Hirsutism: male pattern hair growth
What is it?
Hirsutism is characterised as excessive terminal hair growth in androgen-sensitive hair follicles (male pattern hair growth), typically appearing on the face, back, chest and abdomen.This condition has a 70-80% prevalence in PCOS patients due to the comorbidity of hyperandrogenism [30].
Hirsutism occurs due to the unnatural extension of the anagen phase of hair growth (development stage), which results in the transformation of vellus hairs (fine colourless hair) into terminal hairs (thick, coarse, coloured hair) [30] [31]
The clinical presentation/ appearance of hirsutism can be highly distressing for the affected individual and can lead to a surplus of anxiety and depression, self-isolation, and low self-esteem [23]. Additionally, the maintenance of hirsutism is exhausting, frustrating and burdensome, furthering the mental strain of the symptom. [39]
How does it occur?
​
Hirsutism occurs because of elevated androgen levels and androgen-sensitive hair follicles in women with PCOS.
When the hair is developing within the hair follicle, many mechanisms are involved in production and nutrient delivery, including blood and oxygen provided from the dermal papilla connecting to the bulb (root) of the hair, and stem cells that reside in the bulge/ pocket of the hair follicle [33]
Androgens are responsible for the activity of hair follicles; excess androgens can prolong the anagen phase of hair, which is the growing and developmental stage of hair, and enlarge the hair follicle [33]. Larger hair follicles and a more extended anagen phase lead to the development of thicker, darker, and longer terminal hair in the affected follicles. [34]
Treatment options
In conjunction with oral contraceptives and anti-androgens, physical hair removal is often used to remove the excess hair; this may include shaving or waxing; however, these are not permanent options [42]
Light-based hair removal (LBHR) is a viable option for semi-permanent to permanent removal, reduction, and management of hirsutism [42]
How does it work?
Laser and light-based modalities (IPL) work by emitting high photonic energy onto the skin. The light uses wavelengths that are highly attracted to melanin (pigment/colour) of the hair. [30]
Melanin in the hair resides in the bulb (root) of the hair, which is connected to the dermal papilla (blood supply). As the light is emitted onto the skin, the melanin in the hair bulb engulfs this light and generates heat. The immense energy absorbed by the melanin exerts the bulb's heat capacity, leading to the demise and detachment of the hair root. [30] [45]
This process results in the inhibition of new hair growth and development, additionally the heat generated in the bulb of the hair disperses into the remainder of the hair follicle, which includes the bulge of the hair, this is a pocket within the hair follicle that houses stem cells, that are key for stimulating and aiding in the regeneration and development of new hair growth [30] [45]
Laser and light-based modalities:
Another option
Electrolysis
Electrolysis is another permanent hair removal technique, although it is used for specific or smaller areas of hair and can be far more time-consuming and uncomfortable for the patient [26]
Often recommended when few hairs remain post laser treatment, or for a small collection of sporadic hairs. [26]
How does it work?
There are two forms of electrolysis: a combination of both or a monotherapy can be used.
Both are done through placing a fine wire into the hair follicle; this wire is used as an electrode, by transferring an electrical current through the wire to the target tissue. [27]
The galvanic technique uses direct current to pass through the fine wire; this causes an electrochemical reaction, producing sodium chloride, which is used to break down the bulb and ultimately denature and detach the hair follicle from its blood supply. [26]
The thermolysis technique uses a high level of alternating current, which produces heat in the hair follicle, leading to disruption and damage of the hair bulb, preventing new hair growth. [26]