Hirsutism

Problem: Hirsutism

Hirsutism is a condition in which women have excessive and unwanted male-pattern hair growth. It is a common disorder that affects approximately eight percent of women.1 Women who suffer from hirsutism may experience extreme hair growth on various areas of the body including the face, neck, chest and abdominal region. Studies have shown that of women with apparent hirsutism typically 10 percent present hair on the chest, 22 percent present with hair on their chin, and 49 percent present with hair on the upper lip.


This excessive hair growth is often the result of a condition that is not life-threatening; however, it can signal a serious pathology and should be monitored by a physician if the hair growth is rapid or if it is accompanied by other male features such as acne, deepening voice, increased muscle mass, and decreased breast size.
Risk factors for hirsutism include family history and ancestry. Some of the conditions that cause hirsutism, such as congenital adrenal hyperplasia and polycystic ovary syndrome, have a tendency to run in families and women of Mediterranean, Middle Eastern and South Asian ancestry. In these cases, the onset of the hirsutism is often apparent during puberty with gradual progression over the years following. The ethnic background, as well as distribution and density of hair growth, determine the degree of hirsutism. The age at onset, rate of growth and progression, and associated symptoms and signs can determine the severity of the problem.
Most of the time, the condition has no physical complications. In fact, the most devastating effects of the condition are often the psychological and emotional effects. Many women feel self-conscious about the presence of unwanted body hair and find it to be embarrassing and emotionally distressing.
Since the causes of the condition are typically benign, cosmetic treatment is often the only type of treatment that is required. In cases where medical treatment is employed, cosmetic treatment is often used in conjunction with the medical treatment because it is faster and, therefore, more effective in treating the emotional component of the condition.

Resources:

1 Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R . Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83:3078–82

Case Study:

A new client comes to see you for a consultation. The apparent growth of excess hair on her face is troubling her and she is looking for treatment options. She is 17 years old and explains that her facial hair has been thickening and getting darker since she started puberty at the age of 12. She is of Middle Eastern heritage and shares that there is a family history of excessive hair growth. She is very embarrassed by her excess facial hair and says that the students at school tease her. She is going to be a senior in high school this fall and wants to eliminate her facial hair before she takes her senior photographs.

As a skin care professional, what solution would you propose to treat
this case study on hirsutism?

Solutions:

Carmella Hammond, CPHI (C), owner of North London Electrolysis and Laser

“The treatment plan I would propose to this young lady with hirsutism would be electrolysis. I would explain that she is not alone and that facial hair is very common in women. I would explain that she has contacted the right place and that electrolysis is the best method to eliminate unwanted hair permanently, provided that the treatment schedule is followed.
The treatment program would start with short appointments, initially, to ensure the skin’s integrity is maintained and to ensure there are no adverse reactions. Treatments would increase to bi-weekly appointments in order to clear the hair from the face. As treatments progress, the amount of hair would be significantly decreased and any new growth or regrowth would be quickly removed.
The client would start to feel better and more confident as the hair diminishes. As the time gets closer to the day that senior photographs will be taken, the hair will no longer bother this young lady because it will be well on its way to being gone.”

Catherine Kooiman, L.E., founder of Sweet Professional®

“I would first sympathize with this client as this disorder is extremely emotionally painful. I would want to gain her trust and help her to feel comfortable with me first by explaining to her that I am happy to help her and will find a solution together to improve this bothersome issue for her.
Once the appropriate background information was taken and hirsutism was of concern, I would inform her that removing the unwanted hair could actually hinder a physician in accurately diagnosing this condition to properly help her. I would urge her to seek a physician to care for her condition first and foremost to properly diagnose her. Hirsutism can involve serious medical conditions and the unwanted body hair that brought the client to me is something that can be addressed once a proper diagnosis and physician's care has been completed.
Once under a physician's care, I would be comfortable treating the client with organic sugaring for hair removal techniques as I feel that is the most safe and effective form of hair removal to help rid clients of unwanted body hair.”

Kathleen Carney, CEO of Skin Blends LLC

“Excess facial hair has been a problem for many women worldwide forever. I think this client should have her doctor do a hormone test to make sure her hormones are in balance. After she fills out the consent forms and we make sure that it is safe for her to have waxing done, I could easily remove her facial hair that day with a gentle wax made specifically for the face.
First, I would cleanse her skin and then I would apply a little bit of oil so the wax will pull only hair and not skin. It will feel like I am pulling off a Band-Aid, but it will be quick and then the hair will be gone instantly! But it will grow back and she will need to come and see me every four weeks.
If she wants to have permanent hair reduction, we can do a laser hair removal treatment in two weeks and rotate the treatments to get the best of both worlds – instant and permanent. She must promise to wear at least SPF 30 broad spectrum sun protection.”

Dr. Marina Peredo, associate clinical professor of dermatology at Mount Sinai Hospital in New York and founder of Spatique Medical Spa in Smithtown, N.Y.

“In a case like this, it is important to keep in mind that hirsutism can be embarrassing for women of any age, particularly a teenage girl, and it is difficult for one to even address their concerns with a professional.
During the consultation, put the client at ease by explaining that what she is experiencing is more common than she may realize and, more importantly, is treatable in time for her big moment. It is imperative to share all options of treatment including the benefits and possible set-backs of at-home treatments, so that she can feel in control and involved in the decision of her treatment plan.
I would recommend laser hair removal as her best option, as treatments like plucking, shaving and depilatories may cause irritation, folliculitis and hyperpigmentation. I would also recommend a consult with a dermatologist to discuss prescription topicals that slow the rate of hair growth significantly.”

Emily Fritchey, president of Sunshine Botanicals LLC

“Over the years I have treated many clients with excessive facial hair growth (hirsutism). Fortunately, nature provides us with several highly effective botanicals and natural treatment options that can help combat this difficult condition.
The botanicals that I would incorporate into a herbal, nutritional-based treatment protocol for this particular metabolic imbalance are: Saw Palmetto (Serenoa repens), which helps break down testosterone so that any excess within the system can be recycled or excreted. Chaste tree (Vitex agnus castus) standardized extract because it has anti-androgenic effects. Green tea because recent scientific evidence suggests that it may also be helpful for treating hormone-related hirsutism. Cinnamon since it has some extraordinary properties that may help increase insulin sensitivity and thus treat hirsutism in insulin resistant women. Romaine lettuce because it is packed with the trace mineral chromium, which is a component of the glucose tolerance factor (GTF). And sunflower seeds, which are supercharged with hirsutism-fighting nutrients! Sunflower seeds contain high levels of vitamin B2 (riboflavin) and vitamin B5 (pantothenic acid), a stellar nutrient combo for fighting unwanted body hair."

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