First Report of Retroperitoneal Mucinous Cystadenoma in a Patient with Hirsutism

Primary retroperitoneal mucinous cystadenomas (PRMC) are rare benign neoplasms with only 55 documented cases in the English literature so far. A 19-year-old female exhibited hirsutism and was found to have a cystic mass measuring 5.8 cm × 3.9 cm × 5.8 cm in the left retroperitoneum. During subsequent work up, a high pre-operative value of dehydroepiandrosterone sulfate (DHEA-S) was noted. The patient was referred to surgical oncology and underwent an uneventful laparoscopic cystectomy. Pathology classified the cyst as PRMC. Post-operatively, the patient's DHEA-S levels normalized, though there was no appreciable decrease in the patient's hirsutism in the short-term follow-up. The origin of PRMC is uncertain. Due to their unknown biological potential, surgical resection is usually recommended. To the best of our knowledge, this is the first report documenting a PRMC and elevated levels of androgens in conjunction with hirsutism.

Multidisciplinary eyelid reconstruction in Barber-Say syndrome: A case report

Barber-Say syndrome is an unusual dysplasia caused by the mutation of the TWIST2 gene (2q37.3), which encodes a protein that acts at an epigenetic level. The case is presented of a 2-day-old male child in whom ectropion, hypertelorism, hypertrichosis and other dysmorphic features led to the clinical diagnosis of Barber-Say syndrome, which was later confirmed with genetic tests. Around 20 cases have been reported on this syndrome, of which less than half have described the surgical technique, as it represents a surgical challenge. The approach in this case included a lateral tarsorrhaphy and skin grafts taken from the volar surface of the forearm, retroauricular area and supraclavicular fossa, as well as autologous lipografts from the inner side of both thighs for palpebral reconstruction. This is the first case of Barber-Say syndrome in which the use of skin grafts are taken from supraclavicular fossa and forearms.

[Dermatologic laser surgery]

In this article we give an overview of which skin conditions that are currently treated with laser and explains the basic principles of treatment. In addition, we summarize recommendations of the Danish Dermatological Society for demarcation of medical treatments which can be provided free of charge from cosmetic self-payment treatments.

"Occult" ovarian Leydig cell tumor: when laboratory tells more than imaging

Hyperandrogenism is a common finding in premenopausal age and is generally caused by polycystic ovarian syndrome or other benign disease. Androgen-secreting tumors represent only 0.2 % of the causes of hyperandrogenism and usually present with severe clinical features, abrupt onset, and very high androgens levels. We describe here three cases of occult ovarian Leydig cell tumors suspected on the basis of severe clinical features of hyperandrogenism rapidly worsening, with elevated serum total testosterone levels, in which bilateral ovariectomy was performed and tumor was confirmed by post-operative histology. In all three cases, imaging was negative for ovarian tumor. Moreover, in one case the confounding concomitant finding of bilateral adrenal masses posed an additional challenge. Our experience highlights that testosterone levels represent the most helpful marker in the diagnosis of androgen-secreting ovarian tumor. In the absence of imaging findings, bilateral ovariectomy should be indicated, if supported by unequivocal clinical and laboratory data.

Increasing hirsutism due to a granulosa-cell tumor in a woman with polycystic ovary syndrome: case report and review of the literature

BACKGROUND

Granulosa-cell tumors (GCT), rare malignancies that arise from sex-cord stromal cells, account for less than 5% of ovarian tumors. These tumors present with an endocrine syndrome and mass signs. Surgery is the primary treatment approach. The risk of recurrence is more frequent in the juvenile-onset form.

CASE REPORT

We report the case of an obese 18-year-old Caucasian women with hirsutism and oligomenorrhea. Abdominal palpation revealed a voluminous firm mass. Hormonal evaluation documented severe hyperandrogenism. The ovary-specific tumor marker CA125 was elevated, whereas human-chorionic-gonadotropin was in the normal range. Abdominal imaging examination revealed a 19 cm mass in the left ovary. Twenty-four hours after removal of the mass, menstrual flow reappeared and androgens progressively normalized. Microscopically, the predominant pattern was one of uniform, bland, epithelioid to spindle-shaped cells. After three months, a significant weight loss was recorded, hirsutism had decreased slightly and oligomenorrhea reappeared. Δ4-Androstenedione levels remained elevated (4200 ng/L), whereas CA125 had normalized. In light of the pre-existing polycystic-ovary-syndrome (PCOS), the patient started estrogen-progestin treatment.

