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Treating Hirsuitism Permanently With Electrolysis

by Stephanie Fracassa, C.P.E.

Hirsutism is often an early symptom of non-classical CAH, and may appear after puberty in classical CAH.  Excess facial and body hair is not just a “cosmetic” issue. Hirsutism has profound psychological and sociological side effects for the afflicted patient.

In treating CAH, medication is used to lower the overall level of androgens in the blood. This prevents the hirsutism from becoming worse.  However, it will not reverse the excess hair growth.  Once a hair follicle has been stimulated to grow a pigmented hair, it will continue to do so unless the hair follicle is permanently destroyed.  To date, there is only one proven method of hair removal that can achieve this, and that is ELECTROLYSIS.

Electrolysis is permanent hair removal achieved by the insertion of a fine, sterile probe into a hair follicle and the application of electrical current, which destroys the follicle through a chemical reaction, heat, or combination of both.  Electrolysis, also known as Electro-epilation, is gentle to the skin, comfortable for the patient, and yields beautiful results.

To appreciate how Electrolysis works, it is important to understand that hair grows in cycles.  At any given time, a hair will be in one of the following three stages of growth:  anagen (active), catagen (transitional), or telogen (dormant).  In any given area, not all hairs are in the same stage of growth at the same time.

To prevent a hair from growing, the technician must disengage 2/3 of the hair follicle where hair germ cells exist.  To achieve this, a hair is best treated during the anagen phase.  Because not all hairs are in this active phase at the same time, a hair may need to be treated several times over a period of months before all hair germ cells are effectively destroyed.  For this reason, it could take 12- 18 months to complete a large project such as the bikini and inner thighs.  At the beginning of treatment, the patient will come in for sessions that are longer in duration and more frequent.  Eventually, she will come in for ‘clean-up’ sessions perhaps once every 6- 8 weeks. To complete Electrolysis treatments in the shortest amount of time, it is important to commit to a regular treatment schedule.  In addition, the CAH patient must be in good hormonal control throughout the treatment period and beyond.  This is to make sure androgen levels do not rise too high and stimulate new hair to grow in untreated follicles.

Electro-epilation encompasses three methods or modalities:  Electrolysis, Thermolysis, and Blend.

Electrolysis was the first modality applied to permanent hair removal in 1875. Dr. Charles Michel, an ophthalmologist of St. Louis, MO, used it to treat ingrown eyelashes.  Electrolysis is the application of direct current (DC) to a solution of salt water, which produces the byproduct sodium hydroxide (lye).  In this method, a sterile probe is inserted into the follicle and DC flows through the probe.  When DC meets the natural salt and moisture in the skin, a tiny amount of lye is produced.  Since lye is a caustic solution, it causes damage to the hair germ cells.  Electrolysis utilizes a chemical reaction to destroy the hair. It is gentle and comfortable because the chemical reaction takes place slowly.  The probe remains in the follicle for several minutes while the lye develops. Today’s epilators use multiple probes simultaneously to speed up the process.

Thermolysis uses oscillating current or high frequency (HF) to produce heat, which coagulates the hair germ cells in the hair follicle.  This is the most common modality of permanent hair removal practiced today because it is fast.  A single, pre-sterilized, disposable probe is inserted into the follicle. HF flows through the probe and a small amount of heat is produced for fractions of a second.   The heat disengages the hair germ cells and cauterizes the follicle’s blood supply.   This method is also known as shortwave or flash.

Blend is a combination of direct current and high frequency.  In it, DC and HF are sent through the sterile probe simultaneously.  This method takes advantage of the strengths of both modalities.  All three methods of Electro-epilation can achieve permanent hair removal.  Which modality a patient is treated with depends on her hair type, her tolerance, and her Electrologist.

One of the biggest misconceptions about Electrolysis is that it is very painful. The hair follicle is surrounded by nerve endings, so the patient will feel something.  Most patients, however, find the treatment quite comfortable. If a patient is very sensitive, her electrologist can offer sugestions to make treatment easier, for example, the use of a topical anesthetic such as LMX Cream.  Without fail, new clients are always surprised at how comfortable Electro-epilation really is.

In addition to being comfortable, Electrolysis is also cost-effective. Remember, it is a permanent solution to unwanted hair.  While temporary solutions like shaving and waxing are less expensive up-front, over a lifetime a patient will spend thousands of dollars more on these methods than on Electrolysis treatments.  Electrologists charge by the amount of time a patient spends in a treatment session, not by the area being treated.  Hourly rates will vary according to geographic location.  While HMOs generally do not reimburse for Electrolysis, some might allow a patient to seek reimbursement if it is deemed medically necessary by a physician as part of the overall treatment of a disorder such as CAH.  A precedent has already been set to this effect (Abernathy vs. The Prudential Insurance Company of America, No. 21178, Supreme Court of South Carolina, March 31, 1980).  

Immediately following an Electrolysis treatment the skin might be slightly red and/or swollen.  This usually disappears within 1- 2 hours.  In the days following, the treated area may develop tiny scabs.  These scabs are part of the normal healing process and should not be touched. Your Electrologist will go over specific post-treatment instructions with you to ensure proper healing. 

Electrolysis is safe for all skin types and effective on all types of hair.  It has been studied extensively and found to have no long-term negative side effects.  It can be done safely on all parts of the body except the inside of the ears and nose because of the risk of possible infection.  You should not have Electrolysis if you are on Accutane because of the skin’s compromised ability to heal on this medication. Diabetics should get their doctor’s written permission before beginning Electrolysis treatments for the same reason.

In the United States, regulation of Electrologists varies from state to state.  Most states require licensure for Electrologists, but some do not, i.e. New York.                  

If you are seeking treatment in an unregulated state, it is especially important to look for a practitioner who is a Certified Professional Electrologist (CPE).  This is a national board certification credential established by the American Electrology Association ( www.electrology.com ).  It is a voluntary credential and requires ongoing continuing education to be maintained. It shows that the practitioner adheres to specific standards of practice established by the AEA such as those for Infection Control.  These standards include the sterilization of all Electrology instruments which may have parenteral contact, the use of pre-sterilized, single-use disposable probes, hand washing, and the use of disposable gloves for each treatment.

An article on Electrolysis would not be complete without mentioning laser hair removal.  The most important fact that must be clarified about laser hair removal is the following:  It is not proven permanent.  The FDA has ruled that laser manufacturers are not allowed to claim that laser hair removal is permanent (http://www.fda.gov/cdrh/consumer/laserfacts.html ).  No long-term studies have been conducted on laser hair removal’s efficacy or safety.

Since its creation in 1875, the benefits of permanent hair removal with Electrolysis have been proven again and again.  The CAH patient who suffers from hirsutism can rest assured that Electrolysis will provide a solution that is safe, comfortable, cost-effective and above all, permanent.

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