Hirsutism

Hirsutism is defined as an excess of thicker darker hairs in a malepattern of distribution where they are normally thin or absent in thefemale. Affected areas are those that are stimulated by circulatingandrogens and include the face, chest, arms, and areolae. This disordermay be caused by several types of endocrine disorders that lead toexcessively high androgen levels or by hair follicles that areparticularly sensitive to normal levels of androgens. The latteraccounts for approximately 95% of all reported cases. An estimated 1 in20 women of reproductive age are affected by this disorder.

Treatment for excessive hair in hirsutism is not generally requiredif no clear etiology of the disorder exists and the patient does notfind the excessive hair growth objectionable. However, treatmentgenerally relies upon antiandrogen to inhibit the effects of androgenson the skin, such as 5-alpha-reductase inhibitors, spironolactone, orflutamide. Whether choosing to treat medically or with any of theaforementioned methods of hair removal, patients must understand thattreatment is long-term and must be continued to maintain low levels ofvisible hair.
Hypertrichosis

A hair growth pattern in a nonandrogen-dependent pattern is termedhypertrichosis and may involve vellus, terminal, or lanugo type hair.This may be associated with a number of congenital syndromes or occuras an isolated finding. What is considered a normal amount andappearance of body hair can vary widely among different ethnic groups,and treatment should be tailored to the needs or desires of theindividual patient. Hypertrichosis may be an unwanted adverse effect ofmedications such as cyclosporine, minoxidil, and oral and topicalcorticosteroids that are used to treat other disorders.

Pseudofolliculitis barbae

When hair grows in a curly and tightly coiled pattern, patients maybe afflicted with numerous ingrown hairs that may cause skinirritation, papules, and pustules. These may eventually lead to changesin pigmentation and even scarring. Pseudofolliculitis barbae occursmost commonly in the underarm or bikini area with shaving, or, in men,at the lower neck, where coarse facial hair grows. Laser hair removalis effective in treating this disorder by temporarily or permanentlyremoving the hair from the chronically inflamed lesion. Laser treatmentleads to resolution and healing of the papular and pustular lesions,dramatically improving skin texture and the associated postinflammatoryhyperpigmentation.

Acne keloidalis nuchae

This condition is most commonly seen in African Americans and ischaracterized by follicular papules and chronic plaques on theoccipital area of the scalp. It may often lead to keloidal thickeningof the skin and permanent scarring. In early lesions, an entrapped hairis usually in evidence, and early treatment with laser hair removal ismost effective at this stage. The entrapped hair acts as a foreign bodyin the skin and, when chronic, can cause skin changes, decreased hairgrowth, and scarring of the affected area. The treatment goals withlaser hair removal for this disorder are to destroy the impacted hairand cause a delay in new hair growth, thus decreasing further scarring.