Depilation and epilation: mechanism of action, methodology, indications and contraindications

Most women and men constantly remove unwanted hair. However, the discomfort associated with unwanted hair worries everyone to varying degrees. Some use a razor or wax, not suffering at all from the fact that it has to be done often and regularly. Someone wants to solve the problem once and for all, trying to find the best way for themselves. And accordingly, there are two approaches to solving this problem - depilation and epilation.

Depilation is the removal of the hair shaft located above the surface of the skin, or “temporarily”.

Epilation is the removal of hair from the root, which damages the hair follicle, or "permanently". Depending on the task, clients can choose hair removal at home (plucking, shaving, chemical depilation), in a beauty salon (waxing, electrolysis) or in aesthetic medicine centers (all methods of epilation).

In addition to women who come for unwanted hair removal procedures to improve their appearance, those for whom excessive hair growth is already a symptom of a serious somatic disease turn to specialists in desperation. Having watched beautiful advertising, patients expect a miracle and demand it from the doctor. In order not to provoke disappointment, the doctor should already during the first conversation talk about real possibilities and explain the mechanism of action of the proposed method for a particular problem. First of all, we will talk about hirsutism, hypertrichosis.

Hirsutism is defined as excessive hair growth in androgen-dependent areas due to increased levels of circulating androgens (or hypersensitivity of hair follicles to normal levels of androgens). The most common forms of hirsutism are idiopathic (constitutional, or primary) and secondary, associated with endocrine disorders. Less commonly, hirsutism is caused by taking androgenic or anabolic drugs. Idiopathic hirsutism occurs in boron women of some ethnic groups, while the level of androgens. They may be within normal limits or slightly higher than normal.

The most common causes of secondary hirsutism associated with endocrine disorders are adrenal diseases, ovarian diseases, etc.

Hirsutism diagnostics is based on clinical manifestations of the disease. Excess hair can be either fine or coarse pigmented, and the excess
hair growth itself can be limited to one or more anatomical areas. D Ferriman (1961) defined hirsutism in women by the degree of hair growth in 11 zones, 9 of which are androgen-dependent: upper lip, chin, chest, upper back, sacrum, upper and lower abdomen, shoulders, forearms, thighs and shins. The scale is four-point, the score "0" means the absence of hair. The higher the number of points, the higher the degree of hirsutism in a woman. It should be noted that each ethnic group may have a different upper limit.

When collecting anamnesis, it is important to pay attention to the hereditary anamnesis, gynecological (infertility, menstrual irregularities) anamnesis, and the use of any medications. Often, it is necessary to appoint consultations with related specialists (gynecologist, endocrinologist).

Hypertrichosis is intense focal or widespread hair growth not associated with androgen stimulation.

It occurs in both sexes. There are congenital and acquired hypertrichosis. Congenital hypertrichosis is a very rare disease that occurs due to an anomaly in the development of hair follicles that produce depigmented thin hair without medulla. With this type of hypertrichosis, the entire surface of the skin (except for the palms and soles) is overgrown with hair from childhood, although there are also limited forms.

Acquired hypertrichosis may be a precursor to malignant neoplasms, such as tumors of the gastrointestinal tract, lungs, mammary gland, gall bladder, uterine body, and urinary bladder. Often, the cause of acquired hypertrichosis is the use of drugs, such as minoxidil, cyclosporine. Symptomatic hypertrichosis is also distinguished, which develops with the following diseases: hypothyroidism, alcoholism, late cutaneous porphyria, nervous anorexia, at the site of repeated injuries or prolonged inflammation.

Diagnosis of hypertrichosis is also based on the clinical manifestations of the disease. There are widespread and limited forms of the disease. When collecting anamnesis, first of all, it is necessary to pay attention to the onset of complaints, the age of the patients, the hereditary history, the presence of concomitant pathology; find out whether the patient takes any medications.

Thus, finding out the causes of hirsutism or hypertrichosis and the possibility of their correction allows any hair removal method to be made more effective and not to discredit the possible results.

