Electrolysis and thermolysis for permanent hair removal

Electrolysis and thermolysis for permanent hair removal

IOURNAL Of the AmeRICaN A c a D e m y OF AAD "¢, 1938 DerMaTOLOGY OO ~e~A~o v VOLUME 12 I I1! IlU I NUMBER 3 MARCH, 1985 II Continuing me...

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IOURNAL Of the

AmeRICaN A c a D e m y OF

AAD "¢,

1938

DerMaTOLOGY

OO

~e~A~o v

VOLUME 12 I

I1!

IlU I

NUMBER 3

MARCH, 1985

II

Continuing medical education Electrolysis and thermolysis for permanent

hair removal Richard F. Wagner, Jr., M.D., John M. Tomich, M.D., and Donald J. Grande, M.D. Boston, MA The historical, legal, and theoretical aspects and clinical technics of both electrolysis and thermolysis are critically reviewed. The pitfalls of electronic tweezers and the dangers of self-electrolysis are discussed. Complications of electrolysis and thermolysis and the pathophysiology of hair regrowth are presented. In the United States, the lack of uniform training requirements and standards for electrologists may pose an unrecognized risk to public health. It is suggested that more responsible state legislation be enacted in order to decrease the present potential threat to the public health and safety. (J AM ACAD DERMATOL12:441-449, 1985.)

The permanent physical destruction of the germinative cells of hair for cosmetic and medical purposes is probably performed more extensively in the United States than in any other country in the world.1 Those practitioners of permanent hair removal are termed electrologists, in reference to the original method of hair destruction that is rarely used today. Although physicians were responsible for the initial development and clinical application of galvanic epilation (electrolysis) and diathermic epilation (thermolysis), physicians today are rarely trained in their use.

~, P ~ , . The CME articles are made possible through an ~,~,,,°'~ educational grant from Syntex Laboratories, Ine, From the Departments of Dermatology, Boston University School of Mealie'me and Tufts University School of Medicine, Reprint requests to; Dr. Richard F. Wagner, Jr., Department of Dermatology, Boston University Medical Center, '75 East Newton St., Boston, MA 02118.

Laws regarding the practice of electrology in the United States are regulated by each state. Physicians are exempt from licensing requirements where such laws are in effect. Currently, there are no legal training requirements for the practice of electrology in twenty-five states or the District of Columbia (Table I). The amount of training required prior to licensing varies markedly among those states that require licensing. Most states have separate licensing for electrology and cosmetology, but the three states of Alabama, Arkansas, and South Dakota require a state-issued license in cosmetology in order to practice electrology. These uneven standards in the field of electrology have been the subject of criticism by many medical authors. Although the earliest developers of these treatment modalities realized that, in their operations, they were destroying living tissue, a New York court ruled that electrolysis did not "constitute the practice of medicine within the 441

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Table I. Cont'd

Table I. Survey of state electrolysis and diathermy laws State

Minimum hours of training

State examination

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri

1,200 No state law No state law 200 500 No state law 120 300 None required No state law No state law 600 800 No state law 1,200 100 1,000 No state law 600 None required 100 1,100 300 No state law No state law No state law

Yes No No Yes Yes No Yes Yes No No No Yes Yes No No Yes Yes No Yes No Yes Yes Yes No No No

meaning of the medical practice act of New York," any more than clipping nails or shaving. 2 The legal details of this decision are very interesting, In 1917, Mollie Gerstenfeld sued Rose Engel because EngeI had not paid Gerstenfeld for the electrolysis she had performed on Engel. The Brooklyn Municipal Court had ruled that Engel owed Gerstenfeld for the services that she had performed. In the appeal, Engel contended that she should not be required to pay for the electrolysis since electrolysis was a part of the practice of medicine and Gerstenfeld did not possess a medical license. The Appellate Term of the New York Supreme Court found in favor of Engel; because Gerstenfeld had committed a misdemeanor by practicing medicine without a medical license, Gerstenfeld was not entitled to recover in this action.* This court decision was reversed in 1918 *Enget vs Gerstenfeld, 168 N.Y.S. 434.

