Synergy of Eflornithine Cream with Laser and Light-Based Systems for Hair Management

When one speaks of beauty in women, it is generally the facial characteristics of women that one is referring to. With this in mind, nothing is more devastating to women, or can impact the

Gurpreet S. Ahluwalia (ed.), Cosmetic Applications of Laser and Light-Based Systems, 383-397,

feminine beauty at its core, than the presence of facial hair. It is estimated that over 40 million women in the United States alone suffer from this problem, and at least half of them routinely remove facial hair. A recent report by Lipton et al. [1] showed that women living with facial hair suffer from a high level of emotional distress and psychological morbidity. Women in the study were highly bothered (81%) and self-conscious (70%) about their condition, and felt overwhelmed with the effort that was needed for them to keep their facial hair under control. Another study compared excessive facial hair in women to dermatological conditions, such as psoriasis and eczema, as having a similar dermatology life quality index score [2].

The conventional hair-removal methods that women generally rely on for facial hair include: shaving, depilatory creams, bleaching, waxing, mechanical epilators, and plucking. Each of these methods has certain advantages and shortcomings that influence their acceptability, depending on the desired outcome. While these methods are convenient and low in cost, they have significant limitations, including: the lack of femininity, post-shave stubble, and skin irritation from the shaving method; the offensive sulfur odor and skin irritation from the use of depilatory creams; skin sensitivity and poor performance of bleaching creams used to hide the pigmented terminal hair; skin irritation, in-grown hair, messiness, and pain/discomfort of epilation methods such as waxing, mechanical epilators, and plucking. These are some of the disadvantages associated with the aforementioned methods. Moreover, hair removal by these conventional means is temporary, lasting from 1-2 days after shaving to up to several weeks following epilation (waxing and epilators).

In spite of the wide range of options available, facial hair management remains a significant challenge for women. Depending on the extent of the problem, women may choose just one or multiple methods to control facial hair. The determining factors are the location of the hair: upper lip, chin, cheek or neck; pigmentation: blonde/gray to dark; hair type: terminal, vellus or vellus-like growth; character: coarseness, thickness, density, and the growth rate of hair. Women with significant facial hirsutism, defined as a heavy male pattern terminal hair growth, are often not satisfied with the conventional epilation or depilation methods mentioned earlier and require a combination of both medical and cosmetic treatments to manage their condition. The medical treatment options include an Rx topical cream Vaniqa that is used to inhibit the rate of hair growth, the hormonal treatments that effect the androgen – dependent hair growth and the laser or intense-pulsed light (IPL) treatments to primarily remove the pigmented hair. For treatment of clinically hirsute patients, the systemically administered hormonal drug treatments include steroidal and nonsteroidal anti-androgens namely, spironolactone, flutamide, cyproterone acetate, finasteride, and cimetidine [3-10]. The anti-androgen approach has a sound scientific basis for the androgen-dependent facial hair growth, though it has not been highly successful because of its limited efficacy and safety issues [11-14]. A prolonged treatment time of up to one year is generally required to see good efficacy with the hormonal treatments. The attraction for the eflornithine cream, Vaniqa is that it can be applied topically, similar to a facial moisturizer, and carries no significant safety concerns. The biochemical pharmacology of eflornithine and its use in combination with the laser treatment is described in detail in the following sections.