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Hirsutism, or the growth of coarse, dark hair on the face, back, chin or inner thighs, affects 5 to 15 percent of women. Having male-pattern hair growth can cause significant embarrassment and anxiety to women with this condition. Hirsutism treatment typically includes both medical and cosmetic aspects, which include suppressing excess androgen, blocking peripheral androgen and removal or destruction of unwanted hair.
The first step in treating women with excess androgen is androgen suppression. Oral contraceptive pills (OCPs) are used singly or in conjunction with the drug spironolactone to block ovarian androgen production. A one- to two-year course of treatment with oral contraceptives is the most frequently used medication in hirsutism treatment. Research has shown that after treatment with OCPs, androgen levels remain low for as long as two years.
There are some drawbacks to using oral contraceptives, particularly in women with polycystic ovarian syndrome. One study of obese women with polycystic ovarian syndrome did not show any improvement in hirsutism even after six months of treatment with OCPs. Further, OCPs change carbohydrate metabolism, which can be detrimental to women with polycystic ovarian syndrome who might have glucose intolerance, insulin resistance or diabetes.
Spironolactone is an anti-androgen that is effective as a hirsutism treatment. Success of spironolactone treatment is dose-dependent. Thin women might need as little as 100 milligrams daily, and obese women might need up to 300 milligrams each day. Most women remain on a maintenance dose of 25 to 100 milligrams a day. Spironolactone might cause a male fetus to become feminized, so treatment with this medication often is combined with a birth control pill so that pregnancy is avoided.
Other medications that might be used to treat hirsutism are flutamide, cyproterone acetate, ketoconazole, gonadotrophin releasing hormone (GRH) analogs and metformin. Topical treatment with prescription eflornithine cream will slow the growth of hair as long as it is being used. Cyproterone acetate is not available in the United States.
The third phase of hirsutism treatment is the removal of unwanted hair. Hair removal options include electrolysis, laser hair removal, chemical depilatories, plucking, shaving, waxing or bleaching. Only electrolysis provides permanent hair removal.
Electrolysis destroys the hair follicle with an electrical current that flows down a thin needle inserted into the follicle. Using low power, the current stays in contact with the hair bulb for three to 20 seconds; on high power, it is in contact with the hair bulb for less than one second. Electrolysis is painful and can cause swelling, increased or decreased pigmentation of the skin, scarring or infection. Repeat procedures are likely because 15 to 25 percent of the removed hair might regrow. Electrolysis is an expensive hirsutism treatment.
Laser treatments for hair removal target the melanin in individual hair follicles. Melanin absorbs the laser, converting it to heat. This heat then temporarily destroys the stem cells where the hair is growing very quickly. Hair will regrow in about six months, but there will be less of it.
Women will notice that six months following the third laser application, hair regrowth is significantly reduced. Skin in the area surrounding the targeted hair follicle can be scarred if the laser pulse is too long. Other side effects might include itching, pain and altered skin pigmentation. Swelling and redness can last for three days following the procedure. Dark-skinned or tanned women are more likely to have complications, and the procedure is best for women with fair skin and dark hair. Like electrolysis, laser treatments are expensive.
At home, women can use a chemical depilatory, wax, a razor or tweezers remove unwanted hair. Chemical depilatories and waxing are the longest lasting solutions. Shaving and tweezing must be done as a regular part of a woman's personal care routine because of rapid hair regrowth.
Bleaching the hair so it is less noticeable is another option for women with fair skin. All of these home-care options are inexpensive compared to electrolysis and laser hirsutism treatments. The main side effects for any of these methods of hair removal include ingrown hairs, follicle infections, redness and irritation, particularly in women who have sensitive skin.
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