Hair removal methods for treating hypertrichosis
Information on hypertrichosis and hair removal treatments
Hair Removal Treatments
Excessive hair disorders like hypertrichosis give affected people a very repulsive appearance. This ugly appearance makes people shun those affected producing serious emotional problems in them.
Cosmetic treatment, therefore, is much needed. It is the only treatment available in congenital hypertrichosis, which now cannot be medically treated. Even in acquired hypertrichosis cases, where treatment of the underlying medical cause can normalize hair growth, cosmetic treatment is an important part of the total treatment regimen, since treatment takes time.
Currently the common cosmetic treatments available are shaving, plucking, epilation, chemical depilation, electrolysis and laser application.
Shaving: Shaving is the simplest but most tedious since to retain the cosmetic appearance shaving has to be done frequently, perhaps daily. Moreover, women oppose such masculine rituals. There is also the risk of getting pseudofolliculitis due to shaving of kinky hairs.
Plucking: Plucking involves uprooting the hairs by tweezers. It produces a more attractive appearance but is slow and painful and impractical for large areas. Also, plucking encourages hair growth by changing telogen to anagen. Repeated plucking can produce disorders, such as, erythema, pigmentation, folliculitis and scarring. It is suitable for small sites
Epilation: Epilation, or waxing, is glorified plucking, where large numbers of hairs are uprooted at one go. The site is covered with low melting wax, allowed to solidify and then swiftly pulled off plucking the hairs sticking to it. The cosmetic effect lasts longer for about a month but the treatment is painful. Also, breaking of anagen hairs may cause folliculitis. Sometimes patients have allergic reactions to the wax or whatever adhesive is used. Plucking is best when the hairs are at least 1mm. long. It is too painful for children.
Depilation: Chemical depilatories are easy to use and produce excellent results that can last more than two weeks. They are mostly variants of thioglycolates used for perming hair and work in the same way to reduce the hair mass to a soft jelly.
They are used as an aqueous 2% to 6% mixture of an alkali. Alkali is added to bring the pH to an optimal level where the depilatory is most effective and at the same time, safe on the skin. It is applied and left for 3 to 15 minutes depending on the thickness of the hair and the concentration and vehicle of the depilatory. The degraded hair mass and the depilatory are then removed by a spatula.
Depilation produces an irritant dermatitis in 1% to 5% of cases. Different areas of the body react differently to depilatories. Before starting the treatment a test on an unaffected area of the body is done to study the response to the depilatory. After treatment the site is well cleansed and 1% hydrocortisone applied to prevent dermatitis.
For treating coarser terminal hairs like beard, faster acting depilatories like sulfides of strontium, calcium or barium are sometimes used. But they give off a bad odor, which is masked by fragrances. In children it should be used only on small localized site to prevent systemic thioglycolate absorption.
Long term and permanent treatments
Electrolysis: Electrolysis or electrosurgical epilation, holds the best promise of a permanent hair remover. Here electric current electrochemically destroys the hair using galvanic electrolysis or thermolysis using a sophisticated machine called epilator operated by highly skilled personnel.
In galvanic electrolysis, direct current to the hair follicle, using a needle is used to soften the surrounding tissue and destroy the hair. In thermolysis a probe functioning as an electrode and inserted in the follicle is used to send a high frequency alternating current to the hair. Galvanic electrolysis is slower but destroys more hair in one treatment. Thermolysis is faster but shows more hair re-growth.
To remove coarser hairs a combination of galvanic and low intensity high frequency alternating current is used. The destroyed hairs are removed with forceps.
15% to 60% hair re-growth has been observed after electrolysis. Not the least of the reasons could be lack of standardized equipment and treatment and inadequate personnel training. Faulty probe insertions may result in untreated hairs. It may also cause androgen-stimulated conversion of fine vellus into terminal hairs. Moreover, telogen respond less to electrolysis for reasons not yet clear. Electrolysis is best for localized coarse hair sites.
The main disadvantage of electrolysis is length of each treatment and the number of treatments required on each site. Each session can extend from 15 minutes to 1 hour destroying 25 to 100 hairs. These sessions are uncomfortable and are poorly tolerated by children.
The side effects of electrolysis include immediate temporary swelling and erythema and also folliculitis, post inflammatory hyperpigmentation and hypopigmentation.
Laser application: It is a non-invasive hair removal treatment. Various treatments are being used, all based on the principle of selective photothermolysis where the melanin pigment in the follicle is the chromophore targeted while sparing the dermis around it.
The different laser treatments use different parameters such as, laser wavelength, pulse rate, spot size and repetition rate and different cooling systems. They are more or less equally effective but the parameters selected should give the ideal laser for the individual. On an average 20% hair is removed in one session. For this reason multiple treatments give the best results. Studies show that 80% of patients have shown good hair reduction.
It is seen that chances of permanent hair removal is related to hair color. People with fair skin and dark hair have a better chance of longer lasting hair removal than those with blond, red or white hairs. However laser treatment is not yet a permanent hair remover.
Common side effects of laser treatment are erythema and perifollicular edema. Less common are crusting and vesiculation on the site, hyperpigmentation and hypopigmentation. They are mostly temporary and can be lessened by lightening the skin and protecting it from the sun before treatment, cooling the skin during treatment and sun avoidance after treatment. Laser treatment also is uncomfortable and poorly tolerated by children.