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Hair Removal

It is probably safe to say the majority of people have hair on some part of their body that they would rather not have. Consequently, hair removal is a very common practice. Areas from which guys typically remove hair include the face, chest, shoulders, and back. That said, hair may be removed from any part of the body. Hair follicles in our skin are distributed over our body. During puberty with increasing testosterone these follicles mature and begin to grow hair in characteristic patterns. Heavy hair growth in certain areas of the body is almost always the result of genetics. Unwanted hair can be removed via several methods, yet with most of these approaches the hair will eventually grow back.

There are few, if any, studies comparing different hair removal methods, so choosing one comes down to deciding what works best and is most comfortable for you. Hair should only be removed from healthy skin; you should not remove hair from skin that is irritated, red, cracked, or sore. If you have sensitive skin or your skin is particularly fragile please consult your doctor before undergoing hair removal.

Shaving is often the go-to method for hair removal. It involves using a straight razor, a multiple blade razor, or an electric shaver to cut the hair close to the skin. A clean razor with sharp blades and a quality shaving cream or gel are recommended when shaving any area of the body. For those who dislike using a razor or have sensitive skin, electric shavers and trimmers are good options. Shaving simply shortens the hair, and so must be repeated regularly, often daily, as the hair grows back. Shaving, as with most hair removal methods, can cause skin irritation and ingrown hairs. Shaving creams and gels can also be irritating. Trial and error is often required to find a cream or gel that works best for you. Exfoliating and moisturizing shaved areas may also aid in preventing ingrown hairs and irritation.

Using tweezers to pluck or pull hair out of the skin is an option when you need to remove only a small number of hairs. For example, one may pluck hairs when shaping the eyebrows. However, plucking is not recommended for large area hair removal as it is both time consuming and can be painful. Plucked hairs generally remain absent for 4 to 8 weeks, but invariably do grow back. Tweezers are the most common method for plucking, but threading, a process where thin threads are twisted around and used to pull out the hair, is offered at some salons.

Otherwise known as hair removal creams, depilatory creams are available over the counter and use chemicals to dissolve the hair shaft. They are typically applied generously to an area where one wants to remove hair and then left on for a specified amount of time before being wiped or washed away. Depilatory creams are efficient, but like shaving they only remove hair above the skin. As a result, the hair will grow back after several days. While depilatory creams are generally safe to use they are not all the same, so it is important to read the label. For example, a hair removal cream that is meant for body or pubic hairs should not be used on your face. Additionally, when using these creams ensure you follow instructions carefully. Using a cream improperly or leaving it on for too long can cause skin irritation. In some people depilatory creams can also cause allergic contact dermatitis. It is therefore recommended that you first test the cream on a small area on your arm to ensure you do not have any adverse reactions.

Waxing involves applying a hot wax (usually made with an antiseptic oil) to the skin. As the wax cools it becomes firm and contracts around hairs, tightly gripping them. Once the wax is firm enough and becomes peelable, it is quickly pulled off the skin to remove the hair. Like plucking, waxing removes hair down to the root, and so hair generally remains absent for 4 to 8 weeks. Waxing can be performed at home or professionally at a salon. However, at home methods tend to use “cold” wax rather than hot, which may not be as effective. Hair removal via waxing can be performed every 4-6 weeks, but requires hair to be a certain length to allow for the wax to grip the hair as it dries. Waxing can be uncomfortable for some as the wax itself can burn those with sensitive skin and the hair removal process can be painful. Additionally, waxing can cause ingrown hairs. It is important to exfoliate and moisturize waxed areas to avoid this side effect.

This is one of the longest lasting methods of hair removal. However, it can be time consuming as it generally requires 4 or more professionally performed treatments spaced 4-6 weeks apart. Additionally, it is generally an expensive option, with prices varying based on the size of the body area hair is being removed from. Nevertheless, it can have long-term benefits. While complete hair removal is uncommon, treatment usually results in less or thinner hair. Maintenance treatments are required every 6 to 12 months.

