Adjuvant eflornithine to maintain IPL-induced hair reduction in women with facial hirsutism: a randomized controlled trial.

BACKGROUND: Photoepilation is the treatment of choice for hair removal in patients with hirsutism, but it remains a challenge to prevent regrowth of hairs. OBJECTIVES: The objective of this study was to investigate whether topical eflornithine maintains hair reduction in hirsute patients after cessation of intense pulsed light (IPL) therapy. METHODS: A randomized, split-face, single-blinded controlled trial on topical eflornithine vs. no eflornithine treatment (control) after 5-6 IPL-treatments in 22 women with facial hirsutism. Application of eflornithine was initiated after the final IPL-treatment (baseline) and applied twice daily for 6 months to half of the face. Patients were assessed at baseline and 1, 3 and 6 months after the final IPL-treatment. The primary endpoint was difference in facial hair counts between eflornithine vs. no treatment. Secondary endpoints were patient-evaluated efficacy, patient satisfaction and safety. RESULTS: A total of 18 patients completed the study protocol. At 1 month after final IPL-treatment, eflornithine reduced hair regrowth by 14% (P = 0.007, n = 20 patients), at 3 months by 9% (P = 0.107, n = 19) and at 6 months by 17% (P = 0.048, n = 18) compared to no treatment. Patient-evaluated efficacy supported blinded hair counts and patients were satisfied with eflornithine treatment throughout the study (median VAS 5-6). Eflornithine was generally well tolerated, but blinded evaluation demonstrated deterioration of acne in two patients at final assessment. CONCLUSION: Topical eflornithine provides a self-administered treatment with a potential to maintain IPL-induced hair reduction in hirsute patients.

Hair growth induced by diode laser treatment.

BACKGROUND: Although hair reduction by long-pulsed red and infrared lasers and light sources is generally quite effective, paradoxical hair growth has rarely been observed following treatment. OBJECTIVE: To report a case of thick hair growth following 810 nm diode laser treatment and its subsequent treatment. METHODS. A 24-year-old man who had previously had laser hair reduction on his posterior neck was treated to a test area on his upper back. RESULTS: Thick terminal hair developed in the treated area subsequent to laser treatment. Further treatment of this area removed the terminal hair but resulted in terminal hair growth in an annular distribution surrounding the treatment site. CONCLUSIONS: Diode laser treatment rarely stimulates terminal hair growth. This phenomenon should be studied to better understand hair growth cycles and to help develop more effective treatments for hair loss and hair growth.

Antihirsutism activity of Fennel (fruits of Foeniculum vulgare) extract. A double-blind placebo controlled study.

Idiopathic hirsutism is defined as the occurrence of excessive male pattern hair growth in women who have a normal ovulatory menstrual cycle and normal levels of serum androgens. It may be a disorder of peripheral androgen metabolism. In this study we evaluated the clinical response of idiopathic hirsutism to topical Fennel extract. Fennel, Foeniculum vulgare, is a plant, which has been used as an estrogenic agent. The ethanolic extract of Fennel was obtained by using a soxhlete apparatus. In a double blind study, 38 patients were treated with creams containing 1%, 2% of Fennel extract and placebo. Hair diameter was measured and rate of growth was considered. The efficacy of treatment with the cream containing 2% Fennel is better than the cream containing 1% Fennel and these two were more potent than placebo. The mean values of hair diameter reduction was 7.8%, 18.3% and -0.5% for patients receiving the creams containing 1%, 2% and 0% (placebo) respectively.

Low-dose (2.5 mg/day) finasteride treatment in hirsutism.

This study was performed to confirm the therapeutic effects of low-dose, (2.5 mg/day) finasteride in hirsute women. Our study was a non-randomized prospective clinical trial. Twenty-nine patients with hirustism were included in the study. The patients received 2.5 mg finasteride once a day over a period of 12 months. Follicle stimulating hormone, luteinizing hormone, sex hormone binding globulin, 17 alpha-hydroxyprogesterone, estradiol, androstenedione, total and free testosterone, dehydroepiandrosterone sulfate levels and hirsutism scores were determined in all patients before treatment and at every 6 months during the therapy. The hirsutism score decreased from a mean of 18.4 +/- 4.6 to 8.4 +/- 4.2 during the study. The per cent reduction in hirsutism score (mean +/- SD) at 6 and 12 months was 29.2 +/- 14.5 and 55.7 +/- 14.9%, respectively. There were no significant differences in any of the hormone levels and no serious side-effects were observed during the treatment. In conclusion, low-dose finasteride (2.5 mg/day) is a cost-effective, well-tolerated therapeutic agent without significant abnormal biochemical findings and can be used in place of high-dose (5 mg/day) finasteride in the treatment of hirsutism.

Side-effects after IPL photodepilation.

BACKGROUND: Intense pulsed light (IPL) has been successfully used as an efficient hair removal system; however, possible side-effects have been not specifically addressed in the literature. OBJECTIVE: To assess all possible side-effects after IPL hair removal in a series of 49 females with facial hirsutism during a total of 390 treatment sessions of IPL photodepilation. METHODS: Immediate post-treatment clinical, photography evaluation, and a two-month post-treatment questionnaire were done in 49 females with facial hirsutism submitted to photodepilation with an IPL source (EpiLight trade mark, ESC, Israel). RESULTS: Side-effects observed were: transient erythema (n = 30), late evanescent erythema (n = 3), mild pain (n = 43), moderate pain (n = 6), crust formation (n = 9), superficial burning (n = 1), isolated vesicles (n = 3), transient hyperpigmentation (n = 8), transient hypopigmentation (n = 1), paradoxical effect (n = 5), persistent local heat sensation (n = 1), and minimal scar (n = 1). CONCLUSION: Even though common, most side-effects secondary to IPL photodepilation are mild and transient. Permanent side-effects such as scars are unlikely but they may occur. Growth of new, fine and dark hair may be seen in untreated areas in close proximity to the treatment area, especially in the neck, a side-effect that is reported for the first time in the literature.

Paradoxical effect after IPL photoepilation.

BACKGROUND: Intense pulsed light (IPL) is an effective and safe hair removal method. However, it is not exempt from side effects. OBJECTIVE: To evaluate clinical and hormonal characteristics of females with facial hirsutism that developed hair growth in untreated areas close to the area submitted to IPL photoepilation ("paradoxical effect"). METHODS: A total of 49 females with facial hirsutism were included in a protocol of photoepilation with an IPL source. Hyperandrogenism of tumoral origin was excluded in all subjects. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-OH-progesterone (OHP), and sex hormone binding globulin (SHBG) were determined prior to IPL treatment. Clinical and photographic evaluation was performed immediately before each treatment session and 2, 6, and 9 months after the last treatment session. Only cases with "paradoxical effect" were included in this study. RESULTS: A total of five patients with "paradoxical effect" were identified. The patients' ranged in age from 13 to 44 years and all of them had skin phototype III (Fitzpatrick scale). All these subjects were diagnosed with polycystic ovarian syndrome and presented ovarian hyperandrogenism. Patients underwent six to nine IPL sessions, and "paradoxical effect" appeared at different times during the protocol, between treatment session 3 and 6 months after the conclusion of treatment. CONCLUSION: IPL may induce activation of dormant hair follicles in untreated areas close to hirsute-treated areas.