What's that on my face?

Jyotsna had just turned 53. As always she was scanning her face in the mirror for the usual suspects – wrinkles, age lines, blackheads, warts and left-over hairs from waxing. Panic struck when she found a goatee of sorts: a straggly, single hair about an inch-and-a-half long sprouting from her chin.

Why do women sprout facial hair in the post-menopausal period? Striking at the root of the problem, Dr. Mukta Sachdev, Consultant Dermatologist, Manipal Hospital, Bangalore says, “Post-menopausal women may develop hair growth particularly on the face. This is because the oestrogen normally produced by a woman during the reproductive years stimulates a blood protein called sex hormone binding globulin (SHBG). This absorbs and holds any male hormones such as testosterone or DHEA, which circulate in small amounts in all women. These male hormones called androgens stimulate hair growth in a male pattern with beard, moustache and abdominal hair besides acne. When the level of SHBG is high, it deactivates the androgens. Before menopause when the ovaries do not ovulate regularly, oestrogen levels drop and androgen levels are free to stimulate hair growth and acne. That is why most menopausal and some peri-menopausal women notice increased facial hair growth.”

“The main areas for such growth are lip, chin, jaw, cheeks and neck. In older women it can become a problem as their formerly light coloured soft hair becomes coarser and darker and then eventually becomes very stiff, gray or white,” she continues. There are ways to deal with this problem. Dr Deepak Vohra, Senior Consultant Dermatologist, Fortis Hospital, New Delhi, points out, “There are several ways to remove or decrease facial hair including depilatory creams, waxing, plucking,shaving, electrolysis, bleaching, topical creams and laser therapy.

Options

Since such hair growth is likely to persist till old age (but is liable to fluctuate) women have to necessarily look for some form or other of hair removal. For those splitting hairs about which method works best and scouting for permanent cures if any, Dr. Mukta Sachdev lists the merits and demerits of each.

Tweezing is the most common form but can be painful if you have more than a few stray hairs. It is not permanent and usually the hair grows back in two to eight weeks. Other side effects besides pain are folliculitis (infection of the hair follicle) irritation, hyper pigmentation and scarring.

Shaving is another common method but the hair will return in a few days. The side effects include chemical dermatitis, minor cuts and a condition called pseudo folliculitis barbae, the medical term for razor bumps.

Waxing is probably the easiest way and it prevents regrowth for four to six weeks .But some women are sensitive to this procedure. It can also cause burns, pain, irritation and sometimes scarring.

Depilatory creams can be used effectively. But individuals can be sensitive to the chemicals in the cream and it can cause chemical dermatitis or allergic dermatitis. The hair generally does not grow back for about two weeks.

Electroloysis is also popular. An electric current is used to destroy the hair root .Each hair follicle has to be done individually so it can be painful and time-consuming as it needs multiple sessions. Other side effects include oedema (swelling), redness and scarring, keloid formation, pigment changes and other skin irritations. Also this method cannot be used by patients with pace makers.

Laser hair removal is the latest and most effective method. It requires at least 8-12 sessions. It is effective in reducing thick dark hairs. This method specifically targets the melanin in the hair bulb. The energy of the laser destroys the hair bulb. But it must be done only by trained experienced dermatologists. However it may not be effective for older women as the gray or white hair is a poor target for the laser.

Topical Eflornithine cream is the first topical medication that has shown success in removing unwanted facial hair. This removes facial hair for as long as eight weeks after therapy is discontinued. It also improves the success of laser hair removal when used in conjunction.”

Lifestyle tips

Dr Deepak Vohra suggests a few more tips. “Obesity, dietary habits, lack of exercise and stress can all affect hair growth.  Losing weight, if obese, helps decrease androgen levels. A balanced diet rich in proteins, vegetables and fruits and regular exercise levels are also advocated.”

If the hair growth is such that it causes distress, then “drugs that reduce the androgen levels or reduce the effect of androgens at the hair follicle may be tried. But the potential serious side effects must be kept in mind and the lowest dose should be used for the shortest time under the supervision of a doctor,” says Dr. Jayashree Gopal, Consultant Endrocrinologist and Diabetologist, Apollo Hospitals and Seetapathy Clinic, Chennai.

The bottom line, according to Dr. Mukta Sachdev, is to find the method that works best for an individual, depending on one's complaints and degree of hair growth in consultation with a dermatologist.