Removal of unwanted hair
- Donald W Shenenberger, MD, FAAD, FAAFP
Donald W Shenenberger, MD, FAAD, FAAFP
- Assistant Professor of Dermatology
- Eastern Virginia Medical School, Norfolk, VA
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Jeffrey S Dover, MD, FRCPC
Jeffrey S Dover, MD, FRCPC
- Section Editor — Cosmetic Dermatology
- Associate Clinical Professor of Dermatology
- Yale University School of Medicine
The majority of post-pubertal persons in the world regularly practice some form of hair removal. Be it by shaving, plucking, or by other methods, most of us have hair on some part of our bodies that we try to remove.
This topic reviews options for removal of unwanted hair. There are only limited data from clinical trials, so much of the information presented here is based on expert opinion. The evaluation and management of hirsutism are discussed separately. (See "Pathophysiology and causes of hirsutism" and "Evaluation of premenopausal women with hirsutism" and "Treatment of hirsutism".)
We are born with all the hair follicles we will ever have . At puberty, as a result of androgenic effects, some of these follicles enlarge and produce their characteristic growth patterns (beard growth, pubic hair). In some people, hair growth has a strong genetic influence leading to some of the more predictable ethnic patterns of hair distribution and thickness. The cells of the matrix at the base of the hair shaft differentiate under the influence of the dermal papilla and then proliferate to form the growing hair. Melanocytes within the matrix give the hair its color. The primary growth phase of the hair is called anagen, and it makes up the majority of the time a hair spends in the growth cycle. The other two phases are called catagen and telogen. (See "Evaluation and diagnosis of hair loss", section on 'Hair cycle'.)
During catagen, the hair follicle involutes, bringing an end to the active growth phase (anagen). The next phase, telogen, is the quiescent or resting phase that typically lasts for several months. At this stage, hair may be shed by brushing or during washing. Most hairs spend the majority of time in anagen (80 to 90 percent of the growth phase); however, this depends upon where the hairs are located. Scalp hairs typically spend the most time in anagen and can remain in anagen for several years before transitioning to telogen. Eyebrows and lashes have a much shorter anagen phase, and thus a relatively shorter length. It is during anagen that a hair is most susceptible to some of the newer methods of removal [2,3].
Temporary methods — The following methods typically result in only temporary removal of hair; however, in some circumstances the dermal papilla may be damaged by the removal, leading to permanent removal of hair.
- Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med 1999; 341:491.
- Olsen EA. Methods of hair removal. J Am Acad Dermatol 1999; 40:143.
- JOHNSON E, EBLING FJ. THE EFFECT OF PLUCKING HAIRS DURING DIFFERENT PHASES OF THE FOLLICULAR CYCLE. J Embryol Exp Morphol 1964; 12:465.
- Taber's cyclopedic medical dictionary, Thomas CL (Ed), F. A. Davis, Philadelphia 1997. p.511, 657.
- Ramos-e-Silva M, de Castro MC, Carneiro LV Jr. Hair removal. Clin Dermatol 2001; 19:437.
- Urushibata O, Kase K. A comparative study of axillar hair removal in women: plucking versus the blend method. J Dermatol 1995; 22:738.
- BHAKTAVIZIAM C, MESCON H, MATOLTSY AG. SHAVING. I. STUDY OF SKIN AND SHAVINGS. Arch Dermatol 1963; 88:874.
- Lynfield YL, Macwilliams P. Shaving and hair growth. J Invest Dermatol 1970; 55:170.
- Barba A. Techniques for hair removal. In: Cosmetic Dermatology, McGraw-Hill, New York 2002. p.188.
- van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. Interventions for hirsutism (excluding laser and photoepilation therapy alone). Cochrane Database Syst Rev 2015; :CD010334.
- Vaniqa package insert www.fda.gov/cder/foi/label/2000/21145lbl.pdf (Accessed on March 07, 2005).
