Treatment of Hirsutism In Women

Unwanted Facial Hair Facts

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Vaniqa Facial Hair Medication

VANIQA TREATMENT FOR UNWANTED AND EXCESS FACIAL HAIR IN WOMEN
Everything You Need To Know About Unwanted Facial Hair In Women
Facts And Information About Unwanted Or Excess Facial Hair In Women
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Treatment of Hirsutism In Women

Overview

The most important evaluation for the patient with hirsutism is to determine the source of the androgens. In the constitutional familial type there will be no obvious increase in androgens but essentially end organ sensitivity. In searching for abnormalities in the production of hormones in the adrenal glands and ovaries there are useful markers that can be tested in the blood.

If the hirsutism starts abruptly and progresses very quickly the suspicion for ovarian, adrenal or pituitary tumours is much higher. If the hirsutism is associated with the nipples, or the sides of the face and neck, androgens are usually ovarian in origin whereas those associated more with the upper abdomen, anterior chest, side of the neck and chin usually are adrenal in origin. The excess hair on the sides of the face and the back tend to be drug related.

In evaluating the patient with hirsutism the testosterone level needs to be checked. If the testosterone is normal or slightly elevated this can be part of constitutional hirsutism. If there is a slight elevation in the DHES this is ovarian in origin. If the DHES is increased and the cortisol level reduced this is seen in adrenal hirsutism. Prolactin levels are elevated in hyper-prolactinemia. If the testosterone levels are moderately elevated the possibility of polycystic ovary has to be considered. Markers for adrenal gland activity can show increased cortisol and DHES. To evaluate the ovarian source of elevated testosterone CT scans and ultrasound studies of the ovaries can be helpful to try to determine if there are any solid tumours.

To rule out any underlying medical conditions

Suspect further tests need to be done if

·	Rapid increase in hair growth

·	Sudden onset of hair growth

·	Signs of virilization (deepening voice, cliteromegaly)

·	Signs of Cushing's syndrome

Self Treatment of Hirsutism

Tweezing : Plucking out the hair. It is quick, inexpensive convenient for small areas. Painful, needs to be done frequently, sometimes daily. May develop ingrown hairs as twisting of the hair follicle can cause future hair to become embedded in the skin.

Shaving: Shaves hair off at the level of skin. Quick, easy, painless inexpensive and can be used for large areas. There is a stigma associated with this for some. It leaves stubble that can be both seen and felt. Gives the shortest benefit. Cuts can occur. Folliculitis is sometimes seen as well as razor bumps. It will not make the hair grow thicker although the sharp cut ends can be more easily felt.

Waxing : Pulls hair out from the root by waxing or sugaring. Quick, convenient home kits are available. It is painful and can be messy. A disadvantage is that the hair has to grow to a certain length for it to work. It may also cause burning.

Bleaching : A cream is applied to the hair which removes the dark colour. Quick (15-20 mins), painless and easy. Skin must not be broken, chapped or recently tweezed. It can burn and rarely an allergy may form. It has a strong smell. Hair bleaching can be performed using either 6% hydrogen peroxide or 20% ammonia solution.

Home Electrolysis : Electric current applied through a pair of tweezers. Good for small areas. Fast. Painful. May last for many weeks or months. Can be costly and may produce persistent discoloration.

Epilatories : Rubber roller or coiled spring that catches the hair so it can be pulled out from the roots. Quick, painful.

Depilatories : Chemical agents that dissolve the sulfur bonds that holds the hair together The cream or lotion is applied to the hairy area and left on for a few minutes. A fast method giving results fro up to 2 weeks. It can be irritating to the skin producing dermatitis. The risk of scarring is small although there may be some persistent pigmentation.

Hirsutism Treatment - Growth Inhibitors

Vaniqa

This is a new drug that blocks an enzyme that is required for the growth of hair.

·	Approved use : Used for the treatment of female facial hair. The history of this drug is interesting in that it was first used for African sleeping sickness.It no longer is the drug of choice for this use.

How does Vaniqa work? : It inhibits the enzyme ornithine decarboxylase(ODC) which is a required enzyme for hair growth.It reduce the rate of hair growth .It does not remove hair but blocks the production of hair shaft protein as well as stopping the growth of the hair matrix cells after they have been stimulated by androgens blocks the conversion of the protein Ornithine to Putrecine. The drug is applied as a cream to the skin Less than 1% is absorbed through the skin and this is excreted unchanged by the kidneys. It does not accumulate in the plasma. This drug is not genotoxic, not carcinogenic, no photo carcinogenic and not teratogenic.

·	How is the drug used? : Apply twice a day to the area to be treated. It can be combined with other treatments to enhance the effectiveness of both treatment modalities.

