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Literature Review
Richards RN & Meharg GE. Electrolysis: Observations from 13 years and 140,000 hours of experience. J Am Acad Dermatol33: 662-666
Abstract
Electrolysis has been performed since 1875. Electrolysis satisfactorily removes hair from women with static hair growth, but women with hirsutism often require concomitant management of their hormonal problems. We have found the blend method to be the most effective modality for permanent hair removal. Attention must be given to proper electrolysis technique, including accurate needle insertion and appropriate intensities and duration. Scarring does not occur with properly performed electrolysis. Hair is not an electrical conductor and electronic tweezers do not result in permanent hair removal. Shaving 1 to 5 days before electrolysis greatly increases efficacy because it ensures that only growing anagen hairs are epilated. The recent availability of EMLA (eutectic mixture of local anesthetics) has been beneficial in reducing the sensations of electrolysis. The availability of prepackaged, presterilized, individual electrolysis needles has greatly reduced the need for more complicated sterilization procedures.
- ... Prior to the advent of LHR, electrolysis was the predominant method used for removal of unwanted hair. Electrolysis is the process of electric epilation, in use since 1875 and approved by the FDA for permanent hair removal (16,17). It involves the insertion of a fine needle or probe into each hair follicle for delivery of an electric current in attempt to destroy the follicular unit responsible for hair regeneration (17). ...... Electrolysis is the process of electric epilation, in use since 1875 and approved by the FDA for permanent hair removal (16,17). It involves the insertion of a fine needle or probe into each hair follicle for delivery of an electric current in attempt to destroy the follicular unit responsible for hair regeneration (17). Hair reductions up to 90% have been reported; however, the treatment efficacy is highly variable and operator-and modality-dependent, with regrowth ranging from 15-50% (16,18). ...... Hair reductions up to 90% have been reported; however, the treatment efficacy is highly variable and operator-and modality-dependent, with regrowth ranging from 15-50% (16,18). Because each hair follicle must be treated individually, multiple hours of treatment on a weekly or biweekly basis for up to a year are generally required for best results (17,19). ...Genital gender affirming surgery (GAS) involves reconstruction of the genitals to match a patient's identified sex. The use of hair-bearing flaps in this procedure may result in postoperative intra-vaginal and intra-urethral hair growth and associated complications, including lower satisfaction with genital GAS. Despite the significant increase in genital GAS within the past 50 years, there is limited data regarding hair removal practices in preparation for genital GAS and notable variation in hair removal techniques among dermatologists and other practitioners. We present a literature review, recommendations from our experience, and a practical laser hair removal (LHR) approach to hair removal prior to genital GAS.
- ... Electrolysis involves inserting a needle into the hair follicle and applying heat (thermolysis), a chemical reaction (galvanic), or both (blend), which results in a constant, gradual decrease in hair growth in the target region (12). Since each hair follicle is treated individually, multiple treatment sessions are often necessary for a protracted period of time, such as sessions every week or two weeks for a year or more (13). Additionally, electrolysis is extremely painful, especially in sensitive and nerverich areas like the face, which can slow treatment (14). ...Purpose: Hair removal procedures, including electrolysis and laser hair removal, are the most commonly pursued gender-affirmative medical interventions by transfeminine people, but previous empirical studies have not examined their relationship to psychological well-being. Materials and Methods: Participants were 281 transfeminine adults in the United States who responded to an online questionnaire. Results: Satisfaction with one’s current state of hair removal was negatively correlated with situational body image dysphoria, depression symptoms, anxiety symptoms, and negative affect, and positively correlated with positive affect. Conclusions: Results of this study suggest that hair removal is associated with both decreased distress but also increased subjective well-being (e.g. higher positive affect). Though the construct of ‘gender euphoria’ has been introduced in previous publications, it has thus far not been rigorously defined or operationalized within health research. These results suggest that gender euphoria can be understood in terms of increased subjective well-being associated with gender affirmation, including gender-affirmative medical interventions. This study demonstrates a significant association between hair removal services and depression symptoms, anxiety symptoms, situational body image dysphoria, positive affect, and negative affect in transfeminine adults. These findings cast significant doubt on the assertion that hair removal services for transfeminine people are ‘cosmetic.’
- ... Electrology, although never tested in a randomized controlled setting, has been reported to be an effective means of permanently eliminating unwanted hair growth. 36 Of interest is our observation that patients who elected to undergo electrology in conjunction with their suppressive therapy seemed to do better than those who did not (Fig. 2), although we recognize the differences did not reach statistical significance. Patients electing to undergo adjuvant electrology therapy had a longer mean time to follow-up, suggesting that these individuals may also be more compliant with therapy. ...Background: Polycystic ovary syndrome (PCOS) affects 5%-15% of women and is the most common cause of hirsutism. Data on the time-course of improvement to suppressive therapy and predictors of that response in PCOS are lacking. The objectives of our study are to determine the long-term response and identify predictors of response in PCOS women treated with suppressive therapy, including spironolactone (SPL) + oral contraceptives (OCs). Materials and methods: Retrospective cross-sectional analysis of 200 women with PCOS (1990 NIH criteria) treated with suppressive therapy in general, and a subgroup of 138 subjects treated with OCP+SPL who had been prospectively included in a biorepository. Main outcome measure included improvement rate per 100 person-month of follow-up for hirsutism, menstrual irregularity and acne measured qualitatively as "feeling better", and changes in the severity of hirsutism quantified by modified Ferriman-Gallwey [mF-G] score. Results: During a mean follow-up of 34.2 months, 85.1%, 82.7%, and 79.3% of patients reported improvement in hirsutism, menstrual dysfunction, and acne, respectively. The modified Ferriman-Gallwey (mF-G) hirsutism score improved by 59.9%. The net reduction in mF-G score and the percent of patients reporting improvement in hirsutism were greater for OC+SPL than for either drug alone, with no difference in the percent of patients free of adverse effects. Among those treated with OC+SPL (n = 138), the initial mF-G and sex hormone-binding globulin (SHBG) independently predicted successful therapy for hirsutism. Conclusion: There is a high rate of patient satisfaction with suppressive therapy in PCOS. The efficacy of suppressive therapy for hirsutism was greater with OC+SPL than with either drug alone. Successful treatment of hirsutism with combination OC+SPL requires at least 6 months of therapy, with the proportion of satisfied patients continuing to increase with treatment duration. The probability of patient satisfaction with OC+SPL treatment for hirsutism can be predicted by her initial mF-G score or SHBG level.
