Hair Removal

Introduction

We are born with all the hair follicles we ever have.

  • At puberty, as a result of androngenic effects, some of these follicles enlarge and produce their characteristic growth pattern (e.g. beard growth, pubic hair).
Options for removal of unwanted hair include

  • Methods that temporarily remove hair - plucking, waxing, shaving, chemical depilatories, and pharmacologic methods; and
  • Methods that may be able to permanently remove hair - electrolysis and laser/light treatments.

Decisions among these options involve patient preferences, tolerance of discomfort and pain, risks of complications, and cost.




Plucking/Epilation

A relatively safe and inexpensive method of hair removal is epilation, better known as plucking.

  • The term "epilation" means to extract hair.
  • Plucked hairs can remain absent for 6-8 weeks.

However, plucking can be very uncomfortable and time consuming.

  • Moreover, epilation can cause irritation (folliculitis) due to the traumatic nature of the procedure.

Plucking can be performed with tweezers, by use of thin threads (threading), or any one of a number of commercially available devices and is best suited for relatively small areas such as the face.




Waxing

Waxing, which is technically a form of epilation, involves applying a layer of wax to the area where hair removal is desired.

  • When the wax is pulled off, the trapped hairs are pulled out.
  • Although operator dependent, waxing may be less painful than plucking individual hairs.

Waxing can be used on a broad range of body areas such as eyebrows, back, bikini area, and legs.

  • As long as the hairs are removed with the bulb intact, one can expect similar results to plucking.



Depilation

Depilation is the use of a chemical (a depilatory agent) to essentially dissolve the hair.

  • The active ingredients in most products are thioglycolates, which chemically disrupt disulfide bonds in the hair.
  • The end result is dissolution of the hair into a gelatinous form, which can be wiped or scraped away.
Depilatories work well, but the results do not typically last much longer than two weeks.

  • In addition, since most depilatories are sulfur-containing compounds, the odor produced can be unpleasant.
  • Irritant or allergic contact dermatitis can occur with the use of depilatories as a result of the sulfur component in addition to added coloring and fragrances.



Shaving

Shaving is a popular method of hair removal.

  • Methods of variable expense are available including old-fashioned straight razors, multiple blade safety razors and electric shavers.

Shaving only removes hair down to just below the surface of the skin.

  • When used for facial hair, most people must repeat the process daily with some needing retreatment in less than 12 hours.
  • The process is purely mechanical and provides only shortening of the hair involved.
  • Most body areas are amenable to shaving.

Shaving does not cause hair to grow back thicker.
  • Rather, the sharp, beveled edge created from the shearing off of the hair creates the rough texture.
  • Thickening of hair is produced by exposure to androgens either as a normal result of sexual maturity or in pathologic disease states.



Pharmacologic Options

Pharmacologic therapy is commonly used for the treatment of hirsutism (excessive male-pattern hair growth) in women.

  • The main systemic treatment options are oral contraceptives and antiandrogens (such as spironolactone and flutamide).
  • Eflornithine 13.9% cream is a topical option for the treatment of hirsutism in women.



Laser and Intense Pulse Light

Photoepilation therapies (laser and intense pulsed noncoherent light sources) can be used to reduce hair via selective photothermolysis.

  • Total removal of hair is uncommon, and realistic expectations for treatment include less hair, lighter hair, and thinner hair.
  • In general, dark hair responds best.




Electrolysis

Electrolysis can permanently remove hair when done correctly, but it is a slow process that can be uncomfortable and can occasionally cause scarring.

  • It is performed by inserting a very fine needle into the hair follicle and applying an electrical current.
  • The basis of its therapeutic effect is the destruction of the rapidly dividing cells of the matrix and the follicle itself.



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