·	Is Vaniqa a prescription only drug? : YES

·	Can Vaniqa be used in all groups' women regardless of race or colour? : YES

·	Does Vaniqa interact with other topical medications? : No interactions known

·	Can Vaniqa be used with various hair removal methods? : YES

·	Can Vaniqa be used whilst pregnant or during breast feeding? : No evidence to suggest a problem but it is best to avoid in both situations.

·	How much Vaniqa should be used? :A pea sized amount twice a day. Not more than30g per month

·	Can Vaniqa be used in other parts of the body? : At this time it is indicated only for unwanted hair on the face

Combination therapy with laser - 2 studies

Reported at American society of Laser Medicine and Surgery Abstracts 2003 105:32.
Hair removal with combined Alexandrite laser and Vaniqa was superior to removal of unwanted facial hair with laser alone

Reported at 61st annual Meeting of the Academy of Dermatology San Francisco 2003(Poster 649)
"Concomitant use of Vaniqa and laser(1064nm Nd-YAG and a 755nm Alexandrite laser) showed synergistic effect with greater benefit, both with r respect to onset and degree of removal, for the initial period(22weeks) of hair removal therapy. Patient satisfaction clearly supported the use of combination therapy"

Studies with Eflornithine

Two Efficacy and safety phase 111 trial of Vaniqa in the treatment of women with hirsutism

reported in Annual meeting of the American Academy of Dermatology 2000. Vaniqa shown to be superior to placebo at 24 weeks in 176 women on the active drug compared with 92 on placebo The other study showed 73% had improvement compared with 44% in the placebo group. 67% of women had shown improvement compared with 39% in the vehicle only group.
The longer the study went on the better the results. The benefit only lasted as long as the treatment was used. There was an improvement in the quality of life measurements
The adverse events were mild and transient

Study on long-term(12 month) safety in women with Vaniqa with excessive facial hair
No serious side effects were seen. 1% discontinued because of adverse events. 42% experienced mild side effects

Most frequent side effects reported

·	Dry skin 7.4%

·	Alopecia 6.5%

Acne 6.9%

·	Headache 6.0%

·	Pruritus 5.1%

·	Burning skin 4.6%

·	Stinging skin 4.2%

·	Ingrown hair 3.7%

Rash 3.2%

·	Tingling skin 3.2%

·	Erythema 2.3%

·	Edema 1.4%

Physical Treatment of Hirsutism

Physical treatments offer some advantages. They can be expensive. They vary according to the expertise of the operator. With the popularity of laser hair removal many spas and estheticians offer this treatment. The level of expertise and competence is not always ideal. Lasers should be used where there is always a doctor on site to supervise therapy so that the appropriate laser is used at the best power setting and that any adverse side effects are properly dealt with.

Electrolysis : This is a method when a very fine needle is inserted into the hair follicle and a pulse of electric current is passed through the hair in order to destroy the root. This is a very technique sensitive treatment. The results and safety will depend much on the operator. One hair is treated at a time. Some hairs will be permanently destroyed or reduced. It is a slow painful procedure that requires many repeat treatments. There is a risk of scarring and sometimes infection. It is best used for small areas.

Laser - high intensity high energy single wave length of light : The advent of laser hair removal has given individuals a significantly new option - laser hair removal uses a red light which is absorbed by black or brown pigments. Lasers such as the long pulse Alexandrite laser (GentleLASE) or the long pulse YAG laser (LYRA) target the pigment in the base of the hair follicle. The absorption of the laser energy is confined to the pigment, self damaging the hair root but not the surrounding skin. This process is called selective photo-thermolysis. The laser energy passes through the entire skin. In order to protect the very surface of the skin epidermis, cooling devices and cooling sprays are used. This protects particularly against pigmentary changes following the laser treatment. Intense pulsed light therapy can also be used. Instead of a single wavelength of light a non coherent band of light at high power is used. Usually many treatments are recquired. The hair is trimmed or shaved. It will not be plucked or waxed as the melanin target which is the hair root has to be present or the laser light to be absorbed. A treatment for the upper lip will take about a minute whereas a leg may take 20 mins. Lasers work best for those with fair skin and dark hair. There is permanent hair reduction and in some cases permanent removal. Hair on the upper lip and particularly on the chin need many treatments as they are in very hormone sensitive parts of the skin. In some chin hair cannot be fully treated. The fine vellus type hair which can be extensive on the cheeks of menopausal and older women does not respond well to laser. Much larger areas of skin can be treated compared with electrolysis. Treatments are painful but local anesthetic creams can be very helpful. Be suspicious of centers that promise a guarantee of permanent removal as it is not always possible. There is a risk of scarring and blisters can occur however pigmentation changes after treatment is much more common than scarring. This can be reduced by not treating if the skin is tanned. Whilst the cost of laser treatment can be high it may in many instances be cost effective. The most important factor is that the correct laser is used in the right situation and that they are used at the appropriate power setting.