- ... It has been postulated that telogen phase follicles exhibit treatment resistance by merely undergoing a growth delay in response to treatment, followed by synchronization and eventual massive hair regrowth [18,19]. These findings seemingly coincide with the transient increase in hair counts recorded 3 months after the treatment series. ...Objective The purpose of this study was to determine the efficacy and safety of a 1060 nm diode laser system with multiple handpieces for permanent hair reduction. Study Design An open‐label, prospective, multi‐center study of adult subjects (≥18 years old) of any skin type, having dark brown or black hairs at the areas to be treated and seeking to permanently remove hair underwent six treatment sessions, at 4 to 6 weeks intervals with either a 1060 nm chilled sapphire tip or seven treatment sessions, at 6 weeks interval with a large spot vacuum based handpiece. Methods Subjects received treatments on various body areas using chilled sapphire tip or large spot size vacuum‐assisted handpiece. Hair counts as well as assessments of hair coarseness and color were performed using photographs taken at baseline, prior to pre‐selected treatments and at the follow up visits. At every visit, immediate skin responses and adverse events were evaluated by the investigator and treatment associated pain level experienced was quantified by the subjects. Subjects were asked to assess their improvement and satisfaction at pre‐selected treatment sessions and at all the follow up visits. A sub group of subjects that were treated with the large spot size vacuum‐assisted handpiece contributed two punch biopsy specimens for histological analysis. Results A total of 16 subjects age 33 ± 10.9 years were treated with the chilled sapphire tip, and 26 subjects age 36.3 ± 7.67 years were treated with the large spot size vacuum‐assisted handpiece. Treatment with chilled sapphire tip yielded a mean of 68%, 82%, and 76% skin type‐independent hair reduction in axillae, shin, and arm, respectively, at 6 month follow up visit as compared to baseline. The majority of subjects (≥80%) rated their hair reduction to be either good or very good and were satisfied to highly satisfied with the outcome. Treatment with the large spot size vacuum‐assisted handpiece, was most effective in axillae and calves, with a 77.9% and 78.5% hair count reduction, respectively, at the 6 month follow up visit. Subjects reported high satisfaction and improvement throughout the treatments and follow‐up periods. Treatments with both handpieces were not associated with intolerable pain levels and common post procedural responses included mild to moderate erythema and/or edema. Conclusion The 1060 nm diode laser system is safe and effective for hair removal and long‐term hair reduction in all skin types including darkly pigmented individuals. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
- ... The thermolysis technique uses a higher level of alternating current to produce heat in the hair follicle immediately surrounding the wire electrode. Some claim a combination of these ("The Blend") is more effective (122). Electrolysis is generally regarded as effective for permanent hair reduction. ...Objective To update the “Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2008. Participants The participants include an Endocrine Society–appointed task force of seven medical experts and a methodologist. Evidence This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen–progestin contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For most women who choose hair removal therapy, we suggest laser/photoepilation.
- ... As expected, individual preferences (often due to economical reasons) are critical in selecting the most appropriate procedure. Electrolysis and the newer methods, such as laser therapy and intense pulse light, are folliculitic treatments that may result in permanent amelioration of hirsutism in the treated area (50,51). This technique destroys the base of the hair follicle without causing a scar on the surface. ...Hirsutism is a common medical complaint among women of reproductive age, and affects the majority of women with the polycystic ovary syndrome (PCOS). Increased androgen production rates and tissue availability represent the main pathophysiological mechanisms responsible for hirsutism. In addition, androgens may be generated de novo in the hair follicle, therefore circulating androgen levels do not quantify the real exposure of the hair follicle to androgens, since a quota is locally generated. Hirsutism is a clinical sign and not a disease in itself; its presence does not therefore necessarily require treatment, particularly in his mild-to-moderate forms and when an affected woman does not worry about it. Physicians should decide whether hirsutism is to be treated or not by evaluating not only the severity of the phenomenon, but also the subjective perception of the patient, that does not necessarily correspond to the true extent of hair growth. In any case, a physician should manage a woman with hirsutism only on the basis of a diagnosis of the underlying cause, and after a clear explanation of the efficacy of each therapeutic choice. Cosmetic procedures and pharmacological intervention are commonly used in the treatment of hirsutism and are discussed in this paper. Importantly, there are different phenotypes of women with hirsutism and PCOS that may require specific attention in the choice of treatment. In particular, when obesity is present, lifestyle intervention should be always considered, if necessary combined with pharmacotherapy.
- ... Till date, electrolysis is considered to be the treatment of choice. [4] There are chances of folliculitis, post-inflammation hyperpigmentation and scarring if electrolysis current is applied at too high a level. Further, since only dermal papilla is destroyed in electrolysis procedure, there are chances of regrowth from upper portions of the follicle (bulge region). ...
- Importance Hair removal can be an essential component of the gender affirmation process for gender-minority (GM) patients whose outward appearance does not align with their gender identity. Objective To examine the health insurance policies in the Affordable Care Act (ACA) marketplace and Medicaid policies for coverage of permanent hair removal for transgender and GM patients and to correlate the policies in each state with statewide protections of coverage for gender-affirming care. Design and Setting Private health insurance policies available on the ACA marketplace and statewide Medicaid policies were examined in a cross-sectional study from September 1 to October 31, 2019, and January 17 to 30, 2020. Policies were assessed for coverage of permanent hair removal. Language concerning hair removal was found in each policy’s medical or clinical coverage guidelines and separated into general categories. Main Outcomes and Measures Logistic regression analyses were performed to compare Medicaid policies and ACA policies in states with and without transgender protections. Results A total of 174 policies were analyzed, including 123 private insurance policies and 51 statewide Medicaid policies. Of these policies, 8 (4.6%) permitted the coverage of permanent hair removal without explicit restrictions. The remaining 166 policies (95.4%) broadly excluded or did not mention gender-affirming care; prohibited coverage of hair removal or did not mention it; or only permitted coverage of hair removal preoperatively for genital surgery. The ACA marketplace policies in states without transgender care protections were less likely to cover hair removal without restrictions than ACA policies in states with protections (2 of 85 policies [2.4%] in states without transgender care protections vs 5 of 38 policies [13.2%] in states with transgender care protections), and Medicaid policies were less likely to cover preoperative or nonsurgical hair removal compared with ACA policies (6 of 51 Medicaid policies [11.8%] vs 47 of 123 ACA policies [38.2%]). Conclusions and Relevance Despite adoption of statewide restrictions on GM health care exclusions by several states, most Medicaid and ACA policies examined in this study did not cover permanent hair removal for transgender patients. Many GM patients seeking hair removal may be required to pay out-of-pocket costs, which could be a barrier for gender-affirming care.
- BACKGROUND: Unwanted hair growth is a common aesthetic problem. Laser hair removal has emerged as a leading treatment option for long-term depilation. OBJECTIVES: To extensively review the literature on laser hair removal pertaining to its theoretical basis, current laser and light-based devices, and their complications. Special treatment recommendations for darker skin types were considered. MATERIALS AND METHODS: A comprehensive literature search related to the long-pulse alexandrite (755 nm), long-pulse diode (810 nm), long-pulse neodymium-doped yttrium aluminum garnet (Nd:YAG; 1,064 nm), and intense pulsed light (IPL) system, as well as newer home-use devices, was conducted. RESULTS: The literature supports the use of the alexandrite, diode, Nd:YAG and IPL devices for long-term hair removal. Because of its longer wavelength, the Nd:YAG is the best laser system to use for pigmented skin. Further research is needed regarding the safety and efficacy of home-use devices. CONCLUSION: Current in-office laser hair removal devices effectively provide a durable solution for unwanted hair removal.
- Background Hirsutism has a relatively high prevalence among women. Depending upon societal and ethnic norms, it can cause significant psychosocial distress. Importantly, hirsutism may be associated with underlying disorders and co-morbidities. Hirsutism should not simply be looked upon as an issue of cosmesis. Patients require appropriate evaluation so that underlying etiologies and associated sequelae are recognized and managed. Treatment of hirsutism often requires a multidisciplinary approach, and a variety of physical or pharmacologic modalities can be employed. Efficacy of these therapies is varied and depends, among other things, upon patient factors including the underlying etiology, hormonal drive, and local tissue sensitivity to androgens. Objective The objective of this paper is to review and summarize current evidence evaluating the efficacy of various treatment modalities for hirsutism in premenopausal women. Methods Online databases were searched to identify all relevant prior systematic reviews and meta-analyses as well as recently published (2012–present) randomized controlled trials (RCTs) on hirsutism treatment. Results Four recently published RCTs met criteria for inclusion in our review. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Topical eflornithine can be used as monotherapy for mild hirsutism and as an adjunct therapy with lasers or pharmacotherapy in more severe cases. Combined OCPs as a class are superior to placebo; however, antiandrogenic and low-dose neutral OCPs may be slightly more efficacious in improving hirsutism compared with other types of OCPs. Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes. Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. Lifestyle modification counseling is recommended. Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances. Additional therapies without sufficient supportive evidence of efficacy are ovarian surgery, statins (HMG-CoA reductase inhibitors), and vitamin D supplementation. Limitations In general, most therapies garner recommendations that are weak (where the estimates of benefits versus risks of therapy are either closely balanced or uncertain) and are based on low- to moderate-quality evidence. Conclusions Risks and benefits of treatment must be carefully considered and discussed with the patient. Expectations for efficacy should be appropriately set. A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit.