State

Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio , Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Minimum hours of training

State examination

600 No state law 1,000 1,100 No state law 500 No state law No state law 300 500 4-year college degree and 600 hours No state law No state law 650 No state law 2,100 No state law No state law 500 No state law No state law No state law None required 280 No state law

Yes No Yes No No Yes No No No Yes Yes No No Yes No Yes No No Yes No No No No Yes No

by the Appellate Division of the New York Supreme Court, which ruled that electrolysis did not constitute the practice of medicine.* New York state later developed a test case in which Gertrude Budoff, an investigator who was employed by the Department of Education, went to a beauty parlor where the operator, Mary Lehrman, performed electrolysis on her.I" At first, Mary Lehrman was convicted by the court of unlawfully practicing medicine. The Appellate Division o f the N e w York Supreme Court subsequently ruled that electrolysis did not constitute the practice o f medicine, and the judgment of the lower court was reversed. In spite of these court rulings, Lerner wrote that " . . . the electrocoagulation method, though safe in the hands of an experienced dermatologist, could prove ineffective, destructive, and disfig*Engel vs Gerstenfeld, 171 N.Y.S. 1084. tPeople vs Lehrman, 296 N.Y,S. 580,

Volume 12 Number 3 March, 1985

uring if used by an amateur. Since it is really electrosurgery, its use should legally be limited to licensed physicians. ''3 Several years earlier, Cipollaro4 had expressed a similar viewpoint. More recently, Mahoney5 wrote, "It would be helpful if standards acceptable to the medical profession regarding training, qualifications and practice in electrolysis be established and enforced by law." The problem of licensing requirements for electrologists is not a problem that is confined to the United States. In the United Kingdom, although the services of electrologists are provided to patients through the National Health Service following the recommendation of a dermatologist, there is often hesitation to make such a referral on an ethical basis. 6 This may be because in the United Kingdom there are no licensing requirements for those wishing to practice electrolysis.7

History and definitions After several years of attempting to permanently destroy hair, Michel s,* published his first report in 1875 that detailed the operation of electrolysis, the use of galvanic current to electrochemically destroy the gerrninative cells of the hair follicle. Michel used this new procedure primarily for ophthalmic disease, but he also successfully removed facial hair. Hardaway and Foxg.1" also applied this method to dermatology for removing hair. Kree'° is given credit for developing the method of the multiple galvanic needle treatment in 1916. The next advancement in the field of permanent hair destruction was by the Frenchman, Bordier, who developed the method of thermolysis in 1924.:~,§ Thermolysis involved high-frequency electrocoagulation of the germinative hair cells. Thermolysis permitted many more hairs to be treated during the same treatment period than could be treated by galvanic electrolysis. By 1928, *Michel CE: Trichiasis and districhlasis; reflections upon their nature and pathology, with a radical method of treatment. St. Louis Cour Meal 1:121-144, 1879. tFox GH: On the permanent removal of hair by electrolysis. Med Rec 15:270-271, 1879. :~Bordicr H: Noveau traitement de l'hypertrichose par Ia diathermic. Vie todd, Paris 5:561-562, 1924. §Bordier H: Technique de l'epilation diatherrnique. Monde todd, Paris 42:78-81, 1932.

Electrolysis and thermolysis for hair removal 443

Na+ CI"

iii

Saline Solution

I

2 CI'- CI

Net

Reaction:

2 NaCI + 2 H=O Energy 2 NaOH (Lye) + H~ + CI2 t

Fig. 1. Mechanism of electrolysis: A direct current is passed into a saline solution, which results in formation of hydroxyl ions and hydrogen gas at the anode and chlorine gas at the cathode. Lerne? wrote that thermolysis had become the preferred method of permanent hair removal in Europe. Rostenberg,* in 1925, was the first American author to tout the method of thermolysis over that of electrolysis. In the 1940s, there were several publications by American authors who focused on the technic of thermolysis? '~'''2'1" ErdosBrown ~2recommended thermolysis as the method of choice for permanent hair removal in 1942. Thermolysis gradually replaced galvanic epilation in the United States and in the current era thermolysis remains the most popular modality.~3 St. Pierre and Hinkle ~Q introduced a method that they named "the blend" or "dual action" in 1945. This method employed the simultaneous use of galvanic and low-intensity high-frequency currents. Since electrolysis, thermolysis, and "the blend" rely on the destruction of the germinative hair cells to permanently prevent hair growth, these technics result in scarring of the healing tissue. The scar needs to encompass the entire generative region of the hair in order to prevent hair regrowth; the scar should extend no further and in this manner it remains a "microscar" that is not visible on the skin surface. Malfunctioning equipment, inexperienced operators, idiosyncratic heal*Rostenbcrg A: Epilationwith diathermy. Med J Rec 121:751, 1925. tRobinson MM: Removal of superfluous hair by mcnopolar coagulation.Med Ann DC IS:531-536,577, 1946.

