Hypertrichosis treatment - Hypertrichosis management

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Hypertrichosis is excessive growth of hair on any part of the body. Hypertrichosis excludes androgen-induced excessive hair growth, known as hirsutism. Acquired hypertrichosis can be treated by removing the underlying cause.

For congenital hypertrichosis there is no cure. Hair removal treatments are the best options for improving the appearance. In patients with localized hypertrichosis, satisfactory results can be realized with the treatment. In extensive and generalized forms, hair removal treatment is time consuming and likely to be unsatisfactory.

In acquired form of hypertrichosis cases, the treatment of the underlying causative factor can normalize the hair growth. However alleviating or completely resolving the medical cause may take considerable time. Till such time temporary cosmetic treatment to remove the unwanted hair is necessary for addressing the associated emotional problems of the patient. However it is to be noted that, in some cases the hair removal methods may cause, dermatitis, hives or scarring.

Hypertrichosis treatment and management

Extensive hypertrichosis may cause cosmetic embarrassment and is psychologically devastating to the patient. Generalized hypertrichosis may involve all three types of hairs, namely, lanugo, vellus and terminal hairs. In localized hypertrichosis, the local vellus hairs transform into terminal hairs.

Temporary hair removal for hypertrichosis

There are many methods of temporary removal of hair. In these methods as the hair follicle is not destroyed, new strands grow after some time. Skin sensitivity, hives, scarring, ingrown hair (pseudofolliculitis), folliculitis, dermatitis, hyperpigmentation and hypopigmentation are the possible problems associated with these methods. It is cumbersome and time consuming for treating large areas of hypertrichosis.

Superficial removal

Abrasives like pumice stones are rubbed on the skin to break and remove hair. Quite often this method damages the skin. Shaving cuts and removes the hair at the skin level. The hair may become apparent after two or three days of growth. Chemical depilatories are available in gel and cream forms. They contain calcium thioglycolate or potassium thioglycolate.

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These chemicals react with the cystine and breaks down the disulfide bonds in keratin. The weakened hair can be just scraped off. In all these superficial methods removal of hypertrichosis condition is highly temporary and chemicals may sensitize the skin.

Depilation

In epilation, hair is completely removed from the hair shaft. It is quite an effective method for temporary removal of hypertrichosis. Each hair may be pulled out individually with a tweezer. By threading also a small group of hairs can be removed at a time. Waxing treatment is done to remove large numbers in one go. As an alternative to waxing, sugaring used. Sugar and lemon juice are heated in water and made into paste. The paste is applied to the skin and a cotton strip is placed over it. The cotton strip is pulled back sharply to pull out the strands stuck on it from the follicle.

Hair growth inhibition in hypertrichosis

Eflornithine cream (Vaniqa cream 13.9%) is successfully used for reducing the unwanted hair. Eflornithine interferes with ornithine decarboxylase. Ornithine decarboxylase is needed in the follicles for hair growth. Eflornithine irreversibly binds to Ornithine decarboxylase and prevents the natural substrate ornithine from accessing the active site of the enzyme. The treatment effects become apparent after 4-8 weeks of application. However hypertrichosis condition returns in eight weeks when the application is stopped.

Permanent hair removal for hypertrichosis

For permanent reduction in hair use of electrolysis and laser technology are the best solutions. Skilled persons are required for carrying out these procedures. Many sittings may be required to reduce hair growth and get satisfactory results. The results of hypertrichosis treatment depend upon the skill of the technician and and use of correct intensity and duration of current.

Electrolysis for hypertrichosis

Electrolysis is aimed to destroy the hair follicle and bulb for successful hair removal. A fine needle is inserted into the hair follicle and a weak electrical current is applied to destroy bulb. There are two types of electrolysis. In galvanic electrolysis direct current is used to destroy the hair bulb. In thermolysis a high frequency alternating current is used to produce heat and cauterize the hair bulb. Hypertrichosis treatments are also offered combining the two procedures.

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Each electrolysis session may extend up to 30 minutes and a number of sittings may be required. Post inflammatory hypopigmentation and hyperpigmentation are common with electrolysis treatment for hypertrichosis. There may be erythema, folliculitis and angioedema at the site of electrolysis. Up to 50% regrowth may be observed after the procedure requiring further sessions.

Laser-assisted hair reduction in hypertrichosis

In laser hair removal, exposure to pulses of laser light destroys the hair follicle by selective photothermolysis. The Food and Drug Administration (FDA) has approved hair removal lasers for "permanent hair reduction". The laser procedure is effective on pigmented terminal hair. Hypertrichosis with lanugo or vellus hairs may not respond to the treatment. In laser-assisted hair reduction side effects like erythema and perifollicular edema are common. In some cases there may be crusting, blistering, hyperpigmentation and hypopigmentation. These side effects are mostly temporary and resolve with skin care measures.

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Reference:
1.Trueb RM. Causes and management of hypertrichosis. Am J Clin Dermatol. 2002;3(9):617-27.
2.Trueb RM. Hypertrichosis. Hautarzt. 2008 Apr;59(4):325-37; quiz 338.
3.Goel N, Rajaram S, Gupta B, Gupta K. Familial congenital generalized hypertrichosis. Indian J Dermatol Venereol Leprol 2013;79:849.

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