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Types of depilation and epilation

Existing types of depilation and epilation can be classified as follows:

Depilation:

1. Plucking.
2. Shaving.
3. Chemical depilation.
4. Waxing.

Epilation:

1. Electrolysis
2. Laser hair removal.
3. Photoepilation.

The simplest methods of hair removal are plucking and shaving. There is probably no one who has not removed hair using these methods. Plucking is a simple and effective method of hair removal using tweezers. Usually, this method is masterfully mastered by women who regularly monitor the shape of their eyebrows. More often, individual hairs or limited areas are subject to plucking, since this is a slow and quite painful method. Often, incorrect advertising appears on our TV screens, in which the concepts of epilation and depilation are confused. For example, hair removal using home electric epilators "Braun soft epil" or "Philips satinelle Ice" is advertised. It is based on the depilation method - plucking. There is information that hair growth after plucking can increase and new hair often grows harder. The fact is that plucking traumatizes the hair follicle, after which it changes and behaves completely unpredictably.

Shaving is a method of hair removal using a razor, blade, soap, foam and water. There are razors for women and men, which differ in shape, color and material. But, as practice shows, there is no significant difference between them. Shaving was and remains a quick, easy, effective and cheap method of hair removal. Previously, it was believed that repeated shaving of hair in one place stimulates its growth. Now it has been proven beyond doubt that this is not the case. The disadvantages of this method are a short-term effect, cuts, irritation, dry skin, ingrown hairs, and the possibility of infection.

Chemical depilation is a method of hair removal using depilatories made on the basis of various enzyme preparations, such as sodium thioglycolate, which dissolve the protein base of the hair, which leads to its easy separation from the skin surface. Depilatories are available in various forms: gel, cream, lotion, aerosol. Modern products allow you to remove hair quickly and painlessly. It is important to remember that chemical depilatories can cause allergic dermatitis in people with a burdened allergic anamnesis, less often toxicoderma. Therefore, these products should be used with extreme caution, with a preliminary skin test. Before use, carefully read the instructions and strictly follow the manufacturer's recommendations for use, so as not to cause skin damage, including chemical burns. It should also be noted that you cannot use these products in the eyelid and eyebrow area, on burned or damaged skin.

Waxing (bioepilation) is the oldest method of hair removal using wax, resin, burnt sugar. The essence of the method is extremely simple - with the help of an adhesive preparation, the hair is glued together, which is then removed as a single block using special wipes. In many beauty salons, this procedure is often called bioepilation. This is incorrect, since there is a contradiction between the essence of the procedure and its name. Waxing is a more painful procedure compared to other methods of hair removal, but it gives the most long-term results. On average, hair growth begins after two to three weeks. The disadvantages of this method include irritation, redness, dry skin, ingrown hairs, and the possibility of infection.

Types of waxes for hair removal

Hard (hot) - made from pine resin and petroleum products with added oils. It takes 20-40 minutes to warm up. The disadvantage of this type of wax is that it sets very quickly, which leads to incomplete adhesion. It is necessary to control the wax temperature before starting the procedure, as there is a high risk of burning the patient's skin.

Soft (cold) - made from a mixture of pine resin and softeners (beeswax, honey). Various soothing and softening agents (azulene, oils - olive, etc.) can be added to the basic composition. The disadvantage is that soft wax does not dissolve in water. Therefore, wax residues on the skin are cleaned with oil products, which can contribute to the development of "oil folliculitis".

Some companies offer complete depilation kits, which include pre-cleansing and pre- and post-treatment skin softening products; a wax "heater"; special roller applicators; paper hygienic strips, waxes. The leading companies offering such products are "BEAUTY IMAGE", "ACADEMIE", "Clean+Easy".

When performing the waxing procedure, certain rules must be followed:

1. Before starting the procedure, treat the skin so that it is clean, degreased and dry.
2. The wax is applied to the skin once in a thin layer in the direction of hair growth.
3. The strip is also glued in the direction of hair growth, and is removed with a quick, sharp movement against the growth, but parallel to the surface of the body.
4. The wax residue is removed in strips as much as possible in order to use as little cleansing oils as possible.
5. Apply moisturizing and soothing post-depilatory products.

Waxing is considered a safe procedure that is performed on almost everyone. However, patients with diabetes should be extremely careful due to their tendency to pyogenic complications and slow regeneration. In addition, the risk group includes patients with pronounced varicose veins and multiple benign neoplasms.

To properly understand the mechanisms of action and prospects of epilation, it is necessary to know: issues of anatomy, growth phase and hair color. In this aspect, the hair follicle itself is of particular importance, since it is the "parent" of new hair. Regardless of the epilation methods used, the hair canal is the conductor of the effect on the follicle. The result of epilation is directly related to the phase of hair growth in which the effect on the follicle is carried out. With any type of epilation, it is necessary to destroy the hair follicle in the growth phase, or anagen, since it is in this phase that there is a close connection between the hair and the follicle. It is known that the number of hairs in the anagen phase varies and depends on the topical localization.