- This paper is intended to outline the current thinking regarding the process involved in depilation by pulsed ruby laser. The key laser parameters of wavelength, pulse duration, energy density, spot size and spatial profile will be discussed together with their impact on the outcome of the procedure. A parallel series of clinical trials have been carried out in a number of centers on both medical complications of hair growth and the cosmetic use of the technology. The results of these trials detail the efficacy of the treatment as well as the incidence of side-effects or complications.
- Unwanted hair is a common problem for which different types of light therapy have been developed as the treatment of choice. Since 1996, when the American Food and Drug Administration approved the first laser therapy for depilation, much progress has been made in light-based technology and lasers. Lasers and intense pulsed light sources with red or near infrared wavelengths (600 to 1200 nm) are the most widely used for removing hair as they target the melanin of the hair shaft, hair follicle epithelium, and hair matrix. The aim of this review is to describe and compare the different photodepilation methods currently available.
- Laser der Wellenlänge 755 nm der im gütegeschalteten Modus zur Entfernung von Tätowierungen u.a. der Farben schwarz, blau, grün und im langgepulsten Modus zur Epilation, Behandlung oberflächlicher Blutgefäße und Lentigines eingesetzt wird (▶ Exkurs „Alexandrit“). Die Zielchromophore sind Pigmente und Hämoglobin. In diesem Beitrag geht es ausschließlich um den langgepulsten Alexandritlaser . In Form eines leicht verständlichen, systematisch gegliederten Kurzlehrbuches werden physikalische Hintergründe, Therapie- und Anwendungsmöglichkeiten des langgepulsten Alexandritlasers-Lasers sowie aktuelle Modelle vorgestellt.
- Hirsutism is the excessive growth of terminal hair in women, localized mainly on androgen-sensitive skin areas, with a male pattern of distribution. It is a highly frequent entity that usually forms part of a more complex clinical picture. However, it does not always correspond to a disease per se and causes social and psychological distress that compromises the quality of life of affected women. In clinical practice, hirsutism must be evaluated on a scale. Pharmacological treatment delays the growth of new hair, but does not affect existing hair and its maximal effect does not become evident for many months. Therefore, pharmacological treatment should be completed by other treatments that remove the unwanted hair. Laser hair removal has been demonstrated to be a safe, effective and lasting method.
- Despite widespread demand for efficient, reliable methods of eliminating unwanted hair from the face and body, available options were limited until the recent development of laser-assisted hair removal systems. This is a review of the various types of hair removal methods available today with an emphasis on laser-assisted hair removal.
- Distinctive properties of darkly pigmented skin contribute to epidemiologic, clinical and therapeutic differences in persons of color. Men of color - particularly those of African ancestry (e.g., African-Americans, African-Caribbeans and Africans) - are a subset of this population in whom several skin disorders present more commonly or almost exclusively. These include pseudofolliculitis barbae, acne keloidalis nuchae and dissecting cellulitis of the scalp or perifolliculitis capitis abscendens et suffodiens. Keloids, although seen in all races and both genders, are more common in darker-skinned racial/ethnic groups and are a leading dermatologic concern among men of color. This article highlights these skin conditions, their medical and surgical management and recent advances in research.
- Hirsutism is a common endocrinological complaint. The causes of this complaint can vary from dissatisfaction with a normal pattern of hair growth on the one hand, to the first clinical manifestation of androgen overproduction by an adrenal adenocarcinoma on the other. The purpose of this short review is to reexamine the physiology of hair growth in normal women, identify the common abnormal patterns, and explore the differential diagnosis associated with each. An approach to working through the differential diagnosis will be described, and the commonly available treatment modalities for the various forms of hirsutism will be examined in terms of risk and benefit. The review is written from the point of view of the physician and the most efficient, cost effective, and safe clinical approach to the patient with the problem.
- Background QuestionsReferences
- BACKGROUND: Hirsutism occurs in 5% to 10% of women of reproductive age when there is excessive terminal hair growth in androgen-sensitive areas (male pattern). It is a distressing disorder with a major impact on quality of life. The most common cause is polycystic ovary syndrome. There are many treatment options, but it is not clear which are most effective. OBJECTIVES: To assess the effects of interventions (except laser and light-based therapies alone) for hirsutism. SEARCH METHODS: We searched the Cochrane Skin Group Specialised Register, CENTRAL (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), and five trials registers, and checked reference lists of included studies for additional trials. The last search was in June 2014. SELECTION CRITERIA: Randomised controlled trials (RCTs) in hirsute women with polycystic ovary syndrome, idiopathic hirsutism, or idiopathic hyperandrogenism. DATA COLLECTION AND ANALYSIS: Two independent authors carried out study selection, data extraction, 'Risk of bias' assessment, and analyses. MAIN RESULTS: We included 157 studies (sample size 30 to 80) comprising 10,550 women (mean age 25 years). The majority of studies (123/157) were 'high', 30 'unclear', and four 'low' risk of bias. Lack of blinding was the most frequent source of bias. Treatment duration was six to 12 months. Forty-eight studies provided no usable or retrievable data, i.e. lack of separate data for hirsute women, conference proceedings, and losses to follow-up above 40%.Primary outcomes, 'participant-reported improvement of hirsutism' and 'change in health-related quality of life', were addressed in few studies, and adverse events in only half. In most comparisons there was insufficient evidence to determine if the number of reported adverse events differed. These included known adverse events: gastrointestinal discomfort, breast tenderness, reduced libido, dry skin (flutamide and finasteride); irregular bleeding (spironolactone); nausea, diarrhoea, bloating (metformin); hot flushes, decreased libido, vaginal dryness, headaches (gonadotropin-releasing hormone (GnRH) analogues)).Clinician's evaluation of hirsutism and change in androgen levels were addressed in most comparisons, change in body mass index (BMI) and improvement of other clinical signs of hyperandrogenism in one-third of studies.The quality of evidence was moderate to very low for most outcomes.There was low quality evidence for the effect of two oral contraceptive pills (OCPs) (ethinyl estradiol + cyproterone acetate versus ethinyl estradiol + desogestrel) on change from baseline of Ferriman-Gallwey scores. The mean difference (MD) was -1.84 (95% confidence interval (CI) -3.86 to 0.18).There was very low quality evidence that flutamide 250 mg, twice daily, reduced Ferriman-Gallwey scores more effectively than placebo (MD -7.60, 95% CI -10.53 to -4.67 and MD -7.20, 95% CI -10.15 to -4.25). Participants' evaluations in one study with 20 participants confirmed these results (risk ratio (RR) 17.00, 95% CI 1.11 to 259.87).Spironolactone 100 mg daily was more effective than placebo in reducing Ferriman-Gallwey scores (MD -7.69, 95% CI -10.12 to -5.26) (low quality evidence). It showed similar effectiveness to flutamide in two studies (MD -1.90, 95% CI -5.01 to 1.21 and MD 0.49, 95% CI -1.99 to 2.97) (very low quality evidence), as well as to finasteride in two studies (MD 1.49, 95% CI -0.58 to 3.56 and MD 0.40, 95% CI -1.18 to 1.98) (low quality evidence).Although there was very low quality evidence of a difference in reduction of Ferriman-Gallwey scores for finasteride 5 mg to 7.5 mg daily versus placebo (MD -5.73, 95% CI -6.87 to -4.58), it was unlikely it was clinically meaningful. These results were reinforced by participants' assessments (RR 2.06, 95% CI 0.99 to 4.29 and RR 11.00, 95% CI 0.69 to 175.86). However, finasteride showed inconsistent results in comparisons with other treatments, and no firm conclusions could be reached.Metformin demonstrated no benefit over placebo in reduction of Ferriman-Gallwey scores (MD 0.05, 95% CI -1.02 to 