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ing patterns of the patient, or any combination of these factors may result in unacceptable scarring.

Electrolysis Electrolysis (galvanism) is the chemical decomposition of tissue that results from the action of a direct electric current. In electrolysis, electrons are removed from chloride ions at the cathode, resulting in the formation of chlorine gas (Fig. 1). At the anode, electrons are added to water to form hydroxyl ions and hydrogen gas. This same process takes place within the hair follicle during electrolysis: the negative electrode is the electrologist's needle and the positive electrode is a moistened pad that is generally pressed against the patient's palm. Hydrogen gas and lye are generated within the hair follicle, and the lye then reacts with and decomposes the follicular tissue. At the positive electrode, the chlorine gas enters into an equilibrium reaction with water that results in the production of hydrochloric acid and oxygen. Since the surface area of the pad is much larger than the negative electrode tip, the concentration of hydrochloric acid at the pad is not clinically significant. In the practice of electrolysis, the needle should always be attached to the negative electrode. Savill noted that if the needle was inadvertently attached to the positive electrode, iron was driven off steel needles into the tissues, resulting in an indelible black tattoo along the tract of the needle. 14

Technic of electrolysis A water-moistened felt pad is connected to the positive electrode, which is pressed into the patient's palm with a 221A=volt dry cell battery furnishing the current. The skin is cleansed with soap and water and then it is swabbed with alcohol. With the skin stretched to help open the hair follicles, the needle is inserted into a follicle to a depth ranging from 3 to 5 mm parallel to the shaft of the hair. The angle of insertion is usually not perpendicular but is slanted at an angle between 15° and 90 ° . The needle should slide in easily. Pain or bleeding indicates that the follicular wall has been pierced and that the insertion angle is incorrect.15 The circuit is then closed with a foot switch. Current is adjusted with a rheostat so that 0.2 to 2 mA of current flow. The amount of current

will be limited by thepatient's tolerance to the pain it produces. After 30 to 60 seconds, tiny white bubbles of hydrogen gas appear around the base of the hair, which can now be removed easily from the follicle with forceps. Contiguous hair should not be removed in order to avoid excessive inflammation. An antiseptic solution is applied to the skin following treatment. In order to increase the rate at which hairs could be epilated, a multiple-needle technic was developed. This method provided for the sequential placing and removal of electrodes while always maintaining several active electrodes within the patient. 16 The multiple-needle method is not widely in use today. In addition to current intensity and duration, Hinkel and L i n O noted another factor that might affect the pattern of electrolytic activity within the follicle. They described the "moisture gradient" as the theoretical progressive increase in water content encountered as one descends from the skin surface into deeper tissues. Noting that the presence of water is essential for electrolytic action, they wrote that the "moisture gradient" helps to concentrate electrical action near the follicular base.

Thermolysis Since the 1940s, thermolysis (diathermy) has been the most popular method of permanent hair removal. In this modality, a current that oscillates rapidly between positive and negative is passed onto an electrode. When the electrode is negative, electrons of atoms within the field of the electrode are pushed away. When the electrode is positive, nearby electrons are drawn toward it. The more conductive the materials within the field, the greater is the effect of the field on its electrons. In thermolysis the needle acts as the electrode and the water within the adjacent follicular tissue is highly conductive. The action of the oscillating current on the water causes the water to become heated. The heat results in damage to follicular tissue. The allowable frequencies of current oscillation are regulated by the Federal Communications Commission. The most commonly used frequency in commercial electrology equipment is 13.56 MHz. 1°

