What is eflornithine cream and how is it used to treat unwanted facial hair?
Eflornithine hydrochloride is applied as a cream on the skin to affected areas to reduce the rate of hair growth. It does not cause physical hair removal like depilatory creams and does not "cure" unwanted facial hair.
Eflornithine cream was sold by the brand name Vaniqa Australia (eflornithine hydrochloride 13.9% cream) for reducing the rate of growth of unwanted hair. However, you can no longer buy eflornithine hydrochloride cream commercially as Vaniqa or as a generic. A shortage of Vaniqa in Australia was documented in 2018 and subsequently became unavailable in the country.
Since the discontinuation of Vaniqa cream from the Australian market, it is now made from scratch and on-demand (i.e. compounded) by specialised pharmacies such as Skin Plus Compounding Pharmacy. A valid prescription from a doctor is required as it cannot be purchased over the counter.
Vaniqa remains commercially available in other areas of the world.
How was eflornithine cream discovered to help with excessive facial hair?
Eflornithine hydrochloride was originally administered by injection for the treatment of African sleeping sickness, a disease caused by a group of microorganisms called protozoa. Hence, it was referred to as the ‘the resurrection drug’. Some patients being treated with this medication were found to be losing their hair. Hence, it was formulated into a topical cream for application to the skin to harness this property of eflornithine hydrochloride in decreasing unwanted facial hair in women. In Australia, eflornithine cream was authorised for the purposes of delaying the regrowth of unwanted facial hair following hair removal.
The Science Behind Eflornithine
What is the working principle of eflornithine hydrochloride?
Eflornithine hydrochloride blocks the enzyme ornithine decarboxylase (ODC) which is found in hair follicles. This enzyme is needed to stimulate hair growth by its involvement in cell proliferation and function. In animal and human studies, Eflornithine cream has been shown to slow down the rate of hair growth. Eflornithine cream has been studied to treat unwanted hair growth around the mouth, chin and lips only. Its use in pregnancy and breastfeeding has not been studied thoroughly and should not be used in such circumstances.
What does eflornithine cream do?
Eflornithine cream is prescribed at a doctor's discretion for the reduction of unwanted facial hair in women. Factors that contribute to excessive hair growth in females include normal variation, aging, menopause, hypertrichosis, hirsutism, androgen excess disorders, polycystic ovarian syndrome, medications and other medical and genetic conditions.
How effective can eflornithine cream be?
Vaniqa appears to be beneficial in two thirds of women after use of the cream for six to eight weeks. It has been seen to work in women of all skin tones and reduces the rate of hair growth in all hair colours.
In clinical trials, some patients saw differences in treatment results as soon as four weeks after they started treatment, while others only noticed the difference after eight weeks.
The effectiveness of eflornithine cream appears to improve the longer it is used. Discontinuing use of the eflornithine cream causes regrowth of hair to baseline levels.
The clinical studies performed on patients using eflornithine also looked at social wellness markers such as feeling ‘uncomfortable at social gatherings’ and ‘uncomfortable in exchanges of affection’. Women who were treated with eflornithine hydrochloride no longer felt as bothered about their facial hair compared to those that used the placebo cream. Reported side effects were minimal and not very common.
Practical use of eflornithine cream
Why do women use eflornithine cream?
Excessive facial hair growth can lead to low self-esteem and embarrassment for women. Eflornithine hydrochloride cream reduces the rate of hair production. It is often used in combination with other hair removal techniques, at least until satisfactory results are seen.
Suggested instructions for application of eflornithine hydrochloride cream (ask your prescriber or pharmacist for individualised advice)
It is recommended that the area of the skin is first cleansed before using eflornithine cream. Apply a thin layer of cream and repeat twice daily. Eflornithine should be re-applied at least 8 hours apart. It is recommended that application of eflornithine occurs at the same time each day to improve adherence to the treatment regimen and to avoid forgetting application. It is not recommended to "make up" a missed application by applying the cream to your skin more regularly thereafter.
After applying a thin layer, the cream should be massaged into the skin thoroughly. It is best to avoid washing the skin for at least 4 hours after application.
Once the cream has been absorbed into the skin, other products such as moisturisers or sunscreen can be applied.
Eflornithine cream should not be applied at least 5 minutes after any other method of hair removal and only if the hair removal method has not caused significant irritation or redness of the skin.
When are results seen?
Results are often seen within 6 to 8 weeks of continual use. Some people will notice improvement as early as 4 weeks whilst in others, improvement can take much longer. The effects of hair growth reduction are seen gradually.
It is advised that other methods of hair removal be continued until the desired effects are seen.
It is recommended that treatment be stopped if no benefit is seen after 6 months of use.
Hair growth returns back to baseline when eflornithine hydrochloride cream is no longer used after approximately 8 weeks.
When should eflornithine cream not be used?
Eflornithine cream is minimally absorbed into the bloodstream after application to the skin. However, it is still not recommended to be used in pregnancy or breastfeeding. Those with severe kidney impairment should also avoid use of this cream. Eflornithine should not be used in children. The cream should also not be used if the expiry date has passed as it may not work as well. If the eflornithine cream packaging is torn or the cream does not look right, it is recommended that one speak to their pharmacist or doctor.
What should not be done with eflornithine cream
Eflornithine is made for use on intact skin. Contact of eflornithine cream with eyes or other mucous membranes such as the lips should be avoided. If this occurs, rinse the eyes or affected area thoroughly with tap water and seek medical attention. The Consumer Information Information (CMI) of Vaniqa in Australia (when it was available in Australia) stated that if someone swallows Vaniqa that they phone their doctor or call the Poisons Information Centre on 13 11 26 or go to the nearest Emergency Department, even in the absence of discomfort or signs of poisoning.
As a prescription item, eflornithine cream should only be used by the person who the prescription is written for. It should not be given to anyone else, even if they have the same problem.
Eflornithine cream should only be used on the skin to the areas directed by the prescriber.
Side effects of using eflornithine hydrochloride cream
Treatment with eflornithine hydrochloride cream is usually very well tolerated. Temporary skin reactions may occur in some which includes redness, mild stinging/burning or tingling sensations, rash. Ingrown hairs and acne can also occur. It is suggested to reduce use to once a day application if skin irritation occurs. It is suggested that using the cream be stopped if irritation of the skin persists. Medical attention should be sought if this occurs.
Eflornithine cream should be kept below 25 degrees celsius and not be frozen. Store in a cool and dry place, away from windows. Do not leave in a car on hot days. Heat and dampness may affect the activity of eflornithine cream on the skin. Keep away from children. The general recommendation is to keep medicines including eflornithine cream in a locked cupboard at least a meter and a half above the floor to minimise the risk of children getting to it. Take the product to your pharmacist for disposal if there are remaining contents in the dispenser.
Eflornithine should be white to off-white in colour and should be smooth and not gritty or grainy in texture. It should apply smoothly to the skin.
Purpose of this information
The information presented on this website and in this article is for general information and example purposes only, does not contain health advice specific for users and must not be relied on for that purpose. Please see your GP, dermatologist or other health care professional for specific advice.