1.12), but the quality of evidence was low. Results regarding the effectiveness of GnRH analogues were inconsistent, varying from minimal to important improvements.We were unable to pool data for OCPs with cyproterone acetate 20 mg to 100 mg due to clinical and methodological heterogeneity between studies. However, addition of cyproterone acetate to OCPs provided greater reductions in Ferriman-Gallwey scores.Two studies, comparing finasteride 5 mg and spironolactone 100 mg, did not show differences in participant assessments and reduction of Ferriman-Gallwey scores (low quality evidence). Ferriman-Gallwey scores from three studies comparing flutamide versus metformin could not be pooled (I² = 62%). One study comparing flutamide 250 mg twice daily with metformin 850 mg twice daily for 12 months, which reached a higher cumulative dosage than two other studies evaluating this comparison, showed flutamide to be more effective (MD -6.30, 95% CI -9.83 to -2.77) (very low quality evidence). Data showing reductions in Ferriman-Gallwey scores could not be pooled for four studies comparing finasteride with flutamide as the results were inconsistent (I² = 67%).Studies examining effects of hypocaloric diets reported reductions in BMI, but which did not result in reductions in Ferriman-Gallwey scores. Although certain cosmetic measures are commonly used, we did not identify any relevant RCTs. AUTHORS' CONCLUSIONS: Treatments may need to incorporate pharmacological therapies, cosmetic procedures, and psychological support. For mild hirsutism there is evidence of limited quality that OCPs are effective. Flutamide 250 mg twice daily and spironolactone 100 mg daily appeared to be effective and safe, albeit the evidence was low to very low quality. Finasteride 5 mg daily showed inconsistent results in different comparisons, therefore no firm conclusions can be made. As the side effects of antiandrogens and finasteride are well known, these should be accounted for in any clinical decision-making. There was low quality evidence that metformin was ineffective for hirsutism and although GnRH analogues showed inconsistent results in reducing hirsutism they do have significant side effects.Further research should consist of well-designed, rigorously reported, head-to-head trials examining OCPs combined with antiandrogens or 5α-reductase inhibitor against OCP monotherapy, as well as the different antiandrogens and 5α-reductase inhibitors against each other. Outcomes should be based on standardised scales of participants' assessment of treatment efficacy, with a greater emphasis on change in quality of life as a result of treatment.
- Background. Laser-assisted hair removal is becoming the treatment of choice for removing unwanted hair.Objective. The purpose of this work was to determine the long-term efficacy of the long-pulsed infrared (LPIR) laser at shortened treatment intervals for the treatment of bikini hair.Methods. Eleven patients received five treatments at 3-week intervals to the right groin using the LPIR laser. Laser parameters were held constant for all treatments: 10 mm spot size, 20 J, and 20-msec pulse duration. Results were evaluated 1 year after the last laser treatment. Hair counts were performed.Results. The average patient had a 78% clearance of hair noted at 1 year with no evidence of scarring or pigmentary changes.Conclusions. A simulated model of cutaneous hair follicles provides evidence that shorter treatment intervals (3 weeks) may be preferable for more complete destruction of the hair follicle bulb and bulge.
- Background: Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce. Objective: To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems. Methods: Twenty women with Fitzpatrick skin types I-IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session. Results: After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2. Conclusion: Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal.
- Hirsutism, defined by the presence of excessive terminal hair in androgen-sensitive areas of the female body, is one of the most common disorders in women during reproductive age. We conducted a systematic review and critical assessment of the available evidence pertaining to the epidemiology, pathophysiology, diagnosis and management of hirsutism. The prevalence of hirsutism is ~10% in most populations, with the important exception of Far-East Asian women who present hirsutism less frequently. Although usually caused by relatively benign functional conditions, with the polycystic ovary syndrome leading the list of the most frequent etiologies, hirsutism may be the presenting symptom of a life-threatening tumor requiring immediate intervention. Following evidence-based diagnostic and treatment strategies that address not only the amelioration of hirsutism but also the treatment of the underlying etiology is essential for the proper management of affected women, especially considering that hirsutism is, in most cases, a chronic disorder needing long-term follow-up. Accordingly, we provide evidence-based guidelines for the etiological diagnosis and for the management of this frequent medical complaint.
- Diagnostic categories in hyperandrogenism include polycystic ovary syndrome (PCOS) and its variants, adrenal and ovarian steroidogenic enzyme deficiencies, adrenal and ovarian androgen secreting tumours and other endocrine disorders such as hyperprolactinaemia, Cushing syndrome and acromegaly. About 95% of hyperandrogenic women will have PCOS. Endometrial hyperplasia can be prevented in hyperandrogenic, anovulatory women by the oral contraceptive pill or progestins. Hirsutism is best treated by a combination of the oral contraceptive pill and an anti-androgen. The first line of therapy for ovulation induction is clomiphene citrate, with human menopausal gonadotrophins (hMG) or laparoscopic ovulation induction reserved for clomiphene failures. hMG together with gonadotrophin-releasing hormone agonist may decrease the risk of spontaneous abortion following ovulation induction in PCOS. Weight loss should be vigorously encouraged to ameliorate the metabolic consequences of PCOS.
- Needle-tract seeding refers to the implantation of tumor cells by contamination when instruments, such as biopsy needles, are employed to examine, excise, or ablate a tumor. The incidence of this iatrogenic phenomenon is low but it entails serious consequences. Here, as a new method for preventing neoplasm seeding, it is proposed to cause electrochemical reactions at the instrument surface so that a toxic microenvironment is formed. In particular, the instrument shaft would act as the cathode, and the tissues would act as the electrolyte in an electrolysis cell. By employing numerical models and experimental observations reported by researchers on Electrochemical Treatment of tumors, it is numerically showed that a sufficiently toxic environment of supraphysiological pH can be created in a few seconds without excessive heating. Then, by employing an ex vivo model consisting of meat pieces, validity of the conclusions provided by the numerical model concerning pH evolution is confirmed. Furthermore, a simplified in vitro model based on bacteria, instead of tumor cells, is implemented for showing the plausibility of the method. Depending on the geometry of the instrument, suitable current densities will probably range from about 5 to 200 mA/cm(2), and the duration of DC current delivery will range from a few seconds to a few minutes.
- The extended theory of selective photothermolysis enables the laser surgeon to target and destroy hair follicles, thereby leading to hair removal. Today, laser hair removal (LHR) is the most commonly requested cosmetic procedure in the world and is routinely performed by dermatologists, other physicians, and non-physician personnel with variable efficacy. The ideal candidate for LHR is fair skinned with dark terminal hair; however, LHR can today be successfully performed in all skin types. Knowledge of hair follicle anatomy and physiology, proper patient selection and preoperative preparation, principles of laser safety, familiarity with the various laser/light devices, and a thorough understanding of laser-tissue interactions are vital to optimizing treatment efficacy while minimizing complications and side effects.
- BACKGROUND: Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce. OBJECTIVE: To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems. METHODS: Twenty women with Fitzpatrick skin types I–IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session. RESULTS: After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2. CONCLUSION: Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal.
