Q: I am a woman recently diagnosed with polymyalgia rheumatica. I was put on prednisone, 30 milligrams a day, and then in decreasing doses and will need to stay on it for several months.
The side effect that distresses me most is that I am growing facial hair. I complained to my doctor and he only laughed at me, but I find it quite upsetting. Will the facial hair disappear when I get off prednisone? What do I do in the meantime? Should I shave or will that only make the hair grow in heavier and faster?
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A: I would complain about the doctor who laughed at you. Women find facial hair growth upsetting and this matter should be taken seriously. Many women have this problem as the result of taking prednisone for such diseases as lupus, rheumatoid arthritis, ulcerative colitis and other autoimmune disorders. It is also a drug taken by transplant recipients to help reduce the chance of organ rejection.
Prednisone has some serious side effects such as causing increased calcium loss in the bones leading to possible osteoporosis, disintegration of the ball joint in the hip, gastric ulcers, acne and weight gain. Fortunately for you, these side effects are less frequent in the lower dosages, but I hope you will be able to soon stop the drug altogether.
You cannot suddenly discontinue it, as this will cause other problems. Your doctor will have to adjust the dose gradually.
Postmenopausal women also suffer from increased growth of facial hair as the lack of estrogen in the body leads to a natural increase in the body’s levels of corticosteroids. Whether or not your hair disappears after discontinuing treatment will depend on how old you are. As most suffers of polymyalgia rheumatica are over 50, I think you are most likely menopausal or close to it, and may be stuck with the hair problem.
There are various ways to manage facial hair. It is a myth that shaving makes the hair grow back thicker and stronger. It is no thicker, but may seem pricklier when it starts to grow back. Depilatory creams are another alternative and this method lasts longer than shaving. You can also bleach the hairs so they do not show as much. Make sure you use special facial bleach such as Joleen. Regular bleach will cause burns. Electrolysis is expensive, and the hair still grows back in time, although thinner, so that treatments have to be repeated at intervals. It is also quite painful. I do not recommend plucking, although some women do use this method for an occasional hair or two. This does cause damage to the hair follicle so that the hair may grow back distorted and thicker. There is also an increased risk of infection such as boils and abscesses.
Bipolar illness
Q: My wife suffers from chronic depression and the psychiatrist says she is suffering from bipolar illness. Can you please explain this? How can she be bipolar if she is never “up?”
A: Some doctors use bipolar disorder to describe any type of severe long-standing depressive illness that has a biological cause, such as serotonin deficiency. It replaced the term “manic-depressive” probably because it sounds better. There were also national differences in terminology. The Europeans used the term manic-depressive while the Americans said bipolar disorder. Eventually most of the world including Canada adopted the American term.
Bipolar disorder usually implies that a person suffers from periods of depression and spells of hypomania. During hypomanic episodes, sufferers tend to spend more money than usual, flit from one activity to another, talk too fast and switch topics frequently. They do not sleep for long, if at all, which leads to eventual exhaustion. They are sometimes even delusional. However, in some types of bipolar disorder there appears to be mainly a depressed mood while in others it is the opposite. Perhaps your wife had a manic episode before you knew her, or perhaps it is yet to occur.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
