Eflornithine (vaniqa) can be used to treat excess hair growth

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Eflornithine (Vaniqa) Hair Removal Treatment

Excess hair growth disorders, such as, hypertrichosis are a common problem seldom discussed in primary care setting. Unwanted hairs are a source of great embarrassment and distress to those affected and can badly disturb their social life. Hair removal treatments are therefore an important part of the total treatment regimen.

There are several treatment options all varying in their efficacy, degree of discomfort and cost. They are shaving, plucking, depilation, epilation, electrolysis and laser treatment. A single treatment will not work on all body sites and patients. The treatment selected depends on the body site, nature of hair growth, the patients and cost. In most cases, more than one method of treatment is needed.

Topical Eflornithine (vaniqa) hair removal treatment

Oral and topical medications, such as, spironolacto and third generation oral contraceptives have been successfully used to remove facial hair. However, long-term safety and efficacy are still lacking

Recently, a novel method of treating excess facial hair growth disorder, by the application of eflornithine chloride or eflornithine (vaniqa) has been introduced. This chemical was earlier used systemically for treating African sleeping sickness where hair loss was one of the side effects observed. A topical eflornithine was then developed to treat facial hypertrichosis and has demonstrated success. It is a topical treatment, simple to apply and has minimal side effects. Overall, eflornithine has shown success in 60 percent of cases and results are visible in about 8 weeks. It is used in a cream form.

Eflornithine chloride, instead of removing unwanted hair, slows down hair growth and makes it less visible and less coarse. It does so by irreversibly inhibiting the action of the enzyme ornithine decarboxylase that is present in the hair follicle. Enzyme ornithine decarboxylase is important for maintaining hair growth. Studies carried out on animals have shown that inhibition of ornithine decarboxylase decreased cell division and other cell functions, which are important for hair growth. Since eflornithine reduces ornithine decarboxylase activity, it affects anagen growth. Plucking on the other hand increases ornithine decarboxylase activity triggering anagen growth. It is for this reason that initial trials of this medication were conducted on hirsute women.

Currently eflornithine is recommended for use only for removal of facial hair in women. A thin layer of cream is applied to clean dry skin. Clinical studies on women showed that twice daily application of 15 percent eflornthine cream was superior to placebo in reducing hair growth, after 2 to 8 weeks of treatment. After 24 weeks of treatment, 58 percent of eflornithine and 34 percent of placebo patients showed some improvement. But 32 percent of eflornithine and 8 percent of placebo patients showed significant reduction in hair growth and were deemed as successfully treated. The results were even better after 6 and 12 months of treatment. These promising results were accompanied by a significant reduction in time spent on other hair removal treatments. However, hair growth returned to pretreatment condition after the treatment was discontinued for around 8 weeks. Treatment should therefore continue but if there is no improvement after four months, it should be discontinued.

Although eflornithine (vaniqa) is recommended as a stand-alone treatment, according to one view, laser treatments would improve if the two treatments are used in conjunction. A contradictory view holds that laser should not be used with eflornithine treatment since it inhibits anagen growth. Eflornithine is a useful option but not a first-line treatment. It is perhaps best used on patients who show poor tolerance to physical methods of hair removal. However, eflornithine may improve the effectiveness of these physical methods of hair removal if used with them.

Side effects

Side effects are mainly local and include acne, stinging, burning and erythema. They are more common in patients treated with eflornithine than in those given placebo treatment. Percutaneous absorption of eflornithine, which causes these side effects, is 4 percent. But it is less than 1 percent when the 15 percent eflornthine cream is applied twice a day on a shaved 50 sq.cm. area of skin under the chin. The no-effect dose is presently not known. However, these side effects generally resolve without treatment or discontinuation of eflornithine.

The use of eflornithine in the generalized forms of hypertrichosis is limited because no data is available regarding the maximum area it can be applied on. Safety and efficacy of eflornithine (vaniqa) for various types of hypertrichosis and on a wider patient population, especially children, has not been established. Eflornithine is a pregnancy category C medication, and it is not known whether it is excreted in human breast milk.

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