Excerpts from an interview conducted by Kashmir Despatch’s Faiqa Masoodi with Dr. Mir Shahnawaz (MBBS, MD), Dermatologist, Laser Expert & Hairtransplant Surgeon
On a murky January evening, coupled with the punishing chill of Kashmir’s harsh winter, 25 years old Shaista (name changed) was anxiously waiting for her turn at a private dermatologist’s clinic in Srinagar city of Kashmir.
Accompanied by her long time friend, Shaista was scrambling to cover her visage with her head scarf and the side locks of her hair. With an uncomfortable body language, she reached out to her head scarf after every minute and kept impatiently staring at the entry manager to let her through to the consultant.
“This is what Hirsutism does to your body and your self-esteem. It makes you doubt your existence and compels you to go into a shell,” said Shaista’s friend while holding her hand.
In medical parlance, Hirsutism refers to excessive coarse dark hair in a male-like pattern in the androgen-sensitive parts of the female body, like the upper lip, chin, face, chest, arms, thighs, back and lower abdomen.
Hirsutism is a medical complaint among young women of reproductive age, and health experts observe a steep rise in its cases. The most common underlying cause of Hirsutism in women is Polycystic Ovary Syndrome (PCOS). PCOS is an endocrinal disorder and causes an imbalance of the sex hormones in a female body, which is often associated with Hirsutism, acne, obesity, infertility, and irregular periods.
To get down to the nitty-gritty of this alarming situation and to know how PCOS leads to Hirsutism and other dermatological problems in women, our reporter spoke to the famed dermatologist of the valley, Dr Mir Shahnawaz (MBBS, MD)- Director and founder of DERMIS- skin , hair and laser clinic, Bemina Srinagar.
Q: A lot has been written and published about PCOS among Kashmiri women. Now we want tohear from a dermatologist about the alarming increase in PCOS-induced skin issues, especially the nerve-wracking Hirsutism?
Dr. MS: Approximately 30-35 per cent of girls coming to my clinic with acne,hyper pigmentation, and hair growth have an underlying condition of PCOS which they are unaware of. In fact, the most common dermatological complaint in a PCOS patient is Hirsutism.
PCOS is one of the major causes of Hirsutism; about 70 per cent to 80 per cent of women withPCOS develop Hirsutism. Androgens, the male sex hormones, including testosterone, are responsible for developing masculine characteristics such as coarse facial and body hair. When the ovaries overproduce androgens, it leads to Hirsutism, acne and other skin problems. This overall jeopardizes the feminine identity of a woman due to alteration in her aesthetic standards.
In my clinical experience of many years, I have found facially hirsute women low on self-esteem. Hirsute women often try to get rid of excessive facial hair and are sometimes overwhelmed by feelings of frustration and depression.
Q: Which age group is most affected by PCOS, and how should one suspect its presence?
Dr. MS: PCOS is common to 15 to 20 per cent of women of the reproductive age group. From 18 years onwards and mainly in the age group of 20s and 30s, women are affected by PCOS.
Sometimes they are asymptomatic and mainly get to know about PCOS only when they have trouble in getting pregnant. At times a patient visits a dermatologist for excessive hair growth,skin discoloration, and acne without even realizing that these are all symptoms of PCOS. Sometimes a visit to a gynecologist for irregular cycles reveals an underlying PCOS condition.
In Kashmir valley, there is an alarming spike in PCOS cases, and it becomes pertinent to keep track of one’s lifestyle in this scenario. You should be quick enough to visit a doctor if you observe any of the following symptoms;
- Irregular menstrual cycles
- Acne eruption V-zone of the face ( Jawline area including chin)
- Hirsutism( excessive facial and body hair growth)
- Melasma (Hyperpigmentation of the face)
- Acanthosis nigricans (darkening of the back of neck, armpits, groins, underneath breasts and inside thighs)
- Alopecia (Thinning of hair or hair fall)
- Seborrhea (Excessive oiliness of the skin, especially forehead, nasolabial folds and behind the ears)
- Abnormal increase in weight
- Family history
Q: What investigation and tests should be done in case one suspects PCOS?
Dr. MS: Patients should undergo a pelvic ultrasound to rule out polycystic morphology of ovaries. Certain hormonal tests like Testosterone, 17-Hydroxy progesterone, Prolactin, LH, FSH,AMH, and DHEAS should be done to substantiate the diagnosis of PCOS further. A routine ultrasound does not always rule out the possibility of PCOS, and one must get the tests mentioned above.
Q: After detecting PCOS, when should one consider visiting a dermatologist?