Laser hair removal works by using a laser beam or light pulse to destroy the hair bulb or root, and so prevent further hair growth from the follicle. While not usually painful, some do report a burning sensation during and after treatments. Furthermore, treatment is most effective for people with light skin and dark hairs, as the laser targets dark melanin pigments in the hair follicle. Laser is not the best option for light haired and dark skinned individuals.

Electrolysis, when performed properly, is the only method that results in permanent hair removal.  During this procedure a very fine needle is inserted into the hair follicle and an electric current is then applied to kill the root, thus destroying its capacity to produce hair. Electrolysis can be used on any part of the body, but is very time consuming and so is best suited to removing hair from relatively small areas. Treatment can be painful; topical anesthetic creams can help with the discomfort. After treatment skin may be pink or red, and sensitive. It is recommended that treated areas be kept clean to avoid infection and kept out of direct sun exposure for up to 48 hours to prevent burning. It is recommended that people with pacemakers not undergo electrolysis as the applied electric current could interfere with the device. For individuals with genital herpes, electrolysis in the genital region may induce an outbreak. If you have genital herpes, and are planning electrolysis in the area, you may want to consider antiviral medication. Lastly, electrolysis is not performed by physicians. Training among those providing the service can vary so make sure you see a certified electrologist.

Acne

Acne is the presence of blackheads, whiteheads, and other types of pimples on the skin. It is caused by the clogging of hair follicles by oil and dead skin cells which creates a plugged environment that allows bacteria to grow. Your hair follicles are connected to oil glands that secrete sebum oil in order to keep you hair and skin supple. Normally sebum is transported along the hair shaft and out through the opening of the hair follicle. However, when your body produces an excess of sebum and dead skin cells, they can build up in the hair follicle creating a clogged pore. As sebum continues to accumulate in the follicle, the walls of the follicle begin to bulge producing a whitehead. If the follicle maintains some exposure to air it will darken to produce a blackhead. Bacteria at the base of the hair follicle, particularly Propionibacterium, thrive in clogged pores and can cause a localized infection. When a clogged pore becomes infected, inflammation occurs, creating a raised, red pimple or pustule. Lastly, blockages and inflammation that form deep inside hair follicles can produce potentially large, painful lumps beneath the surface of the skin called nodules.

Acne is most common among adolescents, affecting up to 90% of young men and then decreases with age. However, as many as 10-25% of people over the age of 40 may still have problems with acne. Increased production of hormones, such as during times of stress or during puberty, can result in excess sebum production, leading to more clogged pores and “breakouts.” The role of diet in promoting acne is unclear. There have been suggestions that dairy products and binging on sugary snacks and candy may play a role, but data are conflicting. Acne can be present anywhere on the body, but most commonly occurs on the face, and for some people, the chest and upper back.

Diagnosis is based on visual examination. Acne typically is composed of multiple clogged follicles on the skin at various stages of inflammation. Symptoms vary with the severity of the condition. Depending on the person, one may have:

  • Comedones: whiteheads (closed plugged pores) or blackheads (open plugged pores that turn dark due to air exposure)
  • Papules (small red tender bumps)
  • Pustules (papules with pus at the tip; aka Pimples)
  • Nodules (large, solid, painful lumps beneath the surface of the skin)
  • Scarring of the skin

Acne can have significant psychological effects. Because it can affect one’s appearance, acne often causes anxiety and low self-esteem, and can lead to limited social interaction.

To help control and prevent acne, skin should be kept clean and moisturized, as dry skin will lead to excess sebum production and clogged pores. Use mild soaps to minimize drying the skin, and avoid oil-based lotions and skin products as these can plug up pores. Physical exercise can increase circulation and decrease stress which may reduce acne breakouts. Lastly, do not pop or pick at acne; doing so can lead to increased inflammation, spread of bacteria, and scarring.