Hair color is mainly determined by two pigments - black-brown (eumelanin) and yellow-red (pheomelanin). The options depend on the quantitative ratio of these pigments, which can change with age and depend on hormonal levels. Melanin is found not only in hair, but also in the skin. People's skin differs in the distribution of melanocytes, as well as in the ability to produce melanin. T. Fitzpatrick developed a classification of skin types based on the skin's ability to respond to UV radiation. The same classification is used to predict the result of laser or photoepilation and when choosing the power.

Basic skin phototypes (according to T. Fitzpatrick, 1993)

Skin type	Characteristic
I	Never tan, always burn
II	Sometimes they can tan, but more often they burn.
III	They often sunbathe, sometimes get burned
IV	Always tan, never burn
V	Never get sunburned
VI	Never get sunburned

The effectiveness of laser hair removal increases with Fitzpatrick skin phototypes I and II in combination with dark hair, and photoepilation - with I-IV.

Until recently, one could only talk about a long-term or permanent effect in the case of electrolysis.

Electrolysis

It is a method of hair removal using electric current.

All methods of electroepilation are divided into 2 groups:

• using tweezers;
• using a needle.

The tweezers method is more gentle and painless, but with a very low speed of procedure. Its essence is that each hair is taken with a thin tweezers-electrode, which is connected to the device producing high-frequency current. The exposure time for 1 hair is 1.5-2 minutes. Hence, it is clear that this method is not used on large areas.

Electrolysis with a needle is more widely used. There are 2 main methods:

1. Thermolysis. It is based on the action of alternating current of high frequency and low voltage. The current is supplied through a thin needle, which is inserted into the skin to the depth of the hair follicle, where local heating occurs - destruction of the follicle.
2. Electrolysis. The method is based on the electrochemical action of galvanic current. As a result of the anodic-cathode reaction, hydrochloric acid is formed, which, when decomposed, is transformed into caustic alkali - an electrolytic burn and destruction of the hair follicle. A sign of the completed chemical reaction is the release of white foam - hydrogen bubbles. Electrolysis is a more painless method of electrolysis, and the risk of complications here is much lower than with thermolysis. However, the speed of the procedure is quite low.

There are standard recommendations for the use of current of a certain strength and the choice of a particular method of electroepilation depending on the thickness of the hair and the depth of the follicle, the epilation zone. The treated hair is removed with regular tweezers. Then, as a rule, the epilated area is treated with an antiseptic solution (chlorhexidine bigluconate, calendula tincture, Bepanthen lotion).

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Combination of thermolysis and electrolysis

A combination of two methods of electrolysis is possible. During the procedure, a staged effect on the follicle is carried out - first thermolysis, then electrolysis. During the first stage, a thermolytic reaction occurs around the follicle with dehydration of the surrounding (perifocal) tissues. The second stage - electrolytic - provides a galvanic reaction, during which the formation of a significantly smaller amount of alkali is sufficient for the final destruction of the follicle. Due to the double effect on the follicle, the chances of its final destruction are doubled. At the same time, with this method of electrolysis, there is a significant risk of folliculitis and burns.

The disadvantages of this method include pain, redness of the skin, swelling, scars, hyperpigmentation, and the possibility of infection. In rare cases, there is an individual intolerance to metal alloys (gold, nickel) included in the needles, as well as intolerance to any current procedures.

There are also contraindications for this procedure. These include: the presence of a pacemaker, pregnancy, mental illness (in particular epilepsy), severe somatic diseases in the decompensation stage, a tendency to keloids, hyperpigmentation, herpes infection in the acute stage, diabetes mellitus, tumors.

In addition, there is a time limitation of electrical procedures, associated with increased impact on the electrical axis of the body. One session should not exceed 1-1.5 hours per day. As a result, the procedure of electroepilation of the shins can stretch out for several days, if not weeks. The consequence of this is uneven hair growth ("chessboard grid").

This method is very effective, but the results depend on many factors, such as the level of professional training of the specialist. At the same time, the patient who comes for electroepilation should be aware that a successful final result will require a lot of patience, time and money.