Dr. MS: Ideally, soon after detecting PCOS, a patient should take a concurrent consultation with a dermatologist and an endocrinologist. The skin treatments can be started in combination with the treatments suggested by an endocrinologist.
Q: What skin-related solutions do you have to offer to distressed young girls suffering from hirsutism and extreme acne eruptions? Tell us about the most effective treatments for treating Hirsutism, acne and other PCOS-related skin issues.
Dr. MS: To put your best face forward, skin lasers are your most effective treatment. Laser technology has evolved with time, and various lasers of different wavelengths and energies are used to cure skin problems. We at DERMIS- Skin, hair & laser Clinic are committed to delivering comprehensive and exemplary skin care. Equipped with top-notch lasers and aesthetic equipments, we strive to give our patients safe, best, and world-class treatments that are time-tested and scientifically advanced.
Let’s talk about Hirsutism first, as it directly affects the psychology of a patient and can lead to a depressed life ahead. Laser Hair Reduction (LHR) is the most effective treatment of unwanted facial hair. Laser therapy selectively damages the hair follicle without destroying adjacent tissues by its photothermal and photochemical effects. The destruction of hair follicles also induces the miniaturization of thick, coarse hairs into thin vellus strands. Lasers like DIODE and ND: YAG are used to reduce hair growth; around four to six sessions can lead to 70 per cent reduction in hair growth. Afterwards, maintenance sessions at three to four months may be required for sometime. In addition to lasers, medications like spironolactone, cyproterone acetate, metformin and oral contraceptive pills (OCPs) may also be helpful. Ointments like eflornithine hydrochloride creams are also used for decreasing facial hair growth but they seldom show any good results.
Another major skin issue caused by PCOS is melasma, which causes discolouration of skin in a patchy form. Q-Switched lasers, vampire facials, gel peels, carbon laser toning and other topical treatments help a great deal in tackling melasma.
Acne, scars and pits are common occurrences in PCOS patients and can be dealt with by medications. However, lasers like fractional lasers, scar subcision, micro-needling, and facial PRPs come into play and provide the best possible solution to this long pending issue.
Q: From the above discussion, we can assume that lasers are a boon in the skin care sector and have revolutionized the skin industry. Now, where should one go for these treatments and how to trust the clinics providing these services?
Dr. MS: Yes, there is not even a doubt that lasers have brought a new ray of hope to the dermatological sector.However, there is a thin line between treating your face effectively with lasers and damaging it.
Unfortunately, in our clinical practices, we come across several patients who have been wrongly diagnosed and irresponsibly treated by non-certified people. Your skin is your most prized possession and you must invest wisely while choosing your dermatologist and the kind of treatment he will provide you.
A few things of paramount importance that a patient must ascertain before opting for a laser session at any centre should include;
(a) The man behind the laser- he/she must be a certified dermatologist with minimum qualifications of MBBS followed by MD dermatology.
(b) The brand of the laser in use- Ensure that it is an FDA-approved laser-like SAPPHIRE, LUMENIS, and ALMA.
(c) The energy parameters used during a laser session and their modulation in subsequent sittings.
Q: Initially, patients are hesitant to go for extensive laser treatments as they doubt it will affect their skin over the years. What is your take on this?
Dr.MS: Lasers are effectively designed to hit the target areas of the skin and minimize the risk factors. The penetration power of these lasers is mild and not beyond a specific layer of skin,thus posing no serious threat to the face and other vital organs.
However, it is pertinent to mention here that if lasers are performed imprudently by a non-professional, they can be hazardous. Therefore, one has to beware of quacks posing as doctors and get it done only by certified clinicians only (MBBS, MD/DNB).
Q: At last, what advice would you give to women facing skin problems and what are the dos anddon’ts that they should follow?
Dr. MS: I would like to tell all the ladies that the skin care industry has developed a lot over the years. Invest in your skin, and don’t let any insecurity become a hurdle.
1) Detection of PCOS symptoms and seeking of medical intervention at the earliest
2) Only visit a certified dermatologist for any treatment and skin procedures
3) Do maintain a healthy lifestyle and eat healthy food
4) Junk is a big ‘NO.’
5) Try to maintain your weight and do light exercises
6) Don’t overstress yourself, as stress can further aggravate it.
7) Don’t fall into the TRAP of discounts and offers circulated on social media by various influencers/shabby clinics/parlours. Please stay away from the clinics and parlours with Chinese/ Korean replica lasers. In most of these cases, there is always a compromise on the quality and standard of such lasers.
Although PCOS cannot be eliminated entirely, there is a genuine need to understand and diagnose it early so that holistic treatment of this disease can be initiated at the earliest, thereby preventing long-term morbidity.