Most mild acne can be treated using over-the-counter products containing either benzoyl peroxide or salicylic acid. Both of these chemicals have been proven to effectively treat and prevent acne. However, if these treatments do not work you should consult your physician. Persistent mild to moderate acne may need treatment with stronger medicines or a combination of therapies. Your doctor may prescribe treatments that are applied directly on the skin, such as retinoid creams (Differin or Tazorac), that can help unclog pores, either alone or with topical antibiotics such as clindamycin to fight bacteria. Oral antibiotics including tetracycline, minocycline or doxycycline may also be used. For acne that doesn’t respond to these treatments your physician can refer you to a dermatologist, or skin doctor. Severe acne may require an oral retinoid called isotretinoin (Accutane). While shown to be very effective, Accutane can have significant side effects and should only be taken under the close supervision of your family physician or dermatologist.

Eczema

Eczema, known medically as atopic dermatitis, is a condition where areas of skin become dry, red, and very itchy. While the exact cause of eczema is unknown, affected individuals appear to have a genetic predisposition to developing eczema with skin that is more sensitive to environmental irritants and allergens. Having allergies, asthma, or a family member who has eczema are all associated with developing atopic dermatitis. Eczema most commonly appears on the face, back of the knees, wrists, hands, or feet. However, it can affect other areas of the body as well. Skin of the affected area generally appears very dry, scaly, or thickened, and tends to be reddish in colour. In those with darker skin, eczema can alter pigmentation, resulting in the affected area becoming lighter or darker. For most, eczema is a chronic condition that repeatedly flares up and subsides.

Typical symptoms of eczema include dry, cracked or scaly skin that is very itchy. Severe eczema can appear as small red bumps on the skin that are intensely itchy and may weep clear fluid. Affected skin may become thickened due to constant scratching.

The diagnosis of eczema is based on examining the skin and knowing what, if anything, triggers flare-ups. Lab tests are usually not needed, although your doctor may suggest allergy tests to determine possible irritants and triggers for your eczema.

Eczema can be persistent and chronic, or repeatedly flare-up and resolve. An important prevention strategy is to moisturize frequently. Factors that can trigger or exacerbate eczema, and should be avoided, include stress, overheating and sweating, low humidity, harsh soaps and detergents that can irritate the skin, and any foods or other substances which you are allergic to.

The goal of treatment is to relieve itching and prevent scratching. Itching can be distracting, cause distress, and disrupt sleep; while scratching can break the skin and potentially lead to infection. Over the counter corticosteroid creams, such as 1% hydrocortisone, can be effective treatment options. If these do not work your doctor may give you stronger steroid creams that are available only with a prescription. If the skin becomes infected, antibiotics may also be required. Other treatment options for moderate to severe eczema include immune suppressants. These may be applied to the skin as creams (Elidel and Protopic) or may be given as oral medications. These medications can have important side effects including an increased risk of infection and should only be taken under the close supervision of your family physician or dermatologist.

 

Moles

Moles are a type of benign skin growth that appear as small, dark brown spots, and can occur anywhere on the skin, alone or in groups. They are caused by melanocytes, or skin cells that contain the pigment melanin. Usually melanocytes are evenly distributed throughout the skin, but when they grow in a cluster they appear as a mole. Most moles appear in childhood and adolescence, and are much more common in Caucasians. By adulthood it is normal to have between 10-45 moles on your body. Moles may change in appearance as we age, often fading or even disappearing over time. While the majority of moles are benign, some can evolve into skin cancer.

Moles are typically small, brown spots on the skin. They may be smooth, flat or raised, and some may have hair growing from them. Normally they are either round or oval in shape, and are less than 6 mm in diameter.

