Have Excess Facial Hair?

It May Be Hirsutism

By: John Kraft, HBSc and Charles Lynde, MD, FRCP(C)

Hirsutism is a term describing excessive growth of dark, terminal hairs in women in a male-type pattern (i.e. hair on the beard area, chest, and abdomen). You can read detailed information on www.UnwantedFacialHair.ca

All women have circulating male sex hormones, but normally the estrogen levels are much higher and counteract these androgens. Androgens are normally produced by the adrenal glands and ovaries. In women with hirsutism, either there are increased androgen levels in the blood or the hair follicles are more sensitive to androgen, or a combination. Excess androgen also affects the skin causing acne, seborrhea (greasy red flaky areas around the nose, mouth and ears, and scalp), and male-pattern baldness.

Hirsutism is a very common problem. Racial and genetic factors play a role in hair growth. For example, in Afro-Americans and Orientals, chest and beard growth is greatly diminished.

There are many causes of hirsutism reflecting overproduction of androgen due to changes in the pituitary gland, adrenal gland and ovaries (i.e. polycystic ovarian syndrome), but most commonly, there is no underlying cause.

Constitutional hirsutism is the most common form of hirsutism. There is no excess androgen, rather the hair follicles are more sensitive to androgen. This often runs strongly in families. Certain ethnic backgrounds, i.e. Mediterraneans and East Indians, are particularly affected.

Drugs can lead to excess androgens, including anabolic steroids, androgens, systemic corticosteroids and progestational agents. Some medications can cause increase hair growth everywhere, not just in male areas. These medications include phenytoin, diazoxide, cyclosporine, and minoxidil.

Liver disease can also lead to apparent androgen excess by making less sex-hormone binding protein.

It is important to properly determine the signs and symptoms and to determine the possible source of the responsible androgen. Usually, free testosterone and serum DHEA-S levels and other hormone tests can help determine the nature of the hirsutism. More investigations may be needed to rule out possible causes of the increased androgens.

Treatment Overview:

The first approach to treating hirsutism should be to identify and treat the underlying cause if present. Regardless of the cause, treatments include temporary hair removal/disguise, electrolysis, laser therapy and pharmaceutical options. A treatment overview can be found here.

Some Treatment Facts:

• Dark hair can be bleached with hydrogen peroxide preparations.
• Depilatory methods such as shaving and chemical depilatories remove hair from the surface of the skin. Shaving is reasonable and does not lead to an increased rate of hair growth, although the blunt tip of the shaved hair may appear coarser than unshaven hair.
• Chemical depilatories often lead to irritation.
• Electrolysis is a method of permanent epilation. Side effects include pain, scarring, and post-inflammatory hypo or hyperpigmentation.
• Although various laser systems have been developed for epilation of unwanted hair, none have been proven to permanently destroy hair and this method works best in dark-haired patients.

Pharmaceutical Treatment Options:

Growth Inhibitors: Drugs that block enzymes in the hair itself that inhibit growth; Ornithine decarboxylase blocker: eflornithine (VANIQA®). VANIQA® is a new drug that blocks an enzyme that is required for the growth of hair.

Hormone Blockers: These are drugs that inhibit androgens working on hair growth. They include oral contraceptives with or without cyproterone acetate and spironolactone, an antiandrogen; Ethinyloestradiol and cyproterone acetate (Diane 35®) or Anti-androgens ( Cyproterone acetate, Spironolactone, Flutamide, Finasteride) or Anti-diabetic (Metformin).

In summary, hirsutism can have many different causes, but most commonly, it is genetic, with no underlying cause. Dermatologists have many effective therapies that can be used to remove unwanted hair.

About the author:

Charles Lynde, MD, FRCPC is Assistant Clinical Professor, University of Toronto Canada. His special interests include paediatric dermatology, cosmetic procedures, contact dermatitis, skin cancer, psoriasis and clinical trials in acne, eczema, and psoriasis. John Kraft, HBSc, is a fourth year medical student at the University of Toronto, with an interest in dermatology.