- A wide variety of lasers can now induce permanent changes in unwanted hair Hair removal lasers are distinguished not only by their emitted wavelengths, but also by their delivered pulse durations, peak fluences, spot size delivery systems and associated cooling Nd:YAG lasers with effective cooling represent the safest approach for the treatment of darker skin Complications from laser hair removal are more common in darker skin types Pain during laser hair removal is generally a heat related phenomenon and is multifactoral Laser Treatment of non-pigmented hairs remains a challenge
- Laser-assisted hair removal is the most efficient method of long-term hair removal currently available. Several hair removal systems have been shown to be effective in this setting: ruby laser (694nm), alexandrite laser (755nm), diode laser (800nm), intense pulsed light source (590 to 1200nm) and the neodymium:yttrium-aluminium-garnet (Nd:YAG) laser (1064nm), with or without the application of carbon suspension. The parameters used with each laser system vary considerably. All these lasers work on the principle of selective photothermolysis, with the melanin in the hair follicles as the chromophobe. Regardless of the type of laser used multiple treatments are necessary to achieve satisfactory results. Hair clearance, after repeated treatments, of 30 to 50% is generally reported 6 months after the last treatment. Patients with dark colored skin (Fitzpatrick IV and V) can be treated effectively with comparable morbidity to those with lighter colored skin. Although there is no obvious advantage of one laser system over another in terms of treatment outcome (except the Nd:YAG laser, which is found to be less efficacious, but more suited to patients with darker colored skin), laser parameters may be important when choosing the ideal laser for a patient. Adverse effects reported after laser-assisted hair removal include erythema and perifollicular edema, which are common, and crusting and vesiculation of treatment site, hypopigmentation and hyperpigmentation (depending on skin color and other factors). Most complications are generally temporary. The occurrence of hypopigmentation after laser irradiation is thought to be related to the suppression of melanogenesis in the epidermis (which is reversible), rather than the destruction of melanocytes. Methods to reduce the incidence of adverse effects include lightening of the skin and sun avoidance prior to laser treatment, cooling of the skin during treatment, and sun avoidance and protection after treatment. Proper patient selection and tailoring of the fluence used to the patient’s skin type remain the most important factors in efficacious and well tolerated laser treatment. While it is generally believed that hair follicles are more responsive to treatment while they are in the growing (anagen) phase, conflicting results have also been reported. There is also no consensus on the most favorable treatment sites.
- Infrarotlicht einer Wellenlänge von 1064nm, wie es ein Nd:YAG-Laser emittiert, kann 5-7 mm tief in die Haut eindringen 3. Zwar ist die Absorption des Gewebewassers bei 1064 nm höher als etwa bei den Lasern im sichtbaren Bereich; dies wird jedoch durch die starke Streuung ausgeglichen, die für die Nd:YAG-Laser-Strahlung die oben angegebenen Eindringtiefen ermöglicht 3. Obwohl die Absorption in Melanin bei 1064nm niedriger ist als etwa für Farblichtlaser (532 nm, 694 nm), ist wahrscheinlich die Absorption in Melaninpigment relativ gesehen immer noch deutlich höher als in nicht pigmentierter Haut. Dies ist die Voraussetzung für die selektive Photothermolyse pigmentierter Haarfollikel mit dem Nd:YAG-Laser. Dabei könnten die hohen Eindringtiefen einen weiteren Vorteil darstellen, da Haarfollikel oft einige Millimeter tief in der Haut liegen.
- Since 2014, public and private insurance coverage for transgender Americans’ surgical care has increased exponentially. Training clinicians and equipping institutions to meet the surge in demand has not been as rapid. Through ethnographic research at a surgical workshop focused on trans‐ genital reconstruction and in a U.S. hospital working to grow its transgender health program, this article shows that effects of the decades‐long insurance exclusion of trans‐ surgery are not easily remedied through the recent event of its inclusion because patient access is not the only thing that has been restricted by coverage denial. Decades of excluding coverage for trans‐ genital reconstructive surgery have limited the development and circulation of technical skills required to perform these procedures, as well as the administrative processes needed to integrate them into existing clinical workflows. One surgeon estimates that turning expanded access into realized care is “a five or six‐year problem.” This article is protected by copyright. All rights reserved
- In the United States, an increasing number of individuals are identifying as transgender. Males at birth who identify as females are called male-to-female (MTF) transgender individuals or trans women, and females at birth who identify as males are called female-to-male (FTM) transgender individuals or trans men. The transgender patient population possess unique health concerns disparate from those of the general populace. Exogenous hormone therapy for transgender patients leads to changes in the distribution and pattern of hair growth. Exogenous testosterone can lead to male pattern hair loss and hirsutism, while estrogen therapy usually results in decreased facial and body hair growth and density. A thorough understanding of the hormonal treatments that may be used in transgender individuals as well the unique and complex biologic characteristics of the hair follicle is required for appropriate diagnosis, counseling and treatment of patients. The aim of this article is to provide a framework for understanding hair disorders in transgender individuals and effective treatment options.
- The effectiveness of intense pulsed light (IPL) and laser devices is widely accepted in aesthetic dermatology for unwanted hair removal and treatment of a variety of cutaneous conditions. Overall, most comparative trials have demonstrated similar effectiveness for IPL and laser devices. Literature studies alternatively favor the IPL and laser concepts, but the incidence of severe local pain and side effects were generally lower with IPL. IPL phototherapy, already established as a sound option in photoepilation and treatment of photoaging, hyperpigmentation and other skin conditions, is also considered first choice in the phototherapy of skin vascular malformations. When treating large areas, as often required in photoepilation and many aesthetic dermatology indications, IPL technologies show advantages over laser-based devices because of their high skin coverage rate. Compared to lasers, the wide range of selectable treatment settings, though a strong advantage of IPL, may also imply some more risk of local thermal side effects, but almost only in the hands of poorly trained operators. Overall, the strongest advantages of the IPL technologies are robust technology, versatility, lower purchase price, and the negligible risk of serious adverse effects in the hands of skilled and experienced operators.
- The goal of skin resurfacing is the rejuvenation of the skin by stimulation of its regenerative potential. The outer layer of epidermis is ablated in order to improve the quality of the skin. Sun damage is removed and age-related changes are improved in skin resurfacing. In general, there are several methods for resurfacing procedures: mechanical, known as dermabrasion, chemical peel, electrical, known as radiowave ablation and photoablation, normally referred to as laser skin resurfacing. The difference between these procedures is the varying results, the side effects, the difficulty in performance and reproducibility. Laser skin resurfacing is a well-controlled and precise procedure that shows defined, predictable results with fewer risks of complications [10,15,40]. There are laser wavelengths suitable for laser skin resurfacing. One is the CO2 laser (10 600 nm) and the other is the Er:YAG (erbium:yttrium-aluminium-garnet) laser (2940 nm). The coefficient of absorption in water is more than 16 times higher in the EnYAG wavelength. This results in a more complete absorption in a thinner layer of tissue with ablation of up to 30 μm and a thermal damage zone of less than 50 μm.
- La medición de la presión arterial (PA) en la consulta de forma correcta permite una adecuada estratificación del riesgo de los pacientes, sin embargo, su técnica puede estar sometida a errores frecuentes que deben ser evitados. Los esfigmomanómetros de mercurio han sido el estándar de oro en la toma de PA, sin embargo, no están actualmente recomendados debido al riesgo de toxicidad; sus alternativas, el esfigmomanómetro aneroide, requiere calibración periódica para evitar mediciones erróneas, y los equipos oscilométricos deben ser validados y adecuadamente seleccionados para su función. Mediciones complementarias a la realizada en la consulta, como el monitoreo ambulatorio de PA y la medición en casa, suplementan algunas debilidades de la medición en la oficina. El objetivo de la presente revisión fue evaluar cada uno de los aspectos de la técnica para medir la PA en la consulta.