Volume 12 Number 3 March, 1985

Fig. 2. The entire length of the thermolysis needle is demonstrated prior to its insertion into the hair follicle. Thermolysis can be either uniterminal or biterminal. Uniterrninal thermolysis allows for the use of a single electrode (the needle) without the need for a grounding electrode. Here the mass of body provides the electrical capacitance to allow sufficient current passage through the needle to destroy follicular tissue. Uniterminal thermolysis is currently the most popular technic for epilation. Biterminal thermolysis requires the placement of a grounding electrode and eliminates the capacitance function of the body. Stegman and Tromovitch ~7 wrote that these circuits theoretically discharge the current deeper into the tissues. Few electrologists currently use the bipolar technic. There are two different methods of employing uniterminal thermolysis: the manual technic and the flash technic. In the manual technic, a relatively low intensity of oscillating current is steadily applied to a follicle for a relatively longer duration (3 to 20 seconds). The long duration of treatment allows for greater heating and a higher probability of destroying sufficient tissue to prevent hair regrowth. The flash method employs a higher intensity current for a shorter duration, typically from ½o to ½ second. Its purpose is to achieve sufficient follicular destruction in a time too short to be perceived as painful. Theoretically, although the pattern of tissue destruction produced by the flash method may be smaller than that produced by the manual method, no study has been conducted that

Electrolysis and thermolysis for hair removal

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Fig. 3. Thermolysis needle inserted into the full depth of the hair follicle. Note how the apparent length of the needle seems to be decreased when compared with Fig. 2. At this point, the electrical circuit is completed and the germinative hair cells are destroyed by the heating action of the needle. compares the rate of hair regrowth by these two methods. The speed of the flash method combined with its relative lack of pain and good cosmetic result have made it the most popular technic for epilation. Technic of thermolysis The skin is cleaned as in the technic used for electrolysis, and the needle is inserted into the follicle in the same manner. The initial current duration and intensity settings are chosen based upon the hair type and the body location being treated. The foot switch is depressed, sending this predetermined current into the follicle. The hair is tested with gentle traction by forceps. If the hair does not slide out easily, adjustments are made in the current intensity or the duration, and the foot switch is again depressed. This is repeated until the proper settings for a given area are determined. After the settings are adjusted, epilation can proceed rapidly. As in electrolysis, spacing between treated hairs is important, and an antiseptic is applied after treatment. DeFeo and Allyn ~8developed a modified needle and forceps arrangement that facilitates hair removal. In the technic o f thermolysis, a smaller needle diameter produces a more intense heating pattern than a larger diameter

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Fig. 4. Forceps are used to epilate the hair.

needle because the smaller needle disperses the same amount of energy over a smaller surface area. 10The technic of clinical thermolysis is illustrated in the sequence of Figs. 2, 3, and 4.

The blend The blend technic represents the combination of electrolysis and thermolysis in a single piece of equipment. This is accomplished by employing a current that is both direct and alternating. In the blend, electrons oscillate back and forth within the wire yet have a net progression down the wire. Theoretically, this method has the advantages of both electrolysis and thermolysis in that the hair follicle is subject to both thermal and chemical destruction. However, this method is slower than thermolysis. In this method, the needle is inserted into the follicle and the thermolytic current is activated. One to two seconds later the galvanic current is added and both the direct and the alternating currents continue until the hair can be epilated. These devices permit the operator to use either current separately, sequentially, or simultaneously. 10

The needle Needles used when electrolysis treatment began were generally made of steel. One disadvantage of steel was that tattooing could occur if the needle

was inadvertently connected to the positive pole. Tattooing is not a problem with thermolysis. Later, needles were made of gold and platinum alloys in order to inhibit rust formation, but the stainless steel needle is most commonly used today. Efforts have been made to develop needles that would concentrate electrical action near the hair papilla and that would protect the epidermis. One design was a thin needle with a bulbous tip. Marton TMhas been given credit for the development of the insulated needles. Several theoretical considerations about insulated needles are important. Although galvanic current will be stopped by insulation, the electrical field generated in thermolysis is unaffected by insulation. The destruction of superficial follicular tissue may be critical for the prevention of the regrowth of hair. Needles designed to prevent superficial tissue destruction might therefore lead to greater hair regrowth. A recent development is the introduction of a flexible needle. No scientifically controlled studies comparing relative needle efficacy have been published. Although lasers are of theoretical use in the field of electrology, problems with the development of the laser have included the high cost of the equipment and the fragility of fiberoptic filaments. There are no lasers currently available on a commercial basis for use in electrology.

