Hirsutism is a common disorder affecting between 5 and 15% of the population. One of the most devastating consequences of hirsutism is the presence of unwanted facial hair. Treatment of hirsutism involves a two-pronged approach: treating the underlying cause and reduction of visible hair. Laser hair removal is one of the most effective options for reducing visible hair, however, it may not be wholly effective in all patients and combination therapy may need to be considered. Pharmacological therapy is often used in combination with mechanical hair removal due to the time needed for the drug treatment to demonstrate visible results. Clinical data investigating the use of laser treatment in combination with other treatments has focused on laser with topical eflornithine. The expert working group reviews existing data and provides guidance on the use of eflornithine in combination with laser for resistant hirsutism.

Dorland’s Illustrated Medical Dictionary, ed 31. Edinburgh, Elsevier Saunders, 2007.
Deplewski D, Rosenfield RL: Role of hormones in pilosebaceous unit development. Endocr Rev 2000;21:363–392.
Azziz R: The evaluation and management of hirsutism. Obstet Gynecol 2003;101:995–1007.
Jackson J, Caro JJ, Caro G, et al: The effect of eflornithine 13.9% cream on the bother and discomfort due to hirsutism. Int J Dermatol 2007;46:976–981.
Keegan A, Liao LM, Boyle M: ‘Hirsutism’: a psychological analysis. J Health Psychol 2003;8:327–345.
Barth JH, Catalan J, Cherry CA, et al: Psychological morbidity in women referred for treatment of hirsutism. J Psychosom Res 1993;37:615–619.
Sonino N, Fava GA, Mani E, et al: Quality of life of hirsute women. Postgrad Med J 1993;69:186–189.
Guidelines Working Party: Medical management of facial hirsutism: the outcomes of a guidelines working party. Primary Care Dermatology Society, 2005.
Blume-Peytavi U, Gieler U, Hoffmann R, et al: Unwanted facial hair: affects, effects and solutions. Dermatology 2007;215:139–146.
Yildiz BO, Bolour S, Woods K, et al: Visually scoring hirsutism. Hum Reprod Update 2009 Jun 30.
Azziz R, Woods KS, Reyna R, et al: The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745–2749.
Dawber RP: Guidance for the management of hirsutism. Curr Med Res Opin 2005;21:1227–1234.
Watts J: Understanding the causes and management of hirsutism. Nurs Times 2006;102:26–28.
Moses R, Theile H, Colagiuri S: Postmenopausal hirsutism: the forgotten face. Aust N Z J Obstet Gynaecol 1994;34:500–501.
Mofid A, Seyyed Alinaghi SA, Zandieh S, et al: Hirsutism. Int J Clin Pract 2008;62:433–443.
Rittmaster RS: Hirsutism. Lancet 1997;349:191–195.
Blume-Peytavi U, Hahn S: Medical treatment of hirsutism. Dermatol Ther 2008;21:329–339.
Hunter MH, Carek PJ: Evaluation and treatment of women with hirsutism. Am Fam Physician 2003;67:2565–2572.
Koulouri O, Conway GS: Management of hirsutism. BMJ 2009;338:b847.
Legro R: Management and treatment of hirsutism in the elderly woman. Ann Longterm Care 2002;10:41–47.
Anderson RR, Parrish JA: Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983;220:524–527.
Anderson RR, Parrish JA: The optics of human skin. J Invest Dermatol 1981;77:13–19.
Sanchez LA, Perez M, Azziz R: Laser hair reduction in the hirsute patient: a critical assessment. Hum Reprod Update 2002;8:169–181.
Alai NN, Saemi AM: Laser-assisted hair removal. eMedicine 2009 Jan 26.
Haedersdal M, Wulf HC: Evidence-based review of hair removal using lasers and light sources. J Eur Acad Dermatol Venereol 2006;20:9–20.
Haedersdal M, Gotzsche PC: Laser and photoepilation for unwanted hair growth. Cochrane Database Syst Rev 2006;4:CD004684.
Davoudi SM, Behnia F, Gorouhi F, et al: Comparison of long-pulsed alexandrite and Nd:YAG lasers, individually and in combination, for leg hair reduction: an assessor-blinded, randomized trial with 18 months of follow-up. Arch Dermatol 2008;144:1323–1327.
Clayton WJ, Lipton M, Elford J, et al: A randomized controlled trial of laser treatment among hirsute women with polycystic ovary syndrome. Br J Dermatol 2005;152:986–992.
Lolis MS, Marmur ES: Paradoxical effects of hair removal systems: a review. J Cosmet Dermatol 2006;5:274–276.
Hamzavi I, Tan E, Shapiro J, et al: 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;57:54–59.
Lim SP, Lanigan SW: A review of the adverse effects of laser hair removal. Lasers Med Sci 2006;21:121–125.
Halkiadakis I, Skouriotis S, Stefanaki C, et al: Iris atrophy and posterior synechiae as a complication of eyebrow laser epilation. J Am Acad Dermatol 2007;57(2 suppl):S4–S5.
Herbold TM, Busse H, Uhlig CE: Bilateral cataract and corectopia after laser eyebrow [corrected] epilation. Ophthalmology 2005;112:1634–1635.
Wolf JE Jr, Shander D, Huber F, et al: Randomized, double-blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair. Int J Dermatol 2007;46:94–98.
Vaniqa: Summary of product characteristics. 2008.
Hickman JG, Huber F, Palmisano M: Human dermal safety studies with eflornithine HCl 13.9% cream (Vaniqa), a novel treatment for excessive facial hair. Curr Med Res Opin 2001;16:235–244.
Malhotra B, Noveck R, Behr D, et al: Percutaneous absorption and pharmacokinetics of eflornithine HCl 13.9% cream in women with unwanted facial hair. J Clin Pharmacol 2001;41:972–978.
Claman P, Graves GR, Kredentser JV, et al: SOGC clinical practice guidelines. Hirsutism: evaluation and treatment. J Obstet Gynaecol Can 2002;24:62–69.
Ganger LK, Hamzavi IH: Excess salt and pepper hair treated with a combination of laser hair removal and topical eflornithine HCl. J Drugs Dermatol 2006;5:544–545.
Shapiro J, Lui H: Treatments for unwanted facial hair. Skin Therapy Lett 2005;10(10):1–4.
Smith SR, Piacquadio DJ, Beger B, et al: Eflornithine cream combined with laser therapy in the management of unwanted facial hair growth in women: a randomized trial. Dermatol Surg 2006;32:1237–1243.
Elghblawi E: Idiopathic hirsutism: excessive bodily and facial hair in women. Br J Nurs 2008;17:192–197.
Hamzavi I, Owen MR: Eflornithine treatment of excess facial hair: a review. Dermatol Pract 2006;13:19–20.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.