- Androgen excess (AE) is a key feature of polycystic ovary syndrome (PCOS) and results in or contributes to the clinical phenotype of these patients. While AE will contribute to the ovulatory and menstrual dysfunction of these patients the most recognizable sign of AE includes hirsutism, acne and androgenic alopecia or female pattern hair loss (FPHL). Evaluation not includes scoring facial and body terminal hair growth using the modified Ferriman-Gallwey method, but also recording and possibly scoring acne and alopecia. Assessment of biochemical hyperandrogenism is also necessary, particularly in patients with unclear or absent hirsutism, and will include assessing total and free testosterone (T), and possibly DHEAS and androstenedione, although these latter add a limited amount to the diagnosis. Assessment of T requires use of the highest quality assays available, generally radioimmunoassays with extraction and chromatography, or mass spectrometry preceded by liquid or gas chromatography. Management of clinical hyperandrogenism involves primarily either androgen suppression, with a hormonal combination contraceptive, or androgen blockade, as with an androgen receptor blocker or a 5α-reductase inhibitor, or a combination of the above. Medical treatment should be combined with cosmetic treatment including the use of topical eflornithine hydrochloride, and short-term (shaving, chemical depilation, plucking, threading, waxing, and bleaching) and long-term (electrolysis, laser therapy, and intense pulse light therapy) mechanical treatments. Generally acne responds to therapy relatively rapidly, while hirsutism is slower to respond, with improvements observed as early as three months, but generally only after 6 or 8 months of therapy. Finally, FHLP is the slowest to respond to therapy, if it will at all, and it may take 12 to 18 months of therapy before response is begun to be observed.
- Haarwuchsprobleme sind häufig, Betroffene zeigen einen oft hohen Leidensdruck, und die Behandlungsmöglichkeiten sind beschränkt. Vor diesem Hintergrund hat die Bewältigung von Haarproblemen auf den Ebenen des Informationsverhaltens, der Problemlösekompetenz und der medizinischen Therapie zu erfolgen.
- Haare haben eine sehr wichtige Funktion für das Erscheinungsbild des Menschen. Daher können Störungen des Haarwachstums sehr belasten: Ein Kind mit Alopecia areata totalis wird für krebskrank gehalten; ein junger Mann mit Glatze wird gehänselt; eine Frau mit Haarlichtung verliert ihr Selbstbewusstsein und eine Frau mit Hirsutismus traut sich nicht mehr ins Schwimmbad.
- Die permanente Haarentfernung ist heute mehr denn je ein Problem in der täglichen Praxis von Dermatologen, plastischen Chirurgen, Kosmetikerinnen usw. In den letzten Jahren wurde eine Reihe neuer Verfahren und Technologien zur Haarentfernung entwickelt und auf den Markt gebracht. Einen zentralen Stellenwert nimmt hierbei die Photoepilation mit Hilfe verschiedener Lasertypen wie Rubin-, Alexandrit- oder Nd:YAG-Lasern sowie Blitzlampen ein. Im Rahmen einer ersten Studie zur dauerhaften Haarentfernung mit einer Blitzlampe, der sog. Intense-Pulsed-Light-Technologie (IPL) wurden 10 weibliche Patienten des Medical Centre Maastricht zufällig aus gewählt. Der Behandlungszeitraum erstreckte sich von 1994 bis 1997. Das mittlere Alter der Patientinnen betrug 39,6 Jahre. Es wurden mindestens drei bis maximal zehn Behandlungen pro Patient durchgeführt. Die Pulsintervalle variierten von 0–50 ms und die Energiedichten von 26–46 J/ cm2, bei Filtern von 570 und 590 nm. Ein Nachbeobachtungszeitraum von 44 Monaten zeigte, dass im Durchschnitt 89,5% der behandelten Haaren nicht wiedergekommen waren.
- The objectives are as follows: To assess the efficacy and safety of interventions (except laser and light-based therapies) for hirsutism.
- Unerwünschter Haarwuchs stellt ein weit verbreitetes kosmetisches Problem dar. Die Jahresumsätze auf dem weltweiten Enthaarungsmarkt werden auf über 3 Milliarden US-Dollar geschätzt. Allein in den USA lassen sich nach einer Studie von Moretti u. Miller 21 eine Million Frauen für jährlich 1000 US-Dollar mittels Elektrolyse enthaaren. Weitere 80 Millionen Frauen investieren insgesamt rund 500 Millionen US-Dollar in Epilationsprodukte. Auf dieser Grundlage erlebte die Photoepilation im Lauf der letzten 5 Jahre einen enormen Aufschwung. Auf Laser oder Licht basierende Techniken werden in Zukunft etwa 20% des heutigen Marktes für Elektrolyse einnehmen 21.
- Der menschliche Haarfollikel ist ein komplexes Anhangsgebilde der Haut, das sich aus zahlreichen verschiedenen Zellpopulationen zusammensetzt. Während des Wachstumsprozesses folgt der menschliche Haarfollikel einem charakteristischen, lebenslang sich wiederholenden Wechselspiel zwischen 2–6 Jahre dauernder Wachstumsphase (Anagen), einer in wenigen Wochen ablaufenden Übergangsphase (Katagen) und einer 2–3 Monate anhaltenden Ruhephase (Telogen). Jeder einzelne Haarfollikel durchläuft diese 3 Phasen individuell, sodass das Haarwachstum aller Haarfollikel asynchron verläuft und beim Menschen einem nur noch gering zu bemerkenden Jahreszyklus unterliegt.
- Hirsutism is an excessive terminal hair that appears with a male pattern in women, and it can be the only manifestation or can be part of hyperandrogenism. Hirsutism results from an interaction between the plasma androgens and the apparent sensitivity of the hair follicle to androgen, and it is classified as being produced by an excess of androgens from ovaries and/or adrenals by an increased sensitivity of the pilosebaceous unit by androgens or by the use of medications or changes in sex hormone-binding globulin secretion. The aims of treatment are to normalize the androgen overproduction, to suppress the androgen action, to recognize patients with higher risk of metabolic disorders, and to identify patients with reproductive tract or adrenal neoplasm. Treatment of hirsutism should be individualized and will be according with its etiology.
- This chapter describes the management of the unwanted hair. The main function of mammalian hair is to provide environmental protection. However, this function has now largely been lost in humans, in whom hair is retained or removed from various parts of the body essentially for cosmetic reasons. Though both men and women remove hair, it is the appearance of hair on a woman's body that is perceived as unnatural. Women feel that hair does not belong to their body, except for the scalp, and constantly seek means to rid themselves of this unwanted hair. Generally, women rely on shaving, depilatory creams, bleaching, waxing, and plucking to remove unwanted hair. Hair removal can be broadly put into two categories, depilation and epilation. The two terms are quite often used interchangeably in the scientific and the patent literature. Depilate is defined as “to remove hair by any means.” An important distinction is that in epilation, the complete hair shaft is removed from its roots, whereas, in depilation superfluous hair is removed and the hair-root is left undamaged. Waxing is a time-tested method of hair removal that has seen a renewed popularity. While depilatories remove hair at the skin's surface, “epilatories,” such as tweezers and waxes, pluck hair from below the surface. Waxing and tweezing may be more painful than using a depilatory, but the results are longer lasting. Because the hair is plucked at the root, new growth is not visible for several weeks after treatment.
