How does Vaniqa cream work for reducing facial hair in women?

Dear Dr. Redmond: Can you tell us more about the new cream for reducing facial hair. What do you think the implications will be for electrologists?

    THE INTRODUCTION OF Vaniqa (eflornithine HCl Cream, 13.9%) is a major event for women with facial hirsutism. It is an entirely new approach to treating increased facial hair because it does not work through hormonal pathways. Vaniqa works directly to slow hair growth by inhibiting an enzyme called ornithine decarboxylase (ODC). When this enzyme is blocked by the medication, metabolic activity in the hair follicle decreases, and hairs grow in more slowly. Vaniqa does not itself remove hair so it needs to be used in combination with a removal method.

    Vaniqa seems to have many advantages for women with increased facial hair: It is applied to the skin twice a day instead of having to be taken internally; it works reasonably quickly, and side effects, if they occur at all, seem to be quite mild. When applied right after hair has been removed with a razor, mild stinging can occur; but this is not very bothersome. Although a prescription is required, it is likely that many dermatologists and family physicians will be willing to prescribe it. The price is expected to be about $50 for a tube which should last for about two months. As with other prescription medications, prices will vary between pharmacies.

    The American Food and Drug Administration has just approved Vaniqa, and the manufacturer expects it to be available in pharmacies by late September of this year.

    The manufacturers, Bristol-Myers Squibb and Gillette, were somewhat brave to invest in developing Vaniqa, considering that for years most of the medical profession refused to acknowledge that increased hair growth in women was a problem at all. As a result, women embarrassed by visible facial hair have felt quite isolated. Of course electrologists are well aware of the importance of the problem, as are women who have it.

    In North America alone there are ten million adult women who remove facial hair at least twice a week and more than twice as many who remove it weekly. Medical treatments such as spironolactone (Aldactone®) have been used to treat increased facial hair with some degree of success, but such drugs require that the attending physician has special expertise in their use. And none of them are approved by the U.S. Food and Drug Administration (FDA) for treatment of female hair growth.

    Vaniqa is indicated specifically for the reduction of unwanted facial hair in women – there is no other medication with this indication in the U.S. Spironolactone is widely used for this purpose, but the FDA does not allow it to be labeled as a treatment for hirsutism (although it is in Australia). Another antiandrogen, Cyproterone acetate (Androcur®), is approved in most other countries. In Canada, CPA is available only as one of the hormonal ingredients in the oral contraceptives Diane® and Dianette®.

    I was involved in the studies for Vaniqa and can report that many of the women who used it in the study were quite pleased with the result and have been eagerly waiting for it to become available. The cream works relatively quickly, but not immediately. Hair growth is noticeably slower at about eight weeks, and slows further after that.

    Vaniqa does have some limitations. Studies involved only application on the face, so it is not indicated for increased hair elsewhere. Bikini line use would raise particular concern since a topical applied to that area might be absorbed more than when it is applied on the face.

    Vaniqa is for women already doing some kind of hair removal. Slowing the growth of the hair means fewer hair removal sessions, and more importantly, it increases the time after removal that a woman can feel confident that her facial hair is not noticeable.

    For those women who require hair removal only infrequently, say every two weeks, Vaniqa may not be worth the trouble of twice a day application. And treatment with Vaniqa has to be continued indefinitely to be effective, because studies showed that after use was stopped, hair was growing faster again at eight weeks. Its action is to slow growth; it does not inactivate the follicle. All the hairs are still present; they just do not grow out as fast. Finally, since Vaniqa is not an androgen blocker, those who want treatment of acne or alopecia will still need to use other treatments for these. The same is true for women who want reduction of body hair.

    No studies have compared this new cream to other treatments for hirsutism. Many will be wondering how Vaniqa compares with other medical treatments such as spironolactone and electrolysis. I think it is too early to tell. My expectation is that many women whose primary concern is facial hair will be happy with the result. Vaniqa is easy to prescribe and easy to use. I suspect a large proportion of those women who use it were never bothered enough by their excess hair to seek electrolysis.

    Some women who have had electrolysis will probably change to the cream, but I have no way to estimate what proportion this will be. Many women value the relationship they have with their electrologist, who is often the only one who understands their problem. Some may tire of twice a day administration and opt for permanent removal.

    I know of no reason why women undergoing electrolysis should not also use Vaniqa. For those with heavy facial hair growth, this makes sense because the cream will slow growth within a few weeks and the electrolysis will produce eventual permanent removal. For women who have a small number of hairs or a small area covered, electrolysis may well be more practical.

    There is no doubt that Vaniqa will be a great help for many women troubled by increased facial hair. I doubt it will supplant electrolysis, but some women may discontinue electrolysis once they see results from the cream. At least some of these will come back, however.

             

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