At the Update Pharmacy a young Asian woman has asked Kathy at the cosmetics counter for advice about removal of facial and body hair by laser or electrolysis. Kathy can see that the girl has quite thick, dark hair on her arms particularly, and refers her to Lydia Allen, the relief pharmacist, who is on duty today. In the consultation area, Lydia asks the girl how she can help.

“Well,” she says, holding out her arms, “you can see the hair here. I’ve also got it on my thighs and on my face, although I keep that down by plucking. It’s been getting gradually worse over the last couple of years and I want to get rid of it permanently. So I thought your assistant might be able to tell me about electrolysis or laser treatment, but she passed me on to you.”

“That’s because there might be some medical cause,” Lydia replies, “and Kathy thought I’d be better qualified to find out. So could I ask you a few questions?”

The girl agrees, and Lydia first asks for her age, which is 20, and her height and weight from which Lydia calculates her BMI as 27. She then asks if the girl takes any medication, has ever had a problem with acne or has noticed her hair receding at the forehead. The answer to all of which is no.

Lydia then asks: “Are your periods regular?”

“Well, I don’t have one every month,” is the reply.

Questions

1. What is hirsutism, how common is it and what causes it?

2. Which drugs can cause hirsutism?

3. What was the point of Lydia’s other questions?

4. What drug treatments are available for hirsutism?

5. What information could Lydia give about electrolysis and laser hair removal?

Answers

1. The presence of terminal hair (long, coarse, and pigmented) in women and girls, in a male androgen sensitive pattern. It affects 5 to 15 per cent of women of reproductive age. Androgens, principally testosterone (from the adrenal glands and ovaries), increase hair growth by converting fine, unpigmented vellus hair to terminal hair in androgen sensitive areas such as the face, chest and abdomen.

2. Some combined and progestogen-only oral contraceptives, anabolic steroids and sodium valproate.

3. Acne and/or a male balding pattern may indicate raised androgen levels, to which being overweight can contribute. Reduced or absent menstruation and hirsutism may indicate polycystic ovary syndrome (POS), which causes excessive androgen production.

4. Combined oral contraceptives containing the anti-androgens drospirenone (in Yasmin) or cyproterone (in Dianette); metformin for POS; eflornithine cream, a hair growth enzyme inhibitor.

5. Both processes remove hair for longer than cosmetic methods such as depilatory creams, but only small areas can be treated at a time (eg 25 to 100 hairs per 15 to 60 minute electrolysis session). Treatment is uncomfortable and even painful. Electrolysis should permanently eliminate hairs but there can be up to 25 per cent regrowth. Hair regrows, although less vigorously, after about six months following laser treatment. Both processes are expensive.

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