- Hirsutism is the medical term that refers to the presence of excessive terminal (coarse) hair in androgen-sensitive areas of the female body (upper lip, chin, chest, back, abdomen, arms, and thighs). Virilization is more extensive than hirsutism with additional evidence of masculinization. In particular, the term virilization refers to the concurrent presentation of hirsutism with a broad range of signs suggestive of androgen excess, varying with age, such as ambiguous external genitalia, increased muscle mass, acne, balding, deepening of the voice, breast atrophy, amenorrhea/oligomenorrhea, and increased libido. Hirsutism and virilization usually have different underlying pathologic conditions, generally more severe in virilization that is frequently an expression of a life-threatening disorder such as malignancy (ovarian or adrenal tumors) (Bonfig et al., Eur J Pediatr 162:623–628, 2003) or classic congenital adrenal hyperplasia (CCAH) (White and Speiser, Endocr Rev 21:245–291, 2000; New, Mol Cell Endocrinol 211:75–83, 2003). Hirsutism commonly results from relatively benign functional disorders. Sometimes, however, it is the presentation of a more severe disorder, and it may be the first manifestation of a condition that will ultimately lead to virilization, if untreated. Therefore, both hirsutism and virilization must be seriously considered by practitioners not only for the disorder that they express but also for the considerable psychological negative impact that they exert in the individual affected, especially among young women (Barth et al., J Psychosom Res 37:615–619, 1993; Sonino et al., Postgrad Med J 69:186–189, 1993; Assante et al., International workshop “disorders of sex development: new directions and persistent doubts”, 14–15 Nov 2011, Bologna, Italy, 2011).
- • Hirsutism is related to hormonal factors, mainly an increase in androgen levels. • In females, the main sources of androgens are the adrenal glands (dehydroepiandrosterone sulfate; DHEA-S) and the ovaries (Δ-4-androstenedione): dysfunction of these organs must be excluded when a patient present with hirsutism. • The pituitary, the liver, ectopic hormones, certain drugs, and peripheral failure to convert androgens into estrogens may also be causes of hirsutism. • If minimal or no hormonal abnormalities are found, the patient will be diagnosed as having a constitutional hirsutism (SAHA syndrome) or a familial hirsutism. • As a general rule whenever there is hirsutism that appears abruptly and evolves quickly, one must first suspect that there is an ovarian, adrenal or pituitary tumor. • When the hirsutism is mainly localized to the areola and the lateral surfaces of the face and neck, the androgens usually have an ovarian origin, whereas if the location is central, with a distribution from the pubic triangle to the upper abdominal area, between the breasts, to the neck and the chin, the origin is usually adrenal. • The Ferriman and Gallwey score reflects functional hirsutism when the score is greater than 8 and an organic hirsutism when the score is greater than 15. • A correct biochemical evaluation must request levels of free testosterone, 5-α-dihydrotestosterone (5-α-DHT), DHEA-S, 17-β-hydroxyprogesterone, Δ-4-androstenedione, prolactin, sex hormone binding globulin (SHBG), 3-α-androstanediol glucuronide, and prostate-specific antigen (PSA), a marker of hyperandrogenism. In ovarian hirsutism and HAIRAN syndrome, we expand the laboratory evaluation to include luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH:FSH ratio, and insulin levels. • Depending on the origin of the hirsutism, the treatment is based on antiandrogens, glucocorticosteroids, and contraceptives, in association with topical and dermato-cosmetic therapies.
- Introduction Pseudofolliculitis barbae Acne keloidalis nuchae Dissecting cellulitis of the scalp Folliculitis decalvans Keloids Acknowledgment References
- Although the loss of scalp hair is distressing and many medical treatments focus on its restoration, the removal of body hair has been adopted since ancient times. Beauty standards, which r eflect the culture of each society, have been presenting the depilated body as absolutely desirable. Through the ages various methods of hair removal have been used depending on the requirements of the individuals. In recent years, Laser and Intense Pulse Light devices have been considered as the most promising solution for excess hair growth, without excluding the efficacy of other methods to induce satisfactory epilatory results. The enzyme-based hair removal method has received little recognition even though experimental and clinical data support its efficacy to provide long term or even permanent epilation. The present review presents these data and examines the likelihood of considering the aforementioned method as ideal.
- Hirsutism is the presence of excess hair growth in women in the typical male hair growth areas, thereby reflecting a deviation from the normal female hair pattern. It affects from 5% to 10% of women, depending on age, menopausal status and ethnic background. The presence of hirsutism is very distressing for women, and subsequently may have a negative impact on their psychosocial life. In the treatment of hirsutism several options are now available, including pharmacologic regimens and cosmetic measures. Both the hormonal profile of the patient and her expectations and preferences should guide the therapeutic approach. The aims of the medical therapy are suppression of excessive androgen production, inhibition of peripheral action of androgens, and treatment of patients at risk for metabolic disorders or reproductive cancers. For other diseases related to endocrine abnormalities, such as thyroid disorders or Cushing's syndrome, specific treatment is mandatory. After an ineffective local approach by direct hair removal, a pharmacological treatment should be suggested, using estrogen and progestin combinations, antiandrogens (i.e. cyproterone acetate, spironolactone) or both as a first line. Finasteride, gonadotropin-releasing hormone agonists, and glucocorticoids should be used in selected cases. Adequate contraception is also recommended if antiandrogens are used. Unfortunately, since systemic therapy reduces hair growth in less than 50% of cases, hirsute women frequently require cosmetic measures. The use of a logical combination of different options has been shown to achieve a satisfactory result in most cases. This review provides information and suggestions about the current options of treating hirsutism.
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Montagna W. Electrolysis and the problem of hair re-growth. J Appl Cosmetol 1984;2:6-17. - Videos on galvanic electrolysis, thermolysis, and the blend. Brookheld, Wis: Prestige Electrolysis Sup-ply
- Je Shuster
Shuster JE. Videos on galvanic electrolysis, thermolysis, and the blend. Brookheld, Wis: Prestige Electrolysis Sup-ply. 1990-1993. - The regional anatomy of human skin is discussed in terms of (a) the regional variation of the architectural pattern of the basal layer of the epidermis, (b) the regional variation in the distribution of hair follicles and eccrine sweat glands, and (c) the regional variation in the distribution of melanocytes. (a) The architecture of the basal layer is regionally specific. The epidermis of the cheek is almost flat between the numerous hair follicles. Regions under tension have parallel ridges that end abruptly (neck, breast, abdomen); regions with a thick keratin or mucous layer have deep ridges with circular imprints of tall dermal papillae (sole, palm, knee, heel and oral mucosa). Elsewhere in the epidermis the creases of the skin surface divide the pattern of the basal layer into diamondshaped areas where the imprints of the dermal papillae are to be seen. (b) There is great individual and regional variation in the distribution of hair follicles and sweat ducts' 700 ± 40 hair follicles per cm^2 were counted on the face, but only 65 ± 5 in the rest of the body. The corresponding density for eccrine sweat glands was 270 ± 25 in the face and 160 ± 15 in the rest of the body. There are altogether about two million hair follicles and three million sweat glands in the integument. The epidermal appendages are symmetrically distributed; there is no significant difference between male and female in the density of hairs or sweat glands. The density of appendages is much higher in the foetus and in the infant than in the adult. Numerical estimates have shown that the differential rate of growth of the body surface may be solely responsible for regional differences in the density of appendages. A uniformly distributed foetal population of appendages would become 'diluted' three times more on the trunk and extremities than on the head during postnatal growth. The numerical ratio of sweat ducts/hair follicles is the same throughout foetal and postnatal life. (c) On the average there are about 1500 epidermal melanocytes/mm^2 of skin surface, excluding those in hair follicles. The total number of epidermal melanocytes in an adult is about 2000 million. They occur consistently in the basal layer of the epidermis of 'white' human skin (including the oral and nasal cavities). Their absolute number and their proportion to the keratinizing basal Malpighian cells are constant and characteristic in given regions. The distribution of melanocytes is also bilaterally symmetrical and their regional frequency is the same in male and female. The individual and regional variations of melanocyte distribution are, however, great. There are two or three times as many melanocytes per unit area in the epidermis of the cheek or forehead as in the other regions of the integument. Because melanocytes are mostly located on ridges, the numerical ratio of Malpighian cells/melanocytes is lower on than between the ridges. The cause of the great regional variation of melanocytes is not known. The regional differences are smaller in foetal than in adult skin. Regional differences in the degree of expansion of the body surface by growth cannot, however, explain the regional variation in the adult. Melanocyte density in the foetus is lower than in the adult, and in old epidermis a decrease in melanocyte density is one of the manifestations of ageing. Comparisons of the frequency distribution of melanocytes reveal no significant difference between the various human races. The degree of melanization of skin therefore depends not only on the number of melanocytes, but, more particularly, on their physiological activity in melanogenesis. The absolute number of melanocytes and the ratio of Malpighian cells/melanocytes are high enough to allow melanocytes to make contact with every Malpighian cell and so to disseminate melanin through the entire basal layer of the epidermis.The salient statistical data are presented in the following table:
- The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.
