair removal as well as to assist in setting realistic expectations. It is also important to avoid tanning or using tanning products since this increases the risk of skin blistering or discoloration. Prior to treatment the hair should be short for the treatment to be most effective, so avoid waxing or plucking the hair but you can shave.

Once the treatment is done you may experience some redness or swelling in the first few hours, and maybe some stinging in the first one to two days. Try to keep the skin well hydrated and moist, and avoid exposure to sun, use sun screen, avoid tanning booths, waxing, and avoid rubbing or touching the treated area.

Despite the fact that laser hair removal is a medical procedure, many insurance companies do not cover it and therefore you are responsible for payment. The process may vary according to the areas treated and the number of treatments.



Dr. Mona Alqulali is a board certified OB-GYN.