C3 Hair Reduction:
HAIR REDUCTION USING LASER- AND FLASH LAMP DEVICES
Wyss M
Dermatologist FHM, Meilen, Switzerland

Hypertrichosis is the term used for the growth of hair on any part of the body in excess of the amount usually present in persons of the same age, race, and sex, while the term hirsutism is reserved for androgen-induced hair growth in women. In their generalized and circumscribed forms, hypertrichosis and hirsutism may either be isolated findings, or may be associated with other abnormalities. Therefore accurate classification and endocrinologic work-up as indicated are essential. Excessive hair may cause cosmetic embarrassment, resulting in a significant emotional burden, particularly if extensive. Patients should be adequately advised of the available treatment modalities for temporary or permanent hair removal. No single method is appropriate for all body locations or patients, and the one adopted will depend on the character, area and amount of hair growth, as well as on the age of the patient, and personal preference. The current available physical methods for hair reduction include cosmetic procedures (trimming, shaving, plucking, waxing, chemical depilatories, and electrosurgical epilation), and techniques using light sources and lasers. Hair removal with laser- and flash lamp devices is the most efficient method for long-term hair removal and now a well-established method to treat hypertrichosis, hirsutism, and pseudofolliculitis. Highly satisfactory results can be achieved, if patients are well informed and have realistic expectations. Lack of comparative data make it difficult to choose the most effective system, though the color contrast between epidermis and the hair shaft will determine the type of laser to favour. An overview of different types of laser- and flash-lamp devices is given, including novel indications and side-effects.

ENDOCRINOLOGIC ASPECTS OF HIRSUTISM AND PHARMACOLOGIC TREATMENT
Kopera D
Department of Dermatology, Medical University of Graz, Austria

Hirsutism represents androgen dependent differentiation and growth of hair in females leading to male pattern hair growth in certain body areas. It can be defined either as primary hirsutism when serum androgen levels represent normal ranges or as a second line symptom created by increased serum androgen levels also developing various other symptoms of virilisation. The majority of patients reveal the primary variant developing hypertrichosis due to genetically determined relatively increased sensitivity of the hair follicles as a target structure to all androgens. Thus, driving from the ovary as well as from the adrenal glands they can be ranked in quantitative terms: dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), androstenedione (A), androstenediole, dihydrotestosterone (DHT) and testosterone (T). These substances may also create the typical symptoms of androgenetic alopecia, seborrhea and acne. Established hormonal treatment of hirsutism includes the systemic application of estrogens and antiandrogens. Finasteride, spironolactone and many other substances have been used. Still, the most effective antiandrogenic drug so far is cyproteroneacteate. Combined with estrogens this substance is more or less effectively used for the treatment of hirsute patients, even if it is currently not available in all countries. The efficacy of topical preparations of estrogens and antiandrogens is still a matter of discussion. A newer pharmacological approach in the management of hypertrichosis is topical application of hydrating preparations containing eflornithine. Inhibiting the enzyme ornithine decarboxylase it specifically cuts down the mitotic abilities of the hair follicles leading to sufficient hair reduction during the treatment phase. Hair growth returns to pre-treatment rates within weeks after stopping regular application. Pharmacological treatment options can be combined with laser or intensive pulsed light application for the management of hypertrichosis in order to achieve sufficient hair reduction.