Autoelectrology Electronic tweezers, also known as high-frequency tweezers, with the trade names of Depilatron, Depillex, Permatron, Removatron, and Bioepilator, have been claimed by their manufacturers to have the ability to transmit an electrical current from the hair shaft into the hair follicle, thus resulting in the permanent destruction of the hair. The Food and Drug Administration, the federal agency that regulates medical devices used for hair removal, has taken the position that electronic tweezers are " n o better than nonelectrified household tweezers" for hair removal because there is no proof that there is any benefit from the electronic nature of these devices.* *Willis J: Some basics on hair removal products. FDA Consumer, October, 1979, p. 25.

Volume 12 Number 3 March, 1985

The Food and Drug Administration has sent regulatory letters to the firms involved in their manufacture, and it has seized these devices in several states. In addition, there may be potential dangers of these devices for cataract formation and for patients with cardiac pacemakers.* Nu-Trolysis is a method that was modified after the Depilatron and uses radio waves as a source of heat. There have been no published studies that have compared the efficacy of Nu-Trolysis and the proved methods of electrolysis and thermolysis. A second type of hair removal device for home use is the electrolysis type. A thin needle that is self-inserted into the hair follicle is used. Electric current is then passed through the needle until the regenerative cells of the hair are damaged to the point at which hair will no longer grow. When this method is attempted by those unskilled in its use, there is a great potential for infection and scarring. In Britain, a battery-powered electrolysis device of this type, the electronic pencil, has been declared unsafe by the British Medical Association Dermatologists Group Committee. 19 Ridley~ conducted a small clinical trial with the electronic pencil with fifteen women and concluded that, due to the difficulty encountered by the patients in manipulating the device and the pain and scarring caused by its use, this instrument was not satisfactory for hair removal.

Hair regrowth Several workers have estimated regrowth of hair following treatment with electrolysis or diathermy to range from 15% to 50%. ~3,,,2o,21 These wide variations have been variously attributed to the type of equipment employed and the expertise of the operator. New scientific observations in the phenomenon of hair regeneration have redefined the issues involved in hair regrowth. The earliest developers of electrolysis realized that it was a blind procedure in which the tip of the inserted needle may not be in close enough proximity to the germinative hair cells to result in their complete destruction; in this way, they explained the event of hair regrowth following elec*Willis J: Some basics on hair removal products. FDA Consumer, October, 1979, p. 25.

Electrolysis and thermolysis for hair removal 447

trolysis. The work of Oliverz2 has shed further understanding on this complex topic. Oliver removed the dermal papillae and the root ends from the hair follicles of rat whiskers. He found that all eighteen hair follicles that were deprived of their dermal papillae were subsequently able to produce whiskers. It was also found that twenty-eight of the thirty-seven follicles from which the root ends were removed produced whiskers. Oliver found that if more than the lower third of the follicle was removed, no hair would grow. This study provided conclusive evidence that hair could regenerate in the absence of the original hair papilla. In another study, Oliver investigated whether dermal papillae were regenerated in those hair follicles that regrew hair after the removal of their dermal papillae and root ends. He found that no hair was able to regrow unless a dermal papilla was regenerated. Oliver felt that hair follicle regeneration was due to mesenchymal cell migration to form new dermal papillae .23 Further studies by Oliver~4 demonstrated that when thirteen segments of rat hair follicle walls composed of the inner and outer root sheaths and the mesenchymal layer were isolated from the lower third rat vibrissa follicles and transplanted to the other sites, nine of the segments produced dermal papillae and seven of the segments were able to grow hair. The dermal papillae regrew at the proximal end of the implants and appeared to arise from the mesenchymal layer. Of four other implants that were obtained from above the lower third of the follicle, none regenerated a dermal papilla or grew hair. The realization that hair regenerated in the human axilla following subcutaneous tissue shaving for hircismus and hyperhidrosis led Inaba et a125,z6 to conclude that hair could regrow from the remnant outer root sheath when the upper portion of the follicular isthmus and its nearby sebaceous glands were intact. When this group investigated the effect of thermolysis on axillary hair, they found that hair regrowth started in the isthmus region of the follicle, z7 These workers found that if the isthmus region of the hair and its adjacent sebaceous glands were destroyed by electrocoagulation, the hair was permanently destroyed.