CONCLUSION

We report an interesting case of a woman with severe hirsutism due to GCT, and a history of oligomenorrhea caused by PCOS. After surgery, a dramatic clinical improvement was observed, whereas PCOS signs persisted.

Hair reduction: 48 months of experience with 800nm diode laser

BACKGROUND

The goal of hair removal methods has always been permanent or at least long-term epilation. Laser technology and the axiom of selective photothermolysis allowed a new approach to this subject.

OBJECTIVE

The aim of this retrospective study was to determine the long-term efficacy of a solid state, 800nm pulsed near infrared diode laser system for the reduction of pigmented hair, and extending habitual hair plucking intervals.

METHODS

In 48 months 242 patients received 703 diode laser treatments on 477 sites. Treatment data and an anonymous patient questionnaire on data concerning undesired hair growth (e.g. predisposition, psychological aspects), and hair plucking habits were retrospectively evaluated to verify the benefit of 800-nm diode laser application for the reduction of excess hair.

RESULTS

After an average of 1.97 treatments (range 1-6) sufficient reduction of pigmented hair was achieved for a mean period of 8.1 months. The habitual hair plucking interval was raised from a mean of 3.69 days before treatment to 15.19 days after laser epilation. The procedure was tolerated by 81.4% without local anesthetics and well accepted by 82.55% of the patients.

CONCLUSION

800-nm diode laser assisted hair removal represents a safe and effective treatment option for the reduction of pigmented hair.

Is ovarian surgery effective for androgenic symptoms of polycystic ovarian syndrome?

The effectiveness of laparoscopic ovarian drilling for treatment of anovulation in polycystic ovarian syndrome (PCOS) has been proved. The role of ovarian surgery in the treatment of symptoms related to hyperandrogenaemia, such as hirsutism and acne, has been less clear. This review sought to evaluate the effectiveness of ovarian surgery in the treatment of non-infertility symptoms related to PCOS. A systematic literature review was undertaken, by searching the Medline database for the years 1966-2002 inclusive. The search yielded 19 studies recording the outcomes of hirsutism, acne or androgen levels from surgical treatment for women with PCOS: three assessed unilateral oophorectomy; two ovarian wedge resection; and 14 ovarian drilling. There was no consensus of a clear improvement in hirsutism or acne in women undergoing surgery. There was a trend towards a decrease in serum androgen levels in most studies. We conclude that, while there is evidence that ovarian surgery may decrease androgen levels in some women with PCOS, the evidence that this translates into a clear improvement in hirsutism and acne is less clear. Further high quality clinical research, including data from randomisation, would be required to answer this question.

A qualitative study to assess the effectiveness of laser epilation using a quality-of-life scoring system

BACKGROUND

Facial hirsutism has a negative effect on the quality of life (QOL) of female patients.

AIM

To assess the efficacy of laser epilation on the quality of life in hirsute women.

METHODS

Over a 6-month period, we recruited 38 patients with severe pathological facial hirsutism. Each patient completed a pretreatment questionnaire consisting of a modified Dermatology Life Quality Index (DLQI), a visual analogue scoring system, and an 'out-of-10' scoring system. The patients were also scored independently by a doctor and a nurse. Each patient received a laser-epilation treatment programme and was reassessed in an identical fashion.

RESULTS

Following laser epilation, the mean patient DLQI score fell by 5 points. All three scoring groups scored lower across all scoring methods following laser treatment. There was also correlation in scoring between disciplines.

CONCLUSION

DLQI provides a valid scoring system to assess the efficacy of laser epilation. The interdisciplinary scores in this study indicate that an objective grading system for facial hirsutism could be developed in the future.

Pilonidal sinus disease treated by depilation using an 800 nm diode laser and review of the literature

BACKGROUND

Pilonidal sinus disease is a debilitating, disfiguring chronic ailment that is often resistant to therapy. Its etiology and treatment remain in question.