- Smith SR, Piacquadio DJ, Beger B, Littler C. Eflornithine cream combined with laser therapy in the management of unwanted facial hair growth in women: a randomized trial. Dermatol Surg 2006; 32:1237.
- Hamzavi I, Tan E, Shapiro J, Lui H. A randomized bilateral vehicle-controlled study of eflornithine cream combined with laser treatment versus laser treatment alone for facial hirsutism in women. J Am Acad Dermatol 2007; 57:54.
- Malhotra B, Noveck R, Behr D, Palmisano M. Percutaneous absorption and pharmacokinetics of eflornithine HCl 13.9% cream in women with unwanted facial hair. J Clin Pharmacol 2001; 41:972.
- Weiss RA, Weiss MA, Marwaha S, Harrington AC. Hair removal with a non-coherent filtered flashlamp intense pulsed light source. Lasers Surg Med 1999; 24:128.
- Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220:524.
- Haedersdal M, Wulf HC. Evidence-based review of hair removal using lasers and light sources. J Eur Acad Dermatol Venereol 2006; 20:9.
- Goldberg DJ. Laser hair removal. Dermatol Clin 2002; 20:561.
- Tse Y. Hair removal using a pulsed-intense light source. Dermatol Clin 1999; 17:373.
- Battle EF Jr, Hobbs LM. Laser therapy on darker ethnic skin. Dermatol Clin 2003; 21:713.
- Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49:1.
- Hussain M, Polnikorn N, Goldberg DJ. Laser-assisted hair removal in Asian skin: efficacy, complications, and the effect of single versus multiple treatments. Dermatol Surg 2003; 29:249.
- Liew SH, Grobbelaar AO, Gault D, et al. Ruby laser-assisted hair removal: a preliminary report of the correlation between efficacy of treatment and melanin content of hair and the growth phases of hair at a specific site. Ann Plast Surg 1999; 42:255.
- McBurney EI. Side effects and complications of laser therapy. Dermatol Clin 2002; 20:165.
- Lapidoth M, Shafirstein G, Ben Amitai D, et al. Reticulate erythema following diode laser-assisted hair removal: a new side effect of a common procedure. J Am Acad Dermatol 2004; 51:774.
- Alajlan A, Shapiro J, Rivers JK, et al. Paradoxical hypertrichosis after laser epilation. J Am Acad Dermatol 2005; 53:85.
- Kontoes P, Vlachos S, Konstantinos M, et al. Hair induction after laser-assisted hair removal and its treatment. J Am Acad Dermatol 2006; 54:64.
- Wheeland RG. Permanent hair reduction with a home-use diode laser: Safety and effectiveness 1 year after eight treatments. Lasers Surg Med 2012; 44:550.
- Hession MT, Markova A, Graber EM. A review of hand-held, home-use cosmetic laser and light devices. Dermatol Surg 2015; 41:307.
- Michel CE. Trichiasis and districhiasis; reflections upon their nature and pathology, with a radical method of treatment. St. Louis Cour Med 1879; 1:121.
- Wagner RF Jr, Tomich JM, Grande DJ. Electrolysis and thermolysis for permanent hair removal. J Am Acad Dermatol 1985; 12:441.
- Hinkel AR, Lind RW. Electrolysis, thermolysis and the blend: The principles and practice of permanent hair removal, Arroway, Los Angeles 1968.
- Kligman AM, Peters L. Histologic changes of human hair follicles after electrolysis: a comparison of two methods. Cutis 1984; 34:169.
- Wagner RF Jr, Flores CA, Argo LF. A double-blind placebo controlled study of a 5% lidocaine/prilocaine cream (EMLA) for topical anesthesia during thermolysis. J Dermatol Surg Oncol 1994; 20:148.
- Guardiano RA, Norwood CW. Direct comparison of EMLA versus lidocaine for pain control in Nd:YAG 1,064 nm laser hair removal. Dermatol Surg 2005; 31:396.