- Small tufts of chest hair were epilated at different rates and the roots classified as to growth phase, presence or absence of root sheaths and whether the shafts were fractured. With respect to anagen roots, a slow epilation gives bare roots whereas an increase in the rate of epilation increases the proportion of ensheathed roots. As the rate of epilation increases, the proportion of fractured hair shafts increases. These findings are relevant to epilation used as a diagnostic procedure because it is not possible to have both a high proportion of well-formed ensheathed anagen roots without some breakages.
- Twenty-one patients were included in a double-blind, placebo-controlled, cross-over study with a eutectic mixture of lidocaine and prilocaine (EMLA). EMLA or placebo was placed on the upper lip for 1 hour; diathermy was then performed for 10 minutes. The pain caused by diathermy was evaluated by the patients and the cosmetologist on a four-point scale. The results of the investigation showed that there was significantly less pain after application of 5 gm of EMLA cream on the upper lip than after application of placebo, assessed both by the patient and by the cosmetologist. Eighteen of 20 patients preferred EMLA (p less than 0.0001). Local reactions were few and mild.
- The universal precautions recommended by the US Centers for Disease Control (CDC), Atlanta, for the prevention of HIV (human immunodeficiency virus) transmission to health care workers are widely accepted, despite little documentation of their effectiveness and efficiency. We reviewed the evidence on the risk of HIV transmission to hospital workers and the effectiveness of the universal precautions. We also evaluated the costs of implementing the recommendations in a 450-bed acute care teaching hospital in Hamilton, Ont. On the basis of aggregated results from six prospective studies the risk of HIV seroconversion among hospital workers after a needlestick injury involving a patient known to have AIDS (acquired immune deficiency syndrome) is 0.36% (upper 95% confidence limit 0.67%); the risk after skin and mucous membrane exposure to blood or other body fluids of AIDS patients is 0% (upper 95% confidence limit 0.38%). We estimated that 0.038 cases of HIV seroconversion would be prevented annually in the study hospital if the CDC recommendations were followed. The incremental cost of implementing the universal precautions was estimated to be about $315,000 per year, or over $8 million per case of HIV seroconversion prevented. If all HIV-infected workers were assumed to have AIDS within 10 years of infection the of the program would be about $565,000 per life-year saved. When less conservative, more probable assumptions were applied the best estimate of the implementation cost was $128,862,000 per case of HIV seroconversion prevented. The universal precautions implemented in the study hospital were not found to be efficacious or cost-effective. To minimize the already small risk of HIV transmission in hospitals the sources of risk of percutaneous injury should be better defined and the design of percutaneous lines, needles and surgical equipment as well as techniques improved. Preventive measures recommended on the basis of demonstrated efficacy and aimed at routes of exposure that represent true risk are needed.
- Women with facial hirsutism are burdened with hairs that often interfere with personal and work activities. Temporary hair removal is a major component in the management of hirsute patients. From a caseload of 1,000 patients, we submitted questionnaires to 271 and interviewed 135. We found that shaving was the most helpful and most frequently used temporary method. Judicious plucking can be helpful if tolerated, but care must be taken to avoid folliculitis, pigmentation, and scarring. Waxing and depilatories were used by less than 6 percent of patients on the face and by about 20 percent on other parts of the body. The avoidance of irritants and the use of hydrocortisone 1 percent cream are important in the management of any irritation due to hair removal techniques. Cosmetic coverups may be helpful.
- Hair follicle density, and definitive length, root status and rate of growth of hairs were determined for defined areas of the thigh and upper arm in 11 females and nine males aged 20-30 years. Hair follicle density did not differ between males and females. However, on the thigh the definitive length of hair was on average three times greater in males. This was attributable mainly to a longer duration of anagen (X 2 X 46), but also to a greater rate of growth (X 1 X 22). On the upper arm the hair was only 1 X 42 times longer and the duration of anagen only 1 X 27 times greater in males than in females. On the thigh the estimated average duration of anagen was 54 days in males and 22 days in females, with corresponding figures of 151 days and 84 days for the complete cycles. On the upper arms the duration of anagen was 28 days in males and 22 days in females, with corresponding figures of 108 and 106 days for the complete cycle. In females, oral contraceptives had no significant effects on any measurement.
- The histologic changes induced by thermolysis of hairs of the scalp and legs were studied by light microscopy. Two techniques were compared on opposite sides: conventional thermolysis (erroneously termed electrolysis) using bare needles and a newly designed precision epilator using an insulated, bulbous-tipped probe. Thermolysis generally did not immediately eliminate the papilla and hair matrix. Thermal injury provoked an inflammatory reaction which eventually destroyed the hair bulb. The insulated probe produced greater damage to the peribulbar tissue below and less necrosis of the perifollicular dermis above, enhancing the likelihood of permanent epilation and reducing the probability of scarring. The infundibulum and associated sebaceous glands regenerated to near-normal architecture. The lower follicle was replaced by a fibrotic streamer--a scar.
- An electroepilation apparatus equipped with a metal tweezer was studied with reference to possible permanent removal of facial hair in women with cosmetically embarrassing hypertrichosis. 8 women were epilated on a fixed area of 1 cm2 and counts of the epilated hairs were done. 5-7 months later, the same area was epilated and the terminal hairs counted. No significant difference in the hair counts was found on the two epilations. The method must be considered inapplicable for permanent removal of superfluous hair.
- The treament of hirsute women is controversial and often presents a therapeutic dilemma. Mechanical methods (such as shaving or using depilatories) are safe but often unacceptable to the patient, whereas suppression of adrenal or ovarian function may not be effective and may have undesirable side effects. An alternative approach is the use of a drug that blocks androgen action at the hair follicle. Such blocking should be successful whether the source of the excess androgen is ovarian or adrenal. Because cimetidine has recently been found to have antiandrogenic activity, we used it to treat severely hirsute women and assessed its effect through measurement of hair growth. Cimetidine produced a decrease of 64 ± 11% (mean ±S.E.M.) in the rate of hair growth (from 28.4±6.8 mg per week to 8.3±1.0) in four of the five patients. There were no statistically significant changes in serum total testosterone, percentage of dialyzable testosterone, levels of dihydrotestosterone and luteinizing hormone, or urinary excretion of 17-ketosteroids (P>0.10). All patients noticed lessening of the oiliness of their skin and acne (if present). Side effects possible related to cimetidine are given in the table. No galactorrhea or abnormalities in liver, renal, or hematologic function were noted. Bleeding from the vagina (not confirmed as ovulatory menstrual bleeding) occurred in three patients within three weeks of the initial of cimetidine.
