Cosmetic therapy of hirsutism

Women suffering from hirsutism feel an intensive discomfort. Hirsutism can be caused by elevated androgen levels due to several diseases or by abnormally high sensitivity of the androgen receptors. After exclusion of an underlying disease, pharmacological treatment can be combined with methods for permanent hair removal. In addition to conventional strategies for hair removal, such as waxing and shaving, there are two methods for permanent hair removal which have been accepted by the US Food and Drug Administration (FDA): photoepilation and electrolysis. Photoepilation should be preferred because of lower rates of side-effects, such as scaring, hyperpigmentation and hypopigmentation. However, photoepilation does not work for fair hair color and very fine hair. Photoepilation is mediated by selective photothermolysis of the follicular melanin. Patients must be informed that permanent hair removal is possible but cannot always be achieved. Selection of the appropriate laser system is based on the skin type of the patient. Topical eflornithin cream is a pharmacological alternative for hypertrichosis in the face but has only temporary effects.