& Hirsusm Strategies for reducing unwanted November 2013 Dr Paul Farrant Consultant Dermatologist Brighton & Sussex University NHS Hospitals Trust Dealing with unwanted hair

• Hypertrichosis vs Hirsusm • When do invesgate • Physical methods • Medical methods Hypertrichosis

• Congenital vs Acquired

• Generalised vs localised Acquired General Hypertrichosis

• AGH Lanuginosa – Fine downy hair replacing normal terminal and – Assoc GI, lung, breast and bladder malignancy • Non-malignant AGH – Hypo/Hyperthyroid – Head injury – Anorexia/Malnutrion – Drugs eg ciclosporin, minoxidil, psoralens, phenytoin Acquired Localised

• Porphyrias • Topical corcosteroids • Latanoprost/bimatoprost • Fricon • Chronic inflammaon eg eczema Hirsusm

• in a woman in a male paern • , moustache, chest, abdomen • Major impact on QoL • Can be due to xs androgens or increased sensivity • Sudden onset should prompt invesgaon for underlying androgen secreng tumour Invesgaon of Hirsusm

• Wide variaon – may not be necessary • Periods normal? If so probably no need for any! • Total /Free Testosterone/SHBG • LH/FSH • DHEA S • 17 OH Progesterone • 24 hr urinary corsol • Prolacn Self/Salon Treatments

• Bleaching • • • • Depilatory creams • Bleaching

• Not removing • Less noceable • 6% Hydrogen peroxide or 20% ammonia soluon • Yellow hue Plucking

• Good for stray • Shaping • Can induce folliculis • Can be part of compulsion > scarring Threading

• Use of intertwined threads rolled over area of hair • Mulple hairs can be removed • More control • More gentle Waxing

• Good for body, can also be used on face • Large amounts of hair can be removed in one go • Need to let hair grow first • Strip – wax and paper • Strip less – hard wax, thickly applied • Painful Depilatory creams

• Thioglycolates – dissolve sulphur bonds within Keran molecules • Hair weakened and then scraped away • Irritant • Good for body,limbs Shaving

• Seen as a very masculine acvity • Needs to be done regularly=daily • Leaves stubble • Hair has sharp p - rough Physical - Electrolysis

• Treats individual hairs of any colour • Probe enters , current passed, hair gentle removed (painless) • Mulple visits required monthly 18/12-2years • Leads to permanent • Minor irritaon Physical- Laser

• Laser energy absorbed by pigmented part of the hair follicle (the anagen hair bulb) • Needs course of treatment with me intervals so telogen hairs enter back into anagen • Works best for dark hairs • Supplemenng with Eflornithine improves outcome Physical – Laser

• Ruby • Alexandrite • ND-YAG

• IPL Physical – Laser limitaons

• Doesn’t work on fair terminal hairs • Can cause post-inflammatory pigment changes • Limited NHS funding in Skin types V & VI

• Pigmented epidermis acts as a chromophore – Longer wavelengths (deeper penetraon) • 1064 ND YAG – Lower Fluences [100 J /cm2 IV/V, 50 J /cm2 VI] • Test spots – Longer pulse duraons (allow epidermal cooling, between pulses) – Epidermal cooling • Contact or cryogen spray • Refrigerated gels & ice packs Medical

• Weight Loss • Cyproterone acetate • Spirinolactone

• Finasteride/Dutasteride • Flutamide Medical

• Cyproterone acetate – synthec progestogen – Acts as both an-androgen, and inhibits gonadotrophin secreon – Decreases 5 alpha reductase acvity – 2mg combined with ethinylestradiol – 50-100mg day 5-15 – s/e weight gain, breast tenderness, dec. libido, VTE Medical

• Spirinolactone – Reduces bioavailability of testosterone (dec. producon, inc clearance) – Binds to androgen receptor – Decreases 5 alpha reductase acvity – 50-200mg daily dose – Take connuously or 3 out of 4 weeks – Need to avoid pregnancy Medical – Exit strategy

• All medicaons have side effects – may need monitoring • Pregnancy contraindicated need a PPP • Not everyone will respond – need objecve measurements • At what point will you stop treatment? • Who is responsible for long term prescribing, monitoring? Summary

• What type of xs hair are you dealing with? • Is there an underlying cause? • What physical means have been tried? • Are they suitable for laser or electrolysis? • Have a long term strategy for medical management?