Vaniqa cream pack photo

What is Vaniqa?

Vaniqa is a brand of face cream which is used to treat unwanted hair on the face and neck of women. As a cream, it is applied directly to the skin on the face and neck, at the site of the unwanted hair.

Vaniqa contains a drug called eflornithine. Eflornithine blocks the action of an enzyme called ornithine decarboxylase, which is found within the hair follicles. Blocking this enzyme results in slower hair growth.

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What are the constituents of Vaniqa?

Vaniqa is a medical product. It is a cream for application to the skin, which contains the active ingredient eflornithine, plus the additional constituents listed below:

  • Cetostearyl alcohol
  • Macrogol cetostearyl ether
  • Dimeticone
  • Glyceryl stearate
  • Macrogol stearate
  • Methyl parahydroxybenzoate (E218)
  • Liquid paraffin
  • Phenoxyethanol
  • Propyl parahydroxybenzoate (E216)
  • Purified water
  • Stearyl alcohol
  • Sodium hydroxide (E524) (to adjust pH/acidity)

Why have I got unwanted hair on my face and neck?

Hirsutism photos

It is understandably upsetting to live with unwanted hair on your face and neck. This is known as 'hirsutism'. It is actually very common, affecting 4-11% of women.

Hirsutism has a genetic tendency, and tends to run in families. It is also more common in women from South Asia, the Middle East or the Mediterranean.

Hirsutism means excessive hair growth in women. However in hirsutism, the hair grows characteristically in a male pattern distribution - in the beard area of the face and neck, but sometimes also on the tummy, lower back and thighs.

Hirsutism is usually not caused by any serious medical conditions. It is most likely due to an imbalance of female and male hormones in your body. Acne and hirsutism are generally attributed to a relative excess of the male hormone testosterone.

Testosterone and other similar hormones are often called 'androgens', and testosterone type side effects are known as 'androgenic' side effects.

If you have troublesome facial and neck hair you should have a consultation with a doctor. There may sometimes be an underlying medical condition which requires treatment.

For further information see NHS - Hirsutism page.


Which medical conditions can cause hirsutism?

The vast majority of women with unwanted hair on the face and neck have no significant underlying cause. This is called 'idiopathic hirsutism'.

Other causes of hirsutism however include:

  • Endocrine conditions
  • Side effects of medication

Endocrine conditions

Endocrine conditions are abnormalities affecting the glands inside your body - notably the ovaries, adrenal, thyroid, and pituitary glands. These are listed below.

Ovarian causes of hirsutism

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome is a common gynaecological condition affecting 1 in 5 women in the UK.

Women with PCOS women have large numbers of tiny follicles in their ovaries. The follicles are the little sacs in which the eggs develop. However in PCOS, these sacs do not function properly, and do not ripen around the time of ovulation and are also unable to release the egg. This is not dangerous, but may result in a variety of symptoms.

Most commonly women with PCOS have altered monthly cycles, or sometimes no periods at all, infertility and other symptoms/signs relating to relatively high levels of male hormones – known as androgens - such as unwanted hair on the face and neck, hair thinning on the head, and greasy skin/acne.

Women with PCOS frequently also have difficulty responding to the hormone insulin. This means they don't break down carbohydrates within their bodies very efficiently, and hence tend to be overweight and have trouble losing weight. There is an association between PCOS and glucose intolerance/diabetes.

If you have PCOS, it is important to get good advice and support about managing the condition.

Ovarian tumours

Rarely, tumours of the ovary can secrete hormones which may result in hirsutism.

Adrenal causes of hirsutism

Congenital Adrenal Hyperplasia

This is a rare genetic disorder, most frequently diagnosed at birth, but sometimes diagnosed in young adults, in which there is an inability for the body to make the hormone cortisol. As a result there is a relative excess of male hormone. One of the clinical manifestations of this is unwanted hair.

Cushing's syndrome

Cushing's Syndrome is a rare condition in which women develop symptoms and signs due to high levels of the hormone cortisol. This may be either from taking high levels of steroids (such as prednisolone) for a medical condition, or from a tumour for example, within the adrenal or the pituitary gland.