OBJECTIVE

To assess the efficacy of an 800 nm diode laser in the treatment of recalcitrant pilonidal sinus disease.

METHODS

Two patients with recalcitrant pilonidal sinus disease were treated in the lower back, buttocks, and perigluteal cleft area with an 800 nm diode laser with a spot size of 9 x 9 mm, fluences of 30 to 48 J/cm2, and pulse widths of 15 to 24 milliseconds.

RESULTS

Long-term relief of pilonidal sinus disease was produced with as few as two treatments 2 months apart to as many as six treatments over a 2-year period. With each successive treatment, fewer pulses were needed and the interval between treatments increased.

CONCLUSION

The 800 nm diode laser may be an effective tool in the treatment of pilonidal sinus disease. By eliminating the source of hair and hair fragments that course along the surface of the lower back and buttocks, interruption of the etiologic source for pilonidal sinus disease can be accomplished.

Epilation with a long-pulse 1064 nm Nd:YAG laser in facial hirsutism

BACKGROUND

Facial hirsutism and hypertrichosis are common problems and a methods are available to clinicians for the unwanted hair in a large number of patients. Several depilatory laser systems are now available and one of these modalities is the long-pulse Nd:YAG laser.

OBJECTIVE

To evaluate the efficacy of the long-pulse Nd:YAG laser in removing unwanted facial hair.

METHOD

In all, 29 patients completed their treatment course with a long-pulse (4 ms) Nd:YAG (1064 nm line) with fluences between 56 J/cm(2) and 70 J/cm(2). The average reduction in hair density was assessed using hair count on digital photographs at removal 3, 6 and 9 months postoperatively. The hair-free interval was variety of also evaluated.

RESULTS

The average reduction of in the hair count (the same diameter as the baseline for the criterion) was 43% at 3 months, 36% at 6 months, and 46% at 9 months. The hair-free interval with laser was two- to sixfold longer than with self-applied methods. No significant complications were observed in the range of skin types treated, even in the darker skin types.

CONCLUSION

The long-pulse Nd:YAG laser is an effective and safe method for long lasting hair removal in all skin types. The delay in hair regrowth most likely explains patient satisfaction.

Synopsis of laser assisted hair removal systems

Conventional treatment options for hypertrichosis and hirsutism are tedious and time consuming. Laser hair removal offers an efficient way to permanently reduce excessive hair growth. Hair is damaged using the principle of selective photothermolysis with wavelengths of light well absorbed by follicular melanin and pulse durations that selectively thermally damage the target without damaging surrounding tissue. Patients with dark hair and light skin are ideal candidates. Multiple treatments (3 to 6) performed every 6-8 weeks are necessary to achieve a permanent reduction of hair growth. As the field develops, a better sense of the effectiveness of laser hair removal will evolve and reasonable expectations will be determined.

Facial hirsutism treated with the normal-mode ruby laser: results of a 12-month follow-up study

Fifty-one patients of skin type I to IV with facial hirsutism received treatment with the normal-mode ruby laser (950-micros pulse; 4-mm spot; mean fluence, 49 J/cm(2); maximum fluence, 66 J/cm(2)). For each patient, one site was treated once only, and a second site was treated 4 times at 4-week intervals. After 48 weeks, 46 patients were available for assessment. After a single treatment, hair counts were reduced to a mean of 45% at 4 weeks (pretreatment median of 63 hairs down to 26), increased to 80% (median, 51 hairs) at 12 weeks, were 65% (median, 41 hairs) at 24 weeks, and were 59% (median, 35 hairs) at 48 weeks. Four weeks after 3 treatments, the hair counts had reduced to a mean of 30% (pretreatment median of 68 hairs down to 15). Twelve weeks after 4 treatments, the hair counts had increased to 45% (median, 24 hairs) and were 39% after 36 weeks (median, 22.5 hairs). No anesthesia was needed. Treatment tolerance improved with consecutive visits, allowing higher fluences to be used. Hyperpigmentation developed in 9 patients, which had faded completely in 8 patients at the end of the study. One patient showed hypopigmentation. Depressions in the skin below the jaw line developed in 5 patients, which resolved completely within 4 to 32 weeks. We conclude that normal-mode ruby laser treatment is well tolerated and leads to significant improvement of facial hirsutism, which is maintained for at least 48 weeks. Repeated treatments result in greater clinical effects.