Moles that don’t change over time are of no concern. To help you determine if you should be worried about a mole utilize the ABCDE guide, one or more of the ABCDE signs may indicate skin cancer. See your doctor if a mole is Asymmetric (one part of the mole is not the same as the rest), has an irregular Border, is not uniform in Colour, has a Diameter greater than 6 mm, or is Evolving, that is has changed in size, shape, height or colour (especially if the mole has turned black). Additionally, if you have a mole that is painful, itches, burns, oozes, bleeds, or has grown back after removal you should see your doctor. Your physician or a dermatologist can perform a biopsy on your mole to check for cancer.

Most moles are harmless and not a cause for concern. However, moles should be monitored for changes in size, shape, colour, or height, which may indicate cancer. Early detection of skin cancer is critical for effective treatment. Additionally, take precautions to avoid excessive sun exposure by wearing sunscreen and limiting periods of tanning to help prevent skin cancer.

While some people find beauty in moles, others may dislike them and wish to have one or more removed for cosmetic reasons. Mole removal is not covered by OHIP, so it can be expensive. If you are considering removing a mole, consult a dermatologist to discuss treatment options.

Skin Cancer

Skin cancer occurs when the DNA in skin cells is damaged, causing the cells to grow abnormally and invade other tissues. Skin cells normally replicate slowly to regenerate the skin or to heal wounds when the skin is damaged. When skin cells become cancerous they replicate even when they don’t need to, causing them to pile up and form a lump or small tumor. Some cancer cells can leave the skin and travel through the blood to form tumors in other tissues; this is called metastasis. The most common cause of DNA damage in skin cells leading to skin cancer is ultraviolet (UV) light from excessive sun exposure. As a result, skin cancer often develops on areas that are commonly sun-exposed, such as the face, neck, arms and hands. However, skin cancer can form on other areas of the body as well. Fairer skinned individuals are at an increased risk of developing skin cancer because they have less melanin in their skin, a pigment that absorbs UV light and protects the DNA. Nevertheless, skin cancer affects persons of all skin tones.

The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.

The signs of skin cancer differ based on the type. Basal cell carcinoma appears as a raised, smooth, waxy or pearly bump normally on sun-exposed areas such as the head and face. Tiny blood vessels are frequently evident within the papule. Squamous cell carcinoma, which also occurs on sun-exposed skin, may have the appearance of a firm, red nodule or appear as a flat lesion with a scaly and crusted surface. Melanoma, a form of skin cancer that develops from melanocytes in the skin, can develop as a new growth on otherwise unmarked skin or from a pre-existing mole. Signs of melanoma include a mole that begins to grow and has an uneven or irregular border, or that changes to become uneven in colour or texture. Melanoma may also bleed or ooze, or appear as a tan or brown-coloured spot with darker specks inside.

Skin cancer is diagnosed by taking a biopsy. Your doctor will freeze the area and then remove the lesion and send it to the pathology lab for analysis. Melanoma has a very high tendency to spread to other organs and areas of the body. If you are found to have melanoma, you will also need a CAT scan to look for spread.

The most common cause of DNA damage in skin cells leading to skin cancer is UV light from excessive sun exposure and tanning beds. Sunscreens and limiting exposure to intense sources of ultraviolet radiation, such as the mid-day sun or tanning beds, are the best ways to prevent skin cancer. However, skin cancers can form on areas of the body not exposed to the sun. Therefore, it is important to monitor your skin for new or growing bumps or spots. Early detection of skin cancer provides the greatest chance of successfully treatment.

Treatment options vary depending on the type of skin cancer and whether it has spread or metastasized. Basal cell carcinoma is slow growing and rarely spreads ,and so is generally the easiest form of skin cancer to treat. Basal cell carcinoma can be surgically removed or treated with liquid nitrogen or with imiquimod cream (Aldara). Prognosis is excellent. Squamous cell carcinoma of the skin is usually treated much like basal cell carcinoma, but it has a greater tendency to metastasize, and so may require the addition of chemotherapy or newer immune targeting therapies. Melanoma has a very high tendency to metastasize to other areas of the body, and so requires a more aggressive surgical approach followed by immune therapies.