Shaving
Shaving is the method used most frequently to temporarily remove unwanted hair. Shaving is fast, easy, painless, effective, and inexpensive. The results are temporary—lasting from mere hours for facial hour to up to 3 days; as a result, shaving requires a constant commitment in order to maintain a hair-free appearance.
Shaving is performed with a razor on wet skin using shaving cream or other lubricants. The razor is often oriented against the direction of hair growth. For sensitive areas, shaving with the direction of hair growth may reduce cuts. Contrary to a widespread misconception, shaving does not result in increased hair growth or thicker hair. [10] The primary disadvantages and/or adverse effects of shaving include skin irritation, cuts in the skin, ingrown hair pseudofolliculitis, the need to shave daily, and stubble.
Compared with waxing, shaving is associated with considerably less discomfort. Both shaving and waxing, however, were found to significantly reduce body odor in the axillae when followed by soap washing. [11]
Epilation
Epilation involves the removal of the entire hair shaft and is the most effective method for temporarily removing hair. Epilation includes waxing, plucking, threading, sugaring, and using abrasives or mechanical devices (eg, Epilady). For epilation to be effective, treated hairs should be long enough for the device to grasp them. The long-term effects of epilation on the hair follicle are not known. Epilation wounds the hair follicle; therefore, repetitive epilation over several years may result in permanent matrix damage, resulting in finer or thinner hairs and, perhaps, as anecdotal evidence suggests, long-term permanent reduction in hair growth. Long-term clinical trials demonstrating the effects of repetitive epilation are lacking.
Plucking
Plucking is best performed using tweezers and is an economic method for removing the occasional coarse hair or a small cluster of hairs, such as those found on the eyebrows, chin, or nipples. The results of plucking last longer than shaving because hair is pulled from the hair shaft, as in waxing. This method is time consuming, tedious, and painful. Generally, plucking does not reduce the number of hairs that ultimately regrow. [12] The reaction of the hair follicle to plucking can be unpredictable, possibly resulting in adverse effects such as folliculitis, hyperpigmentation, scarring, ingrown hairs, and distorted follicles. Adverse effects from plucking include pain, hyperpigmentation, scarring, folliculitis, and ingrown hair pseudofolliculitis.
Waxing
Waxing is essentially mass plucking and involves applying warm or cold wax onto hair-bearing skin and quickly stripping off the hardened wax—along with the embedded hairs—against the direction of hair growth. [10] Waxing is the most expensive yet most effective method of epilation because hair is removed completely from the hair shaft in large quantities. Often, hair can take 2-3 weeks to regrow after waxing. The effects of long-term waxing on the hair follicle are unknown. Theoretically, this modality may reduce regrowth since repeated waxing may destroy follicles. While many kits are offered for use at home, an experienced salon-based operator is able to apply wax quickly to large body surface areas for faster and more successful hair removal.
Preparation of hot wax for hair removal.
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Although no formal studies have been conducted, the recommendation is that patients using systemic retinoids (ie, isotretinoin [Accutane], acitretin [Soriatane]) refrain from waxing until treatment has been discontinued for a minimum of 6 months to 1 year to avoid skin tearing and scarring. Patients using topical retinoids (ie, tretinoin [Retin-A, Avita], adapalene [Differin]) should also be careful when waxing to avoid injuring the skin. It is recommended that a clearly visible sign be placed in waxing salons warning clients not to wax while using systemic or topical retinoids.
Waxing should not be performed on moles, warts, or irritated, sunburned, or broken skin. Pay special attention to the temperature of wax to avoid burning skin. Adverse effects from waxing include pain, hyperpigmentation, scarring, folliculitis, and ingrown hair pseudofolliculitis. A life-threatening Streptococcus pyogenes and herpes simplexvirus infection of the external genitalia occurred in a 20-year-old diabetic woman following a routine perineal "Brazilian" bikini wax. [13] Additionally, while the pathogenesis is not entirely clear, epilation by waxing more frequently results in follicular lesions (folliculitis) in the proximal extremities despite the fact that distal extremities are waxed more often. [14]
Studies have also found that epilation by waxing induces hair follicles to adopt the growth stage. This can be used to significantly enhance the immune response to transcutaneous DNA immunization by applying plasmid DNA to a recently waxed area of skin. The antibody responses to the topical application of a DNA vaccine post waxing are as strong as those following intramuscular injections. [15, 16]
Threading
Threading is an ancient manual technique, popular in the Middle East, that involves the use of a long twisted loop of thread that is rapidly rotated across the skin. By maneuvering the twisted string, hairs are trapped within the tight entwined coils and are pulled or broken off. Adverse effects from threading include pain, hyperpigmentation, scarring, folliculitis, and ingrown hair pseudofolliculitis. One report suggests threading may be beneficial in patients on isotretinoin therapy, which may cause increased skin fragility. [17]
Abrasives
Abrasives such as pumice stones and devices or gloves made of fine sandpaper work by physically rubbing the hair away from the skin surface. This method can be irritating to skin and is not commonly used for hair removal.
Sugaring
Sugaring is similar to waxing. The sugar mixture is prepared by heating sugar, lemon juice, and water to form a syrup. The syrup is formed into a ball, flattened onto the skin, and then quickly stripped away. Similar to waxing, the hair is removed entirely from the hair shaft; thus, sugaring is an alternative to waxing for people sensitive to wax. Adverse effects from sugaring include pain, hyperpigmentation, scarring, folliculitis, and ingrown hair pseudofolliculitis.
Depilation
Chemical depilatories remove part of the hair shaft and are easy and painless to use. The standard chemical depilatory agents, available in gels, creams, lotions, aerosols, or roll-on forms, are mixtures of thioglycolic acid and sodium or calcium hydroxide. Thioglycolate depilatories work by hydrolyzing and disrupting the disulfide bonds of keratin in hair, causing hair to break apart and allowing it to separate from skin. Common brands of thioglycolate-based depilatory products include Nair, Magic Shave, and Veet. Depilatories are good for use on the legs, bikini line, face, and underarms, and they perform best when hair is at a reasonable length. Before using a depilatory, carefully read the manufacturer's instructions. Test a small site before use to assess for irritation or allergic reactions. Do not use these agents on eyebrows, near mucous membranes, or on broken skin.
Results last up to 2 weeks. [18] Adverse effects include skin irritation, burns, folliculitis, ingrown hairs, pseudofolliculitis, and allergic contact dermatitis to either thioglycolate or fragrances.
Bleaching
Bleaching is not a method of hair removal; however, patients use bleaching as an inexpensive method of disguising the presence of unwanted hair by removing its natural pigment. Common sites for bleaching include the upper lip, beard area, and arms. The active ingredients in over-the-counter bleaching agents are hydrogen peroxide and sulfates. Together, this combination lightens, softens, and oxidizes hair, reducing its noticeability. As with chemical depilatories, perform a test on a small patch of hair to assess for allergic reaction.
The disadvantages of bleaching include skin irritation, temporary skin discoloration, pruritus, and the prominent appearance of bleached hair against tanned or naturally dark skin. Reports exist of generalized urticaria, asthma, syncope, and shock in reaction to the persulfate activator added to boost the effect of hydrogen peroxide bleach.
