10.3 Abnormal Hair Growth: Hirsutism and Hypertrichosis

NIC Scientific Concepts I.G pairs structure and cycles with abnormal growth so you can tell cosmetic superfluous hair from a pattern that needs a physician. Illinois 1175.835 lists disorders of the skin in Scientific Concepts and hair-removal methods in the 500-hour practices block. 225 ILCS 410/3A-1 lets you remove superfluous hair for cosmetic purposes and forbids treatment of disease and advice on appropriate medical treatment. That is the whole job of this section: two names, the usual causes, when a wax is enough, and which “permanent” methods are not profession 131.

Hirsutism Versus Hypertrichosis

Do not treat the two words as synonyms. National stems love that swap.

Hirsutism is terminal hair on a woman in a male-pattern (androgen-dependent) distribution: upper lip, chin, sideburns, chest, around the areola, abdomen (especially a midline trail), upper back, and inner thighs — denser or coarser than expected for her ethnicity. The biology is usually androgen effect on vellus-to-terminal conversion: more circulating androgens, more sensitive follicles, or both. The endocrine association esthetics textbooks name first is polycystic ovary syndrome (PCOS). Other medical associations include Cushing syndrome, androgen-secreting tumors (rare, often sudden and rapid), congenital adrenal hyperplasia, and androgenic medications. You do not diagnose PCOS from a chin. You recognize male-pattern terminal hair in a woman and you know when that pattern plus systemic signs is a referral.

Hypertrichosis is excess hair that is not limited to the male pattern. It may be generalized or localized. The extra hair may be vellus, lanugo-like, or terminal. A man with a dense back, a woman with long forearm hair that matches her family, or a localized tuft over a congenital nevus can all be taught as hypertrichosis rather than hirsutism. Hypertrichosis is not defined by androgens in a male-pattern map. That is the discriminators:

Causes you must be able to list

Four buckets show up on teaching outlines. They overlap in real clients; the exam still wants you to name them.

1. Genetics. Follicle density, coarseness, and anagen length are inherited. A family in which women have a visible lip line is not automatically PCOS.
2. Hormones. Puberty, pregnancy, menopause, and androgen excess change vellus-to-terminal conversion. PCOS is the highest-yield endocrine association for hirsutism. Thyroid disease is more often a shedding story (including telogen effluvium) than a new beard, but any unexplained systemic change is still a refer, not a salon diagnosis.
3. Medication. Textbook lists include androgenic steroids, some progestins, danazol, minoxidil, cyclosporine, and phenytoin. Minoxidil and cyclosporine are classic hypertrichosis drug examples (hair in non-male-pattern places). Androgenic drugs push hirsutism. You do not tell a client to stop a prescription. You document, avoid treating inflamed skin, and refer questions about the drug to the prescriber.
4. Ethnicity. Mediterranean, Middle Eastern, South Asian, and some Hispanic and Indigenous family patterns can include denser, darker facial or body hair without endocrine disease. Dark hair is also more visible on a light contrast. Do not label ethnicity as hirsutism. Do not ignore a sudden change by calling it ethnicity either.

When to Wax and When to Refer

Wax, tweeze, depilate, or thread when the hair is superfluous (the statutory word: extra hair the client wants gone for appearance), the skin is intact, there is no infection or inflammation you must refuse under 1175.115, and the client is not in a Chapter 16 contraindication (isotretinoin, sunburn, and the rest — procedures chapter). Stable, long-standing lip or brow hair in a well client is ordinary Illinois esthetics.

Refer for a medical workup — and do not wax over a problem you should not touch — when any of these are present:

• Sudden or rapidly coarsening male-pattern hair in a woman
• Male-pattern hair plus skipped periods, infertility concerns, severe new acne, unexplained weight change, deepening voice, or other androgen signs
• Excess hair plus other skin or systemic disease you are not licensed to sort
• Patchy loss (alopecia areata pattern) or diffuse shed after illness (telogen effluvium from 10.2)
• A client asking you to treat PCOS, “balance hormones,” or diagnose why she is hairy

3A-1 is explicit: you may render advice on what is cosmetically appealing. You may not render advice on appropriate medical treatment for diseases of the skin. The correct script is: you can remove hair on intact skin for appearance, and a physician should evaluate new, rapid, or systemic change. You do not order labs. You do not start spironolactone talk. You do not sell a “PCOS facial.” After a physician has evaluated and the skin is appropriate, cosmetic hair removal can still be part of how she manages appearance while medicine manages the cause. Those are different licenses.

In-Scope Methods Versus Electrolysis and Laser

Illinois is picky about which tool you use. Memorize the in-scope list from the Act and 1175.835, then memorize the two famous outs.

In scope for a licensed esthetician (profession 131):

• Tweezing (1175.835 tweezer method)
• Waxing (1175.835)
• Depilatories (1175.835 “depilitators” — the rule’s spelling of depilatories: chemical dissolution of the shaft at the surface, temporary)
• Threading (named in 225 ILCS 410/3A-1(B) as part of the esthetician definition)
• Dermaplaning of vellus plus stratum corneum as a cosmetic surface method (Public Act 104-0134)

Out of scope as esthetics:

• Electrolysis. Permanent destruction of the papilla with electrical current is the practice of electrology. IDFPR licenses a Professional Electrologist separately (profession 220: 600-hour program, IBEC examination). 225 ILCS 410/3A-1 states that esthetics does not include the services provided by a cosmetologist or electrologist. An esthetics wall license does not become an electrolysis license because a manufacturer sold you a needle. Do not advertise “permanent hair removal” as an Illinois esthetician service.
• Laser (and IPL) hair removal. Illinois treats laser hair removal as medical. IDFPR’s Statement Regarding Lasers and the IDFPR/IDPH medspa memo updated October 30, 2025 list laser hair removal among medical-spa procedures (alongside injectables, fillers, and PRP). A physician examines the patient and sets a treatment plan; operation is by the physician or by a medically delegated, trained provider under the Medical Practice Act — not under Article IIIA. A private “laser technician” certificate does not amend 225 ILCS 410. If a physician delegates a medical procedure, you may not hold it out as esthetics (IDFPR Statement on Prohibited Practices, 04/06/2026).

Temporary versus permanent is an exam discriminator that maps onto those licenses. Wax, tweeze, thread, and depilatories are temporary because the papilla lives. Electrolysis, done by an electrologist, targets that papilla. Laser, done as medicine, targets pigmented anagen hairs with light energy in living tissue — which is exactly why it is not a 3A-1 surface service.

The exam in one line

Name hirsutism when the map is male-pattern terminal hair on a woman. Name hypertrichosis when extra hair is not that map. Remove superfluous hair with tweeze, wax, depilatory, or thread. Refer endocrine and sudden-onset stories. Do not perform electrolysis or laser as an Illinois esthetician. Chapter 16 will teach how to wax safely. This chapter taught you which hair, which cycle, and which license.