Case Studies into the efficacy of performing light-based hair removal treatments on persons with PCOS
Over a four year period between 2006 and 2010, Laser Hair Removal treatments on clients who presented with diagnosed but unmanaged PCOS were monitored closely. Their results were measured against those of other clients with similar hair and skin typing.
Of the latter group, some of those clients had PCOS which was being effectively managed by medication, while others did not have PCOS or any other hormonal irregularities.
In the following results, percentages have been rounded off.
In 55% of cases, clients with unmanaged PCOS experienced neutral results. In 25% of cases, they experienced increased hair growth. Only 20% experienced any measure of reduction, and none of those clients achieved similar results to clients in the comparison groups.
In 80% of clients with managed PCOS, hair reduction was similar to people without PCOS. 15% experienced some hair loss but with slower results than normal. 5% experienced no reduction.
Why PCOS is an issue - PCOS and Hair Removal
With no other studies yet published on this subject, I have relied substantially on information and theories provided by several GPs who are clients, as well as my own family doctor. I thank everyone for their contributions.
The problems arising from PCOS would seem to be twofold. First, PCOS causes radical hormonal shifts in the body, and second, it makes the body's reparative systems work overtime to try to regulate those hormonal changes.
Sometimes the reparative systems get it right and bring the body back into balance. People who have PCOS which is successfully managed by their GP, usually fall into this category.
Without medication though, the reparative systems usually get it wrong and over-compensate. People in this category experience all the usual symptoms of radical hormonal changes, eg facial hair, pigment marks etc. As a result, Hair Removal centres are their first point of contact, as the client may not be aware that they have PCOS.
The problem for these people is that their reparative processes aren't reacting properly. As a result, there is a good chance that the reparative systems will also get it wrong in response to a light based treatment.
The issue isn't necessarily the heat generated by the treatment, but rather, the light.
Even over-exposure to sunlight may cause problems for people with PCOS, such as hyper-pigmentation and premature skin aging. The heat however, has a secondary effect in that it damages surrounding cellular tissue, which is of course the purpose of having the treatment in the first place, and the factor that stimulates collagen renewal. But with the reparative systems out of kilter, this usually positive factor can become a negative.
In PCOS cases, the most common result from all the above factors, is that the body decides to over-compensate again, and will produce too much reparative material. It may actually stimulate new hairs to grow from cells that have lain dormant, eg the soft white facial fluff that might have stayed like that for life, becomes black and coarse, even if the client is blonde.
The surrounding skin tissue can also become darker and thicker to help shield the target chromophores (melanin, haemoglobin, porphyrin) from future 'attack'. The same applies to any other type of light-based treatment. A pigment treatment can make the mark darker and more resistant, a capillary treatment can make the lumen walls grow thicker and tougher, hair may suddenly appear in response to an unrelated treatment, or dormant porphyrin cells may cause an outbreak of acne.
PCOS Management - PCOS and Hair Removal
People often present to us when they notice a sudden amount of unexpected hair growth.
In young post-pubescent women (also see separate article on pubescent hirsutism), especially with male hair growth patterns and no family history of hirsutism, I always suggest that they go and get their hormone levels checked. On more occasions than I can recall, my advice to these clients has led to them discovering that they have PCOS.
Once diagnosed, a GP will usually begin a regime of medication to treat the condition, e.g. a contraceptive pill, usually several to determine which has the greatest efficacy. Often, this medication will normalise the hair growth without our involvement, and the client's problem is solved.
Hair Removal Technicians have a duty of care to their clients and must always recommend this path first. Therapists should not treat a client with PCOS for hair removal if that client's condition is unmanaged.
If however, the client comes back from the GP with the all-clear, the cause for their unusual hair growth may be genetic. For example,there could be an aunt with hirsutism whom the client is not aware of.
Equally as common is for a client to come to us presenting with PCOS which was diagnosed long ago and is successfully managed by their GP.
Regardless, therapists should remain vigilant. Clients do lie, and some will say that their PCOS is managed, believing that they know better than we do. If they have male hair growth patterns - eg excessive hair on their face, chest, lower back, or buttocks, and no history of hereditary hirsutism, there is a very good chance that they are lying. For their own good, do not treat them and tell them to go back to their GP to recheck their medication.
Simply informing them that people with unmanaged PCOS can experience increased hair growth instead of reduction, is usually enough for them to begin taking it seriously.
For the most part however, clients with managed PCOS are aware of the excessive hair growth that goes with the condition, and their meds are doing the job. These clients will present with normal or only mildly elevated hair growth.
Examples of mildly elevated growth could be a patch or scattering of random hairs on the nipples, lip, neck, or chin. A full beard or chest hair however, is not mild. Again, they need to see their GP to normalise their hormone levels, or find out if they have hirsutism in the family.
Summary - PCOS and Hair Removal
Any light based treatment, be it laser or an IPL derivative, can cause any or all of these problems, even if they did not pre-present.
With more evidence coming to light on the subject, and with no regulation in Australia, Reef has made an industry-first stance and adopted the policy of NOT recommending light-based treatments to clients with unmanaged PCOS. It is ethically wrong to do so.
The Therapist always reserves the right to refuse treatments if they deem that the client is not acting in their own best interests, and in such cases, it is our duty to cease treatments.
The best course of action for PCOS-related hair growth or hyper-pigmentation is medical. The client needs to be on the right medical treatment to bring their body's hormone levels under control, and once that's achieved, chances are that problems such as excessive hair growth and odd pigment marks will begin to reduce naturally.
Once the client has achieved that balance, we can help tidy up what's left, assuming that there are no other contraindications to treatment.
On the Articles index page, you can find more quick reads about the subject plus many other topics that delve into the human condition.
Have a brilliant day,