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In an earlier study, Robinson* had compared the methods of electrolysis and both uniterminal and biterrninal thermolysis on human hair by examining treated human skin with skin biopsies from the forearm. He found that while electrolysis and biterminal thermolysis, respectively, caused spindling of the cellular nuclei and lysis of the inner and other hair sheath membranes, uniterminal thermolysis left these regions intact. One year later, Ellis 2~ compared electrolysis, intermittent uniterminal thermolysis, continuous uniterminal thermolysis, and biterrninal thermolysis. He showed that treatment with eiectrolysis and thermolysis was similar in both quantitative and qualitative histologic skin destruction. In the most comprehensive study to date, Peereboom-Wynia29 directly compared the methods of electrolysis and thermolysis on symmetric facial regions of eleven patients with idiopathic hirsutism. These patients were treated every 2 weeks for a period of 20 weeks. At the conclusion of the study, it was found that the same amount of hair had been destroyed with each method. Of the hairs remaining, those treated with thermolysis had a smaller diameter than those treated with electrolysis. It was also noted that there was a relative increase in the amount of dystrophic hairs in the regions treated with thermolysis, although one patient who was treated with electrolysis also showed this. Although the author presented no skin biopsy evidence, it was postulated that the partial destruction of the hair root following thermolysis exp i n n e d the increase in dysplastic hair. It is possible that antiandrogen creams 3° used in combination with electrolysis or diathermy would reduce the risk of regrowth and new hair growth in the hormonal milieu that originally initiated and supported the hirsute state. In the setting of antiandrogen therapy, it remains to be determined whether the permanent epilation of the hair would prevent more regrowth than temporary epilation methods. Complications of electrolysis and thermolysis Serious complications of electrolysis and diathermy have rarely been reported in the medical *RobinsonMM: Removalof superfluoushair by monopolarcoagulation. Med Ann DC 15:531-536,577, 1946.

literature. PetrozzP ~ reported on an instance of verrucae planae that may have been spread by electrolysis. In Australia, Cookson and Harris 3~ reported a patient with valvular heart disease who developed diphtheroid endocarditis following electrolysis treatment. Other known complications of electrolysis and diathermy are pain, edema, erythema, scarring, local infection, postinflammatory hyperpigmentation and hypopigmentation, and the problem of hair regrowth. Tattooing has also been described by several authors as a complication of electrolysis. ~2,33The potential hazards of hepatitis B, herpes simplex, and the acquired immune deficiency syndrome (AIDS) have not been reported in electrolysis or diathermy patients. Although there have been no reported instances of cardiac pacemaker interference during electrolysis or thermolysis, Sebben 34 has written that high-frequency electrosurgery has the potential to cause pacemaker interference. REFERENCES