Symptoms of Cushing's syndrome include a typical body weight distribution with thin arms and legs, an increased fat deposition on the abdomen, as well as a characteristic fat pad on the back of the neck known as a 'buffalo hump'. In addition women may get unwanted hair growth, muscular weakness in the arms and legs, skin which bruises easily, and fatigue.

Adrenal tumours

Rarely, adrenal tumours can secrete hormones which may result in hirsutism.

Thyroid causes of hirsutism

The thyroid gland is a gland in your neck which produces the hormone thyroxine. Thyroxine is an important hormone as it regulates your body processes. The thyroid can become overactive or underactive. In each case there are a variety of different symptoms and it can affect your hair growth. Women with underactive thyroid most commonly complain of hair loss. However, unwanted hair may be a sign of thyroid disease and this should be excluded with medical tests.

Pituitary causes of hirsutism

Acromegaly

Acromegaly is a condition where the pituitary gland produces too much growth hormone. This may be associated with hirsutism.

Pituitary tumours

Pituitary tumours result in raised levels of the hormone prolactin. Characteristic features are absent periods, and infertility. Sometimes there may be hirsutism.

Side effects of medication

Below are listed different types of medication which may cause hirsutism:

  • Danazol - a treatment for endometriosis
  • Fluoxetine – an antidepressant
  • Methyldopa – used to treat Parkinson's Disease
  • Metoclopramide – a treatment to stop vomiting
  • Phenothiazines – tranquilizers used to treat serious psychotic conditions
  • Progesterones – hormones commonly used in contraception and hormone replacement therapy (HRT)
  • Reserpine – used to treat schizophrenia
  • Testosterone – male hormone which promotes hair growth

Which tests do I need for hirsutism?

If you meet the following criteria you may not need any tests at all:

  • Your unwanted hair is a typical male pattern hair distribution
  • This has been slow in onset over a period of years
  • You have regular periods (and for example - have had a pregnancy)
  • You have no other symptoms suggestive of excessive male hormones levels i.e. no deepening of the voice, baldness or enlargement of the clitoris, and no other clinical signs which cause concern.

If this is the case, your doctor may agree tests are not necessary.

However if tests are needed, these are likely to be:

  • Blood tests to measure levels of:
    • Testosterone
    • Cortisol
    • Hormone profile – oestrogen, Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), Serum Hormone Binding Globulin (SHBG) and progesterone
    • Thyroxine
    • Prolactin
  • Pelvic ultrasound

Why choose Vaniqa to treat hirsutism?

Vaniqa is a good choice for women with hirsutism because:

  • Vaniqa is the only topical (local) treatment available for hirsutism

    The active ingredient, eflornithine, works locally within the hair follicles and absorption into the body is low. Eflornithine is excreted in the urine and is not known to be metabolised within the body. This means it has an excellent safety profile.

  • Vaniqa has a specific pharmacological action

    Vaniqa inhibits the enzyme ornithine decarboxylase, and hence it slows hair growth. Vaniqa does not physically cause hair to be lost – it works by slowing the growth of the hair.

  • Vaniqa is effective

    In clinical studies where 596 patients used either Vaniqa or a placebo cream, and neither the women themselves nor the investigators knew which they were taking (a double blind study), the Vaniqa group demonstrated the best results. These were statistically significant, compared to the placebo group.

    After 24 weeks in the Vaniqa group: 6% had total clearance of unwanted hair, 29% had marked improvement, 35% were improved, and 30% showed no improvement. This compared to 0%, 9%, 33%, and 58% respectively in the placebo group.

    Results were slightly less effective in non-caucasian women, and women who were obese. The study included post menopausal women in whom the treatment was significantly effective.

  • Vaniqa is highly recommended

    The National Institute for Care and Excellence (NICE) has recommended the use of Vaniqa for women with moderate/severe hirsutism.

    Vaniqa is also recommended by the British Association of Dermatologists for treating hirsutism.


What other options are there for treating hirsutism?

It is always important to consider any possible underlying cause for hirsutism.

