| The
stigma of unwanted facial hair
By Marie Love Darbouze, Medical
Writer
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 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, UHF may be also a
warning sign for 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
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 (PCOS), 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 reasons 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
light skin people with dark hair. But it 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 theFDA, 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
**********
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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