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Hair-Raising Problem: Excessive Hair

From Medscape

Robin K. Levinson, Medical Writer

Thanks in part to TV talk shows that plumb the deepest intimacies of our lives, almost any topic is fair game for discussion nowadays: infidelity, abortion, baldness, depression, obesity, erectile dysfunction, and every disease imaginable.

Despite all this openness, one subject remains a virtual taboo: excessive hair growth.

When was the last time your best friend confessed distress over her hairy nipples or the unsightly dark hair between her breasts, on her chin, or under her nose? More likely, she shaves, plucks, bleaches, or applies chemical depilatories behind a locked bathroom door. Or she quietly seeks laser hair removal, waxing, or electrolysis.

"Many women don't even tell their husbands they're going for electrolysis treatment," says Teresa E. Petricca, executive director of the American Electrology Association. Petricca worked as a certified professional electrologist for 28 years.

Hirsutism--excessive hair growth in women--is not uncommon, doctors say, but there are no accurate estimates of its prevalence. "Many specialists define it differently. There are no population-based studies, and each specialist sees a different population, so the estimates are always changing," explains Amy McMichael, assistant professor of dermatology at Wake Forest University School of Medicine in Winston-Salem, NC.

Blame It on Hormones

Hirsutism can range from a few dark chin hairs to a miniature mustache and sideburns to a full beard and hairy chest.

In most cases, hirsutism is a symptom of elevated blood levels of male hormones (androgens) being produced by the adrenal glands or ovaries, says Maria New, chairwoman of pediatrics and chief of endocrinology at Cornell Medical Center in New York City. Sometimes, the hormone levels are normal but certain hair follicles are thought to be hypersensitive to the androgens testosterone and androstenedione. In rare instances, an androgen-secreting tumor or polycystic ovarian disease is to blame. Occasionally, no cause can be found. According to Dr. McMichael, hirsutism can begin at any age, but most patients develop symptoms during their childbearing years.

"In young girls who have not yet reached puberty, hirsutism is serious and could be a sign of a hormone-secreting tumor," Dr. McMichael told physicians at a recent meeting of the American Academy of Dermatology. In postmenopausal women, sudden or severe hirsutism could also be caused by an androgen-secreting tumor.

Many women who have become hirsute assume the hairiness is hereditary and never ask a physician about it. Fortunately, hirsutism is rarely a sign of a serious health problem. If, however, excessive or rapidly growing hair appears suddenly in areas where women do not typically grow hair, and if this growth comes with irregular periods, lack of menstruation, acne, or other symptoms, the patient should consult a dermatologist, gynecologist, endocrinologist, or internist as soon as possible, Dr. McMichael advises.

Hirsutism can range from a few dark chin hairs to a miniature mustache and sideburns to a full beard, hairy chest, and even male-pattern baldness. The emotional impact of hirsutism can be extreme.

Feeling "Unfeminine"

"Women often feel unfeminine, embarrassed by the hair, and it can affect job performance, mental health, and desire to interact with others," Dr. McMichael points out. To adolescent girls with hirsutism--especially to those who find wads of hair in their brushes or clumps of hair on their pillow--the condition can be downright terrifying, according to Dr. New.

Terrifying, but far from hopeless.

Karen, 39, a healthcare professional in New Hampshire who declined to give her last name, conquered her hirsutism by using an androgen-blocking medication called spironolactone (Aldactone), birth control pills, and electrolysis. Several other drugs are used to combat hirsutism, including Lupron (leuprolide) and flutamide. Dr. McMichael notes that the effectiveness of any medication is determined by the patient's particular problem. In patients with no measurable hormone abnormality, she says, "these drugs are sometimes completely ineffective."

New Treatment Weighed

The newest technology--laser hair removal-- provides long-term but not permanent results.

To help these individuals, Dr. McMichael joined a team of researchers to investigate the effectiveness of a new topical cream formulated to slow hair growth on the face of a hirsute woman. Developed by Bristol-Myers Squibb Co. and Gillette Co., the cream--to be called Vaniqa--is currently under FDA consideration for approval, she says. If approved, Vaniqa would join the bevy of aforementioned hair-removal methods. (For an overview of each method, visit

Of all the options, Petricca says that electrolysis is the only way to permanently remove hair. According to the Food and Drug Administration, the newest technology--laser hair removal-- provides long-term but not permanent results, although certain lasers provide "permanent hair reduction," according to FDA literature.

Before investing hundreds or thousands of dollars in sophisticated hair-removal treatments, girls and women with hirsutism should try to discover the source of their excessive hair growth, New and Petricca advise. In most cases, the best approach is attacking hirsutism from the inside and the outside simultaneously.

"We often have to start by finding the cause, administering the medication indicated, giving them laser treatment to get rid of what now exists, and hope that our treatment of the hormonal difficulty prevents recurrence," Dr. New says.

Karen says that getting rid of her unwanted hair was time consuming but well worth the wait. "I was definitely more hesitant meeting new people" before getting treated, says Karen, who recently got engaged. "I didn't want people to get too close ... I was definitely self-conscious about it."

Her message to other women with hirsutism: "There's something you can do. You don't have to get a job at the local zoo."

© 2000 by Medscape Inc. All rights reserved.

Robin K. Levinson is a freelance health writer and editor. She has co-authored seven consumer health books, most recently, Safe Eating: Protect Yourself Against E. Coli, Salmonella, and Other Deadly Food-borne Pathogens (Dell, 1998).

Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. BIDMC does not endorse any products or services advertised on this Web site.

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