For example, if you have PCOS, managing this appropriately is likely to improve symptoms. Weight loss for PCOS sufferers is very important. Heavier women tend to have higher levels of steroid hormones including testosterone. It is very important that you see your doctor, and get good advice and support about managing your PCOS, including help with weight loss/weight management.

In addition to managing any underlying conditions associated with hirsutism, there are a variety of ways to treat the condition. These are listed below:

  • Local treatments and removal techniques for hirsutism

    • Bleaching

      Bleaching aims to make dark hairs appear paler. However, using bleaching creams on unwanted hair, may also result in bleaching of the skin. This may not be suitable especially for darker skins. Sometimes the bleach also causes skin irritation.

    • Shaving

      Shaving is effective but needs to be done daily, results in stubble, and can be associated with rashes and ingrowing hairs.

    • Waxing

      Waxing can be done at home or in a salon and may be effective if you have unwanted hair on your upper lip. There is a risk of burning the skin if the wax is too hot. Also hairs may just break off instead of being removed completely, plus there is a risk of infection. You should not use hot wax treatments if you are currently using topical skin creams for acne.

    • Electrolysis

      During electrolysis a very fine needle is inserted into the hair follicle and a small burst of electricity is passed through to destroy cells within the follicle. It is not possible to use electrolysis to treat large areas of unwanted hair.

      Electrolysis is less effective on thick coarse hairs which may need several treatments. It's often said to be painful. If you choose electrolysis always go to a practitioner who is a member of the British Institute and Association of Electrolysis.

    • Laser/Intense Pulsed Light (IPL)

      Laser treatment aims to destroy part of the hair follicle by targeting the follicles and exposing them to heat/light. Several treatments may be needed over a period of months. In one study, using a long pulse alexandrite and 810nm diode lasers, after 3 months there was approximately a 60% reduction in unwanted hair. These treatments are not always available on the NHS. It seems to work most effectively for women with pale skin and dark hairs.

    • Bleaching

      Bleaching aims to make dark hairs appear paler. However, using bleaching creams on unwanted hair, may also result in bleaching of the skin. This may not be suitable especially for darker skins. Sometimes the bleach also causes skin irritation.

  • Drug treatments

    With all drug treatments, patients should continue for 6 to 12 months before judging the outcome.

    • Local drug treatment

      The only available topical (local) drug treatment is Vaniqa (eflornithine 11.5%) cream. This is applied directly to the skin at the site of the unwanted hair growth. It has been shown to be safe and effective in clinical studies.

    • Oral medications

      There are four oral medications used to treat hirsutism:

      • Combined oral contraceptive pill

        Specific brands of the Combined Pill can be very effective in treating hirsutism.

        The pill Dianette is often used to treat hirsutism. The progesterone in Dianette - cyproterone acetate - has an anti-testosterone affect. As a result Dianette users experience a reduction in symptoms such as acne and hirsutism.

        In fact, although Dianette works like a Combined Oral Contraceptive Pill, it is not actually licensed for this purpose. Dianette is prescribed to women as a treatment for moderate to severe acne and hirsutism.

        However, Dianette can be a good choice for a woman with moderate to severe acne and hirsutism, but who also need contraception. There are set criteria for safe prescribing of the Combined Pill, and these criteria do need to be followed when issuing Dianette. Your doctor will only prescribe Dianette after an in-depth consultation. It is not suitable for everyone.

        An alternative to Dianette is the pill Yasmin which also has a positive effect at reducing acne and hirsutism, but Yasmin is licensed as a contraceptive pill.

      • Spironolactone

        This drug directly blocks testosterone. It can however have side effects especially on kidney function. It should not be taken in women on various diuretics. Blood tests for kidney function need to be taken before and during treatment, and blood pressure should be monitored. Spironolactone must only be used with contraception as there is a risk of masculinisation of a female fetus if a pregnancy occurs whilst taking it.

      • Flutamide

        This drug directly blocks testosterone. It can however affect liver function. It must be used with contraception as there is a risk of masculinisation of a female fetus if a pregnancy occurs on treatment.

      • Finasteride

        Only for post menopausal women. This drug blocks the production of testosterone and other male hormones.