A clinical overview of hair removal using lasers and light sources

The tremendous demand for removal of unwanted hair has led to the development of a wide range of noninvasive, user-friendly laser and light source systems; however, despite considerable advances in this field, these devices still have the potential to cause injury when used improperly. It is important to follow precise treatment guidelines in order to attain optimal results. This article gives an overview of the currently available lasers and light sources. It focuses on the practical aspect of laser hair removal by discussing patient selection, safety precautions, techniques using the different systems, pre- and post-laser treatment care, proper treatment endpoints, expected outcome, and possible side-effects and complications.

Hair removal using a long-pulsed alexandrite laser

The use of lasers for hair depilation has become a common modality for physicians in the recent past. As new lasers are developed, the complex mechanisms affecting this form of treatment are now under close investigation. The long-pulsed alexandrite laser functioning at a wavelength of 755 nm has recently been added to the armamentarium of health care providers to assist patients with unwanted body hair. A review of the embryology and anatomy of the hair follicle are discussed, as well as the findings of recent studies using this form of laser therapy. Using the suggested treatment protocols offered laser assisted depilation may be effectively achieved. The degree and duration of reduction vary with anatomic site and improve with multiple treatments.

Hair removal using an Nd:YAG laser system

Laser emission from neodymium-doped glass was first produced nearly 40 years ago. Later, a crystal of yttrium, aluminum, and garnet (YAG) was discovered to be a better lasing host for neodymium. The Nd:YAG laser has since been used for a variety of medical applications, more recently, this instrument has been used for the purpose of damaging hair follicles to epilate unwanted hair. This article reviews the background of the Nd:YAG laser with particular application to hair removal, summarizing the clinical and histologic studies presently available. Its current clinical use and possible future modification for elimination of excess hair are discussed.

Long-term epilation with long-pulsed neodimium:YAG laser

BACKGROUND

Unwanted body hair can represent a severe cosmetic disturbance. The traditional methods used to epilate often have limitations, side effects, and unsatisfactory results. In recent years, various light sources (lasers and others) have been developed for long-term epilation of unwanted hair.

OBJECTIVE

This study evaluates, on a large number of patients, the efficiency and safety of a long-pulsed low-potency Nd-Yag laser invented specifically for long-term hair removal.

METHODS

Some 208 subjects needing epilation were divided into three groups and treated during an 11-month period. Group A included 79 patients with a normal distribution of unwanted hair; Group B 67 patients with constitutional hypertrichosis; and Group C 62 patients with hirsutism. Treatment sessions were performed with a fluence of 23-56 J/cm2 at 1-month intervals until obtaining desirable results. Follow-ups ranged from 1 to 6 months. In 3 patients 4-mm diameter punch biopsy specimens were obtained before the first session and again after 6 hours. A third biopsy was performed after 3 months.

RESULTS

Every session resulted in a 20-40% hair loss, depending on the color of hair. Complete epilation was obtained in 4 to 6 sessions. Only white hair was not receptive to laser light, and its growth was not modified. No patients, including dark-complexioned patients, had blistering, hypo-or hyperpigmentation. No pain was present during treatment except for the axillary area. In the specimen obtained after 6 hours, very extensive necrosis of the hair follicular and sebaceous gland epithelium was evident. Histologic findings of the biopsies taken after three months showed complete disappearance of hair and moderate fibrosis.

CONCLUSION

This study proves that the long-pulsed Nd:Yag laser treatment produces an excellent prolonged epilation with no relevant side effects. This laser light, having a 1064 nm wavelength, is minimally absorbed in superficial skin layers, and pronounced scattering up to 5 mm occurs targeting the deeper follicles.

