WOMEN'S HEALTH

         

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The stigma of unwanted facial hair

 By Marie Love Darbouze 

The Problem

It is believed that of an estimated 100 million American women aged 15 to 74 years, 41 million have removed unwanted facial hair (UFH) within the past six months, and an estimated 22 million have excess facial hair requiring removal at least once a week or more than 20 hairs per session.

Despite the significant number of women affected with this problem, fewer than 10 % of them have sought help from a physician or an electrologist.  Accustomed to bear the stigma as they try to hide it, women are often reluctant to discuss it with their physicians because of either embarrassment or belief that the problem is too trivial to deserve a health care provider’s attention.

It should not be that way for – even when UFH is not caused by an underlying medical ailment – management methods and new treatments options are available.

Unwanted facial hair (UFH) can be defined as "any hair that a woman has on her face that she does not want," said Ken Washenik, MD, PhD, Director of Dermatopharmacology in the Department of Dermatology at New York University School of Medicine.

"If a patient has a certain amount of facial hair. And she finds it troublesome, it bothers her, gives her discomfort, I think that’s unwanted facial hair," added Dr. Washenick.

UFH has also been defined as facial hair growth that is coarser, longer, or more profuse than that would be regarded as ‘normal’ for the age and race of the woman.

UFH may cause intense emotional distress, significant worry in affected women.  According to some experts, unwanted facial hair can have a substantial negative impact, leading a woman to feel less socially acceptable and sometimes to physically avoid situations that would make her feel self-conscious.

On the other hand, UFH may be also a warning sign of an underlying medical condition.

The Causes of UFH

Puberty and menopause are two physiologic (natural ) conditions that bring changes to a woman’s hair throughout her life.  Before puberty, the hair is fine and thin; this type of hair is named vellus.  With puberty, hormonal changes make hair – particularly pubic and axillary – to become coarse, pigmented.  This is terminal hair.  During menopause, changes to facial hair may also occur.

Beyond these natural changes, excess of hair growth occurs in hirsutism and hypertrichosis.

Hirsutism is excessive growth of terminal hair due to overproduction of male hormone (androgen) or change in the androgen/estrogen (female hormone) ratio in a woman’s system.  The condition in the majority of the cases may be, however, caused by a genetic sensitivity to a normal level of androgen. Men and women have both estrogen and androgen in their systems.

Females with hirsutism show excessive hair growth in a distribution pattern typical of adult males (upper lip, chin, shoulders, inside of the thighs, chest, etc).

Hypertrichosis exists when the woman exhibits excess of hair in usually non-androgen-dependent body areas (head hair, eyelashes, eyebrows, and arms).  It, too, has a congenital or genetic component and is usually not linked to hormonal unbalance or illnesses.

Polycystic ovarian syndrome, adrenal gland overgrowth, tumors of the ovaries and adrenal glands, aging, administration by physicians of hormones such as steroids, testoterone, birth control pills with progestins are other causes of UFH.   Drugs such as dehydroepiandrosterone (DHEA) – sold over-the-counter – minoxidil, cyclosporin can also cause hypertrichosis.

Underlying medical causes account only for about 10% of all cases of UFH.  National or ethnic background does not play any role in UFH.

Treatment Options

According to medical experts, among the many treatment options available to women with UFH, there are two general categories: management methods and medical methods.

Management or cosmetic methods

African-Americans women and other women with darker complexion, in selecting a method of control or management of UFH, must not compound the problem with facial keloid scars or pseudofolliculitis barbae (razor bumps), as these two conditions are believed to be more prevalent in black people.  About one out five African-American women develops UFH, most notably on their chins.  And when affected women resort to  management methods such as shaving, pulling, or plucking, they often develop the same unsightly bumps and keloid scarring seen in men.

Other methods of UFH management include bleaching, waxing, depilatories, electrolysis, and laser hair removal.  Bleaching, waxing, shaving, pulling, plucking, depilatories, although inexpensive, are time-consuming, painful, not permanent.

On the other hand, electrolysis is expensive, requires professional application, and its effect lasts only 6 to 8 weeks. Laser hair removal has long-term effect, seems to work well on people with light skin and dark hair. Laser hair removal is expensive, time-consuming and requires also professional application.

Medical treatments for UFH:

For women whose UFH is due to an underlying medical illness or an elusive cause, doctors may prescribe medication. Oral contraceptives are prescribed to reduce the level of androgen in the woman’s body; cyproterone – which is not approved for use in the U.S. – hormone treatments, and spironolactone, are also used by physicians for the same reason.

A drug called eflornithine hydrochloride, approved last year by the FDA, is now being used by doctors as a cream to treat UFH. The medication, the only one approved in the U.S. to treat this stigmatizing ailment, is believed to slow hair growth by inhibiting an enzyme called ornithine decarboxylase that is necessary for hair growth.

