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Many men and women elect to remove unwanted body and facial hair for cosmetic, cultural, social, or medical reasons. There are two main medical causes for excessive hair: hirsutism and hypertrichosis. Hirsutism is characterized by an androgen-dependent hair pattern with excessive and increased body and facial terminal hair distributed in a male pattern.1 It can be idiopathic or genetic in origin; however there are medical conditions that can cause hirsutism (Table 10.1).

TABLE 10.1Medical Conditions Associated with Hirsutism

Hypertrichosis is a condition of excessive hair that is not influenced by androgens.2 It can be an adverse effect of drug administration such as cyclosporine, minoxidil, or phenytoin (Table 10.2) or an underlying medical condition such as porphyria cutanea tarda, thyroid disorders, or malnutrition/anorexia. Primary hypertrichosis has been classified based on the age of onset (congenital or acquired) and the extent of distribution (localized or generalized forms).2

TABLE 10.2Medications Associated with Excessive Hair

A medical investigation to elicit the cause of excessive hair should be conducted prior to or in conjunction with treating the unwanted hair. There are several medical conditions associated with hirsutism (Table 10.1). Patients who may have any underlying medical condition leading to hirsutism may also suffer from seborrhea, acne, androgenetic alopecia, irregular menses, or virilization.1 Rapid onset of hirsutism or other signs of androgen excess should prompt a hormonal evaluation, including levels of free and bioavailable testosterone and dehydroepiandrosterone-sulfate (DHEA-S), to rule out the presence of an androgen-secreting tumor. When underlying disease is suspected, it is advisable to work in conjunction with the primary care physician and/or a specialist if indicated (i.e., gynecologist and/or endocrinologist for polycystic ovary syndrome).

In people of color, there are other medical indications for hair removal, including but not limited to pseudofolliculitis barbae (PFB) (Figure 10.1), acne keloidalis nuchae (AKN) (Figure 10.2), and dissecting cellulites (Figure 10.3). Finally, facial or body hair in excess of the cultural norm can be very distressing to some patients and is more commonly seen in some ethnic subgroups, such as South Asians.

Figure 10.1

PFB with postinflammatory hyperpigmentation in an African American male. Perifollicular hyperpigmented and erythematous papules on the cheek and neck

Figure 10.2

AKN in an African male. Firm, flesh-colored to hyperpigmented papules over the posterior scalp and neck

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