Who benefits from Vaniqa?

Vaniqa is a local treatment - a skin cream - to treat hirsutism, and hence it is an ideal treatment for women with:

  • Moderate to severe hirsutism
  • Who are not suitable for or do not wish to take oral medication for hirsutism
  • Have tried oral medication for hirsutism and it has failed or caused side effects
  • Are having other treatments such as laser treatment, as they can use Vaniqa at the same time, as an adjunct to treatment.

Vaniqa is an effective treatment for hirsutism. It reduces the amount of unwanted hair, and also results in changes to the appearance of the hair, so that individual hairs are paler, shorter, and weaker. In clinical studies, Vaniqa users also demonstrated a significantly reduced psychological discomfort with the condition while using the treatment.

Read Dr Fox patient reviews of Vaniqa cream.


Can Vaniqa be used by men, or only women?

No. Vaniqa is licensed only to treat unwanted facial hair in women.


Can you use Vaniqa anywhere - or just on the face and neck?

Vaniqa has only been studied for use on the face and neck. It is not recommended to use it elsewhere on the body.


How do you use Vaniqa?

  • Wash hands before treatment.

  • Perform any hair removal such as plucking or shaving at least 5 minutes before applying the cream.

  • Do not apply Vaniqa to any skin which is red, chapped, sore, sunburned, or otherwise irritated.

  • Apply a thin film and rub the cream in with the finger tips to the area with the unwanted hair.

  • Do not wash for a minimum of 4 hours after applying Vaniqa. Make-up or sunscreen may be applied as soon as the cream is dry.

  • Apply the cream twice a day at least 8 hours apart.

  • If your skin is getting red or sore after treatment, reduce to only one application per day. If this continues, see your doctor.

  • It may take 8 weeks before you notice any improvement. Try to persevere with the treatment for at least 6 months.

  • After 6 months, if there is no improvement, discontinue treatment.

  • You do need to continue removing unwanted hair while on treatment, as Vaniqa does not cause hair loss - it slows hair growth.

  • Vaniqa needs to be used long term to maintain the improvement. Within 8 weeks of stopping, any benefits will have been lost.

  • Vaniqa should be stored at room temperature and should not be frozen.


Can you use too much Vaniqa?

Try to use a thin layer of cream only. Never swallow Vaniqa by mouth.

If you inadvertently swallow Vaniqa by mouth, you are strongly advised to contact the NHS Poisons Information Service - telephone 111 if in the UK.


Is it dangerous to use Vaniqa longterm?

Vaniqa is only effective while you are using it, so for the best results this should be considered a long term treatment.

Long term studies about the safety of Vaniqa are lacking. However, this is not an uncommon situation as clinical studies are usually short term because they are time consuming and expensive to run. As Vaniqa is a topical (local) treatment, only small amounts of the active ingredient elfornithine get into your blood stream. Many women have used Vaniqa safely for years with benefit.

However it is always important to have medical check-ups and be sure it is in your best interest to continue to use any medication.


Can you be allergic to Vaniqa?

It is possible to have an acute allergic reaction to Vaniqa, although this is extremely rare.

If you have any symptoms or signs suggestive of an acute allergic reaction (anaphylaxis), you must get help immediately - telephone 999 (UK emergency services).

Symptoms/signs of an acute allergic reaction include:

  • Difficulty breathing/tight chest/wheezing
  • Swelling of the face, lips, and tongue
  • Skin rash – urticaria/hives
  • Confusion/collapse/unconsciousness

What are the most common side effects of Vaniqa?

Side effects from Vaniqa have been reported in clinical trials. It is important to note that some of these side effects are also reported in patients using placebo (dummy) preparations, and it is not always possible to be sure if there is a causative effect from Vaniqa itself.

The following side effects have been reported. This list is not exhaustive:

Very common (≥1/10)

  • Acne - the most common side effect with Vaniqa is acne. In clinical trials, 7% of women treated with Vaniqa reported worsening of their acne, compared to 8% using a placebo cream. Of those who did not complain of acne at the start of the trial, 14% of women in both the Vaniqa and the placebo groups, developed acne during the study.