Commenting on the problem of unwanted facial hair in women, Dr. Thomas Cash, with the Department of Psychology Old Dominion University, Norfolk, Virginia, said: "This is about more than excess hair. It’s about one’s psychosocial well-being and about one’s feelings of control over a condition that produces self-conscious feeling of unattractiveness.  So if there’s an efficacious treatment that’s safe and that enable women with proper expectations to increase their control over the condition, then I think that the patient has been well served."  Other physicians believe as public awareness of the problem increases, active clinical research into UFH will increase, and more importantly, a greater number of women will come forward for professional help and lift the veil on what is described by some as a "silent" condition.

Source: Medical Crossfire April 2001; 3(4):51-63

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Why Are Many African-American Women Losing Their Hair?                                          

By Marie Love Darbouze

"Juanita Procope was the type of woman whose hair was always fly. She’d check out the latest styles and head straight to the salon, where she was permed, colored, weaved, braided, or bleached to perfection. "I admit that I have always loved getting a new ‘do. Lots of sisters love new clothes – I love new hair. It’s sort of like trying on a new personality every now and then," she says.

The problem is that years of styling and profiling left 36-year-old Juanita with hair loss on the front, sides, and back of her head. "I was shocked," she explains. "My hair had always been healthy, and I thought of baldness as something that happened to guys."

Now she has dropped the dyes and perms for a loose weave that she hopes will allow her hair to grow back to its former glory. "The urge to at least change the color is almost overwhelming, but I’ve learned my lesson. I’m going to give this head a rest," she says."

This testimonial can be read on page 192 of the book Health & Healing for African-Americans (Rodale Press 1997).

What is the leading cause of breakage?

Although there are no biochemical differences that have been detected among the various forms of human hair, everyone’s hair is phenotypically different, which means, there are visible characteristics associated with human hair.  Hair can be straight, wavy, helical, and spiral.

How we groom and care for our hair is what determines the amount of breakage each one of us will experience.  For instance, many African Americans think that dutiful visits to the stylist for perms, color and braids is hair care. In reality, improperly applied chemical treatments and braids done too tightly are the leading causes of hair breakage in African American women.

A female physician with a large practice located in the Midwest of the U.S. has told Allaboutblackhealth that she has been seeing many cases - like Juanita’s mentioned above - in younger African-American women.

Disorders Associated with Curly Hair

There are four broad hair types that have been defined: straight, wavy, helical (forming coils of constant diameter), and spiral (forming coils that diminish in diameter outward). Black hair has the flattest or most elliptically shaped fibers and is produced by curved hair follicle. Asian hair is generally straight, has a circular structure, and is produced from a straight hair follicle. Caucasian hair is the most variable; it ranges from straight to wavy or helical and has a round or oval shape.

Grooming techniques used to increase the manageability and to lessen the natural curliness of black hair, such as chemical hair relaxers and other straightening techniques (i.e. hot combing and pressing) are often responsible for the hair breakage, or in severe cases alopecia, commonly known as hair loss. "Anything chemical that permanently changes the color or texture of the hair weakens it and can cause damage," says Greta F. Clarke, M.D., a dermatologist in private practice in Berkeley, California (Health & Healing for African Americans, 193).

"Relaxers, especially, can strip away the hair’s cuticle (outer layer), causing a loss of elasticity that can cause strands to snap off during styling," says William Keith, M.D., clinical assistant professor of medicine at Drew Medical School/Martin Luther King, Jr., Hospital in Los Angeles (ibid).

Such breakage will occur immediately or as late as six months after the straightening process and many women may not even be aware of the damage. Too much styling, especially with heated appliances, can only exacerbate the problem.

Please note that properly applied chemical relaxers are usually well tolerated and do not have a tendency to produce complications when used under the guidance of a stylist.

"Traction alopecia" is commonly seen among women and children who braid their hair tightly and often. Traction alopecia is hair loss due to the hairs being pulled out of their follicles, followed by inflammation and atrophy (or death) of the follicle. The distribution of traction alopecia tends to be characteristic to your particular hairstyle, but it usually occurs in uniform symmetric loss of hair in front of and above the ears.

Oil Folliculitis. Do any of you remember your grandmother or your mother telling you to grease your scalp?  Well, please stop this practice if you have been doing it!

Pomades that are frequently applied to the hair and scalp to increase manageability and to improve its appearance can result in oil folliculitis.  Pomades are sometimes so heavy that they clog the pore of the scalp.

Oil folliculitis has the appearance of clusters of pustules (or white bumps filled with inflammatory cells) surrounding hair follicles. The inflammatory cells accumulate in response to bacteria and can obstruct hair follicles (pomade acne) leading to hair loss.

This does not mean you should avoid applying hair oil altogether.  A little bit of olive oil or baby oil can be rubbed into dry hair after shampooing. Or you can use products that do not have any bees wax or any thick pomade which, as said before, may accumulate and block your follicles.

There are several other causes of hair loss in women, such as stress and poor diet.

If you feel that you’ve been doing the right thing for your hair and you still have thinning hair or bald spots, see your doctor.

In summary, it is wise to say that the root of hair loss is not generally found in the way African-American women style their hair (i.e. straight, bone-straight, weaved, gelled, or braided); it is in the way African American women take care of their hair.

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Related Topic: Healthy Hair: Beauty Secrets From The Pros 

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