1, Goldberg HC, Hanfling SL: Hirsutism and electrolysis. J Med Soc NI 62:9-14, 1965. 2. Anon. Medical PracticeActs: Removal of hair by electrolysis not the practice of medicine. JAMA 110:839, 1938. 3. Lemer C: Treatmentof hypertrichosisby electrocoagulation. NY State J Med 42:879-882, 1942. 4. Cipollaro AC: Electrolysis: Discussion of equipment, method of operation, indications, contraindications,and warnings concerning its use. JAMA 111:2488-2491, 1938. 5. MahoneyMG: Electrolysis--a dark horse referral. Cuffs 18:213-214, 1976. 6. Local treatmentof unwantedhair. Drug Ther Bull 3:1112, 1965. 7. Ridley CM: A critical evaluation of the procedures for treatmentof hirsuffsm.Br J Dermato181:146-153, 1969. 8. Michel CE: Trichiasisand districhiasiswith an improved method for their radical treatment. St. Louis Clinical Record 2:145-148, 1875. 9. Hardaway WA: The treatment of hirsuties. Arch Dermatol 4:337-340, 1878. 10. Hinkel AR, Lind RW: Electrolysis, thermolysisand the blend: The principles and practice of permanenthair removal. Los Angeles, CA, 1968, Arroway Publishers. 11. Karp FL: High frequency current in treatment of hypertrichosis. Arch Dermatol Syph 43:85-91, 1941. 12. Erdos-Brown M: Superfluous hair: Removal with the monopolar diathermyneedle. Arch Dermatol Syph 46: 496-501, 1942. 13. Spoor HJ: Depilation and epilation. Cuffs 21:283,286287, 1978. 14. Savill A, Warren G: The hair and the scalp. London, 1962, Edward Arnold, pp. 309-314. 15. Crumay HM: Physical modalities of therapy, in Mos-

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chella SL, Pillsbury DM, Hurley HJ: Dermatology. Philadelphia, 1975, W.B. Saunders Co., pp. 1641-1656. 16. Marton MH: Treatment of hypertrichosis by improved apparatus and technique. Arch Phys Therapy 21:678683, 1940. 17. Stegman SJ, Tromovitch TA: Epilation (electrolysis), i n Cosmetic dermatologic surgery. Chicago, 1984, Year Book Medical Publishers Inc., pp. 211-215. 18. DeFoe CP, Allyn B: Modified needle and forceps arrangement for epilating unit. Arch Dermatol 91:639, 1965. 19. Caldwell IW: The electronic pencil. Br Med J 2:591592, 1972. 20. Behrman HT: Diagnosis and management of hirsutism. JAMA 172:1924-1931, 1960. 21. Chernosky ME: Permanent removal of superfluous hair. Tex Med 67:72-78, 1971. 22. Oliver RF: Whisker growth after removal of the dermal papilla and lengths of follicle in the hooded rat. J Embryol Exp Morphol 15:331-347, 1966. 23. Oliver RF: Histological studies of whisker regeneration in the hooded rat. J Embryol Exp Morphol 16:231-244, 1966. 24. Oliver RF: Ectopic regeneration of whiskers in the hooded rat from implanted lengths of vibrissa follicle wall. J Embryol Exp Morphol 17:27-34, 1967. 25. Inaba M, Anthony J, McKinstry CT: Histological study of the regeneration of the axillary hair after removal with

Electrolysis and thermolysis for hair removal 449

26.

27. 28.

29. 30. 31. 32. 33. 34.

subcutaneous tissue shaver. J Invest Dermatol 72:224231, 1979. Inaba M, Anthony J, Ezaki T, et al: Regeneration of axillaryhair and related phenomena after removal of deep dermal and subcutaneous tissue by a special "shaving" technique. J Dermatol Surg Oncol 4:921-925, 1978. McKinstry CT, Inaba M, Anthony JN: Epilation by electrocoagulation: Factors that result in regrowth of hair. J Dermatol Surg Oncol 5:407-411, 1979. Ellis FA: Electrolysis versus high frequency currents in the treatment of hypertrichosis: A comparative histologie and clinical study. Arch Dermatol Syph 56:291-305, 1947. Peereboom-Wynia JDR: The effect of electrical epilation on the beard hair of women with idiopathic hirsutism. Arch Dermatol Res 254:15-22, 1975. Nielsen PG: Treatment of moderate idiopathic hirsutism with a cream containing cancenone (an antiandmgen). Dermatologica 165:636-639, 1982. Petrozzi JW: Verrucae planae spread by electrolysis. Curls 26:85, 1980. Cookson WOC, Harris ARC: Diphtheroid endocarditis after electrolysis. Br Med J 282:1513-1514, 1981. Lincoln CS: Epilation, in Epstein E, editor: Skin surgery. Philadelphia, 1962, Lea & Febiger, pp. 216-222. Sebben JE: Electrosurgery and cardiac pacemakers. J AM AC_ADDERMATOL9:457-463, 1983.

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