Common (≥1/100 to <1/10)

  • Alopecia - generalised hair loss

    Dry skin

    Folliculitis

    Pseudofolliculitis barbaebarber's rash – bumps/lumps in the shaving area caused by skin irritation/ingrowing hairs

    Stinging/burning/tingling skin

    Skin rash

Uncommon (≥1/1,000 to <1/100)

  • Abnormal hair texture

    Abnormal hair growth

    Bleeding skin

    Contact dermatitis – redness/irritation of the skin

    Cheilitis – sores in the angle of the mouth

    Flushing skin

    Hypopigmentation – patches of skin that are lighter than your overall skin tone

    Ingrown hair – small red bumps

    Lip numbness

    Oedema face – swelling on the face

    Skin soreness

Rare (≥1/10,000 to <1/1,000)

  • Rosacea – common skin condition

    Seborrheic dermatitis – common skin condition

    Skin tumours

    Skin rashes – may be blistering

    Skin cysts

    Skin rash

    Skin tightness


Can children use Vaniqa?

Vaniqa is only licensed for use in adults aged 18 or over.


How long should a tube of Vaniqa last?

One 60gm tube should last for 2 months. Do not use Vaniqa if it is more than 6 months since the tube was first opened.


Can I get Vaniqa on the NHS?

There are 'Prescribing Guidelines' for Vaniqa issued by the different regional CCGs/health boards. These guidelines usually state that Vaniqa should be reserved for women for whom alternative treatments are contraindicated, inappropriate or have failed.

One of the reasons for restricting the prescription of Vaniqa is that clinical experience shows that two thirds of women who are prescribed Vaniqa discontinue treatment. This is because they felt Vaniqa was ineffective, or because of side effects.

If you choose to try Vaniqa, it is important to use it exactly as recommended by the manufacturer and to continue for 6 months before making a decision about effectiveness of the treatment.


Will Vaniqa interfere with my contraceptive pill, or any other contraception?

No. Because Vaniqa is a local treatment only, it will not affect your contraception.


Can I use Vaniqa if I am pregnant or breastfeeding?

It is not advisable to use Vaniqa whilst pregnant or breastfeeding.


How long after starting Vaniqa should I see a benefit?

It may take 8 weeks or longer to see any benefit from Vaniqa. A 6-month trial of treatment is recommended. After 6 months, if there is no improvement, you should stop using Vaniqa.


Do any drugs/medicines interfere with Vaniqa?

No drug interaction studies have been undertaken, so this is unknown. However as this is a local treatment and only small amounts are absorbed into the body, drug interactions are very unlikely.


Where can I obtain Vaniqa?

Vaniqa is a prescription-only drug. This means you need a doctor's prescription to obtain it.

To obtain Vaniqa you therefore have the following options:

  • Make an appointment with your GP/practice nurse. After an assessment, they may give you a prescription for Vaniqa to take to the pharmacy.

  • See a dermatologist via an NHS referral or as a private consultation. The dermatologist will assess you and may then either ask your GP to prescribe Vaniqa, or give you a prescription to take to the pharmacy.

  • Contact your local pharmacy. Some pharmacists with specialist training can undertake consultations and issue Vaniqa without a prescription from a doctor.

  • Purchase Vaniqa from an online clinic such as Dr Fox, after an online medical assessment.


How much does Vaniqa cost?

Vaniqa creamQuantityDr Fox price
60gm tubex1 (2 months)£72.50
60gm tubex2 (4 months)£139.00
60gm tubex3 (6 months)£206.00

£4 prescription fee and £2.90P&P costs also apply.

Is there a cheaper generic version of Vaniqa?

Vaniqa is a brand name authorised for exclusive marketing (patented) in the UK and EU in March 2001 - patents usually expire after 20 years, so around March 2021. Until the patent has expired no generic version can be licensed for sale.

How to order Vaniqa

Dr Deborah Lee

Authored 08 August 2019 by Dr Deborah Lee
Last updated 16 August 2019

Reviewed by Dr Tony Steele
Last reviewed 12 August 2019