Laser Hair Removal

The Evaluatıon Of The Haır Removal Patıent Is Essencıal
In Order Not To Overlook Any Possıble Medıcal Causes

Many individuals seeking laser hair removel are in good health. However alterations in human biology may lead other individulas to seek laser hair removal. The development of localized or diffuse unwanted excess hair may ocur in association with many inherited syndromes, as well as with the use of certain medications, or the presence of ovarian or adrenal tumors. Excess hair may also be seen as a normal genetic variant.

Hypertrichosis is the presence of increased hair in man and woman at any body site.

Hirsutism

Hirsutism is defined as the presence of excess hair in woman only at androgen-dependent sites. Hirsutism is most commonly seen on the upper chin, chest, inner thighs, back, and abdomen. Hirsutism is caused by diseases of androgen excess or by the intake of certain medications. The most common causes are polycystic ovary syndrome and idiopathic hirsutism. The diseases of androgen excess are usually pituitary/adrenal or ovarian in source. Elevated levels of adrenocorticotrophic hormone which increase the adrenal secretion of cortisol, aldosterone and androgens, are a rare cause of hirsutism. Adrenal cause of hirsutism include virilizing types of congenital adrenal hiperplasia and adrenal neoplasms. PCOS is the most common cause of a disease-defined hirsutism. 70% of hirsutism cases show hirsutism. The severity of androgen effect ranges from mild hirsutism to virilization. Hirsutism may also be caused by androgen-producing ovarian neoplasms. Since insulin stimulates ovarian androgen production, another ovarian cause of hirsutism is insulin resistance with its resultant hiperinsulinism.

İdiopathic hirsutism is a diagnosis of exclusion. Total testosterone levels in idiopathic hirsutism may be normal, though free testosterone levels are high. Emotional stress may cause idiopathic hirsutism.

Hypertrichosis

Anorexia nervosa and hypothyroidism may cause hypertrichosis. Patients with anorexia nervosa frequently develop fine, dark hair growth on the face, trunk, and arms, which at times is extensive. In hypothyroidism the hair growth is of the long fine, soft unpigmented type.

All races have similar androgen and estrogen levels, despite the striking differences in amounts of body hair. Whites have more hair than do blacks, asians, and native americans. The number of hair follicles per unit of skin varies among the ethnic groups. Mediterranean, nordic, asian. Asians rarely have facial hair or body hair outside the pubic and axillary regions. White woman of mediterranean than do those of nordic ancestry (blond, fairskinned). Thus a wide range of normal hair growth exists for man and woman, largely based on racial and ethnic predisposition.

Evaluation Of The Hirsute Woman

Althought the overwhelming majority of patients seeking laser and light source hair removal are perfectly healthy, or present with idiopathic hirsutism, a clinical history must be undertaken to rule out those serious diseases that cause hirsutism. Histories that suggest a potential serious underlying disease include

1. The onset of hirsutism that is not peripubertal
2. Abrupt onset or rapis progression of hair growth
3. Virilisation with associate acne, male-pattern baldness, deepening of voice, increased muscle mass, decreased breast size amenorrhea cliteromegaly, or increased sexual drive

If such a history is provided, a full medical evaluation is mandatory.

A careful drug history is also very important. Simple changes in drug regimens may be all that is necessary to reverse unwanted new onset hair growth.

It can be seen that although the patients cosmetic feelings about unwanted hair growth must be considered, the physician must always be alert to rule out the possible medical causes of excess hair growth.

Prior to advent of laser and light source technology, treatment options for hair excess included treatment of associated diseases, suppression or blocking of androgen production and effect, and a variety of frustrating and/or protracted cosmetic measures.