Section 18. Skin Disorders

Chapter 207. Hair Disorders

Topics: Introduction | Excessive Hairiness | Hair Loss | Ingrown Beard Hairs

Excessive Hairiness

Different people have widely varying amounts of body hair. A person's age, sex, racial and ethnic origin, and hereditary factors determine the amount of body hair. The definition of "excessive" hair is subjective. In some cultures, hairy men are considered masculine; in others, hairiness is eschewed. Some women detest having any body hair, whereas others are not concerned by it. Rarely, excessive hairiness is present at birth (because of a hereditary disorder) but usually develops later in life. In women and children, excessive hairiness can be caused by disorders of the pituitary gland, adrenal glands, or ovaries that result in overproduction of male hormones. The condition may also result from the use of certain drugs, such as minoxidil, phenytoin, cyclosporine, and anabolic steroids. Porphyria cutanea tarda, an enzyme deficiency disorder (see Section 12, Chapter 160), also may cause excessive hair growth.

Diagnosis and Treatment

Because some medical disorders stimulate excessive hair growth, doctors must distinguish excessive hairiness that is the result of an underlying medical problem from hair growth that is simply a cosmetic concern.

A doctor first looks for other symptoms of excess androgens, such as irregular menstrual cycles, deepening voice, baldness, or features of Cushing's syndrome (see Section 13, Chapter 164), such as a large round face and a pad of fat between the shoulders. If any of these symptoms are present, doctors perform various blood tests to measure levels of certain hormones.

Drugs possibly causing excessive hairiness are discontinued unless this would cause a health problem. If high testosterone levels are determined to be the cause, drugs that block the effects of testosterone, such as spironolactone, flutamide, or finasteride, can be helpful but are rarely used.

Temporary hair removal methods include shaving or clipping the hair. Although shaving does not make hair grow faster, as is sometimes thought, it does make the hair appear thicker. Other common temporary measures include plucking and waxing, which pull the hairs out at the roots, and using a depilatory (a liquid or cream preparation), which chemically removes the hair at the surface. Eflornithine cream substantially slows hair growth in many people and may decrease the need to manually remove hair. Hair bleach may mask excessive hairiness if the hair texture is fine.

Permanent hair removal requires that the hair follicles be destroyed. Electrolysis, in which an electric needle is inserted into each hair follicle, destroys the hair follicles by heat and electrical current. Multiple treatments are often necessary, and many follicles often survive the procedure, allowing hair regrowth. Laser treatments also may reduce unwanted hair (see Section 18, Chapter 215). Although multiple laser treatments may permanently destroy some hair follicles, much hair eventually grows back.