Ruby laser treatment for hirsutism: clinical response and patient tolerance

We report the results of a study of the ruby laser in normal mode for treatment of hirsutism in 43 patients with skin types I-IV. A pulse width of 950 microseconds, a 4 mm spot and a fluence sufficient to produce minimal whitening of the epidermis were used (mean 48 J/cm2). In each patient, one site was treated once only, and a second site received four treatments at monthly intervals. After a single treatment, hair counts had reduced to a mean of 46% (median 67, reduced to 26) of the pretreatment values at 1 month, but increased to 80% (median 42) at 3 months and were 66% (median 37) at 6 months. One month after three treatments, hair counts had reduced to a mean of 29% (median 60, reduced to 15) of pretreatment values, and 3 months after four treatments at the same site, counts had increased to 44% (median 21). Patient tolerance of the treatment was good and higher fluences tended to be tolerated at consecutive visits. The first treatment was followed by mild, short-lived erythema and swelling in 60% (25 of 42) patients. Fourteen per cent (six of 42) experienced mild blistering and 33% (14 of 42) crusting. More severe reactions were seen infrequently. These results indicate that normal mode ruby laser treatment is well tolerated. Sustained reduction in hair counts can be achieved for at least 6 months, and multiple treatments produce greater clinical effects.

Laser-assisted hair removal

The use of lasers in the treatment of a number of different skin disorders and diseases has become commonplace. This tremendous acceptance by both physicians and patients is a direct reflection of the high degree of precision and selectivity provided by lasers, which helps to minimize the risk of side effects and complications while simultaneously maximizing the opportunity for obtaining a satisfactory outcome. In an attempt to remove unwanted or excess hair, the principles of selective photothermolysis have been employed with several different laser and light devices that permit the effective treatment of large areas of hair-bearing skin with minimal discomfort and with low risk of scarring or other complications. It is possible using current laser technology to permanently remove some hair and induce a prolonged delay in the regrowth of many hairs. With additional experience and an improved understanding of how light can influence the rate and quality of hair growth, it is anticipated that permanent hair removal will be achieved in the near future.

Surgical depilation for the treatment of pseudofolliculitis or local hirsutism of the face: experience in the first 40 patients

Forty patients underwent surgical depilation for pseudofolliculitis barbae or local hirsutism of the face during a 15-year period. The operative method and its results and pitfalls are discussed. Although it is not the treatment of choice, this operation is very useful when other therapy has not been successful. This seems especially true in male-to-female transsexuals.

Hirsutism

The endocrine abnormalities associated with the development of androgen-dependent hirsutism have been presented and discussed in the light of the frequent finding of ultrasonographic abnormalities suggestive of polycystic ovary syndrome. A simple protocol of investigation, which should ideally include pelvic ultrasonography, has been presented. The treatment of hirsutism by combined anti-androgen and oestrogen therapy has been detailed and other approaches discussed.

Histologic study of the regeneration of axillary hair after removal with subcutaneous tissue shaver

It was observed that after subcutaneous tissue shaving for the radical therapy of hircismus and hyperhidrosis axillary hair often regrew. Histologic study of this phenomenon showed that hair bulb and most of the follicle up to a level near the sebaceous duct opening had been removed. Hair regrows from remnant outer root sheath, but only when sebaceous glands are preserved, that is when the upper portion of the follicular isthmus is intact. One or several solid epithelial pegs grow downward from the cut end of the trichilemma, and inner root sheath and new young hair are formed in its center. In hair peg stage, the lower tip of the hair follicle descends while new hair is growing in its center through the mitotic activity is growing in its center through the mitotic activity of hair germ cells and is prevented from pushing toward the skin surface by interlocking fusion between hair cuticula and sheath cuticula. Eventually, the epithelial cells wrap around a mass of mesenchymal cells and form a new bulb from which the terminal hair grows upward. The new matrix acquires a new complement of functioning melanocytes.

Surgical depilation for treatment of pseudofolliculitis or local hirsutism of the face

By cutting away their roots, unwanted terminal hairs can be removed when they are in their active phase (anagen) by a method called surgical (subcutaneous) depilation. There can be recurrences when hirsutism is being treated in females, because of vellus hairs which have their roots in the dermis. The residual vellus hairs can be eradicated by electrical depilation, however. Recurrences in males (pseudofolliculitis) are usually due to terminal hairs in a resting place (telogen); these "club hairs" can also be removed by electrical depilation.