What is Vaniqa?

Vaniqa is a brand-name medical cream which is used to treat unwanted hair on the face. It is for use by women only. As a cream, it is applied directly to the skin on the face at the site of the unwanted hair.

How to order

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How does Vaniqa work?

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. The cream also contains:

• 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)

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

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.

Unwanted facial hair is most likely due to an imbalance of female and male hormones in your body, and the most common cause of this is Polycystic Ovary Syndrome. 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 - Excessive hair growth (hirsutism) page.

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Which medical conditions can cause hirsutism?

Most hirsutism in premenopausal women is linked to Polycystic Ovary Syndrome (PCOS) or obesity.

Other causes of hirsutism however include:

• Endocrine conditions and endocrine tumours (see below).
• Side effects of medication including ciclosporin, minoxidil, steroids and carbamazepine.

Sometimes no underlying reason for hirsutism is found and the cause is either genetic or it is called 'idiopathic hirsutism'.

What endocrine conditions cause hirsutism?

Endocrine conditions are abnormalities affecting the glands inside your body - notably the ovaries, adrenal, thyroid, and pituitary glands. Tumours or overactivity of any of these glands may produce hormones which can cause hirsutism.

What is 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.

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Do side effects of medication cause hirsutism?

Rarely excessive facial hair growth can be linked with ongoing medication. It is occasionally a problem when taking long term minoxidil, ciclosporin, steroids, or phenytoin.

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Which tests do I need for hirsutism?

If unwanted facial hair is a problem to you, it is best to discuss it with a doctor. If the following applies, they may suggest that you do 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 many 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.

However if tests are needed, these may include:

• 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

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Why choose Vaniqa to treat female facial hair?

Vaniqa is a good choice for women with hirsutism because:

• Vaniqa is the only topical skin cream treatment available for hirsutism

  The active ingredient, eflornithine, works directly within the hair follicles in the skin 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.

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What other options are there for treating hirsutism?

It is always important to consider and treat 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.

As Vaniqa works at the level of the hair follicle it can be safely continued alongside any other treatment.

• 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.

• Other drug treatments

  After checking for more serious causes, GPs may offer simple hormone treatments for hirsutism to premenopausal women.

  • Hirsutism in women can be treated effectively in many cases by using a combined contraceptive pill, which alters the hormone balance in favour of less androgen. If contraceptive pills are being prescribed exclusively for hirsutism, then this is an off-label use and doctors take responsibility for the prescribing.
  • Yasmin is a combined contraceptive pill containing the progestogen drospirinone, which has anti androgen properties similar to spironolactone, and is therefore very beneficial to acne and unwanted facial hair. Unfortunately Yasmin carries an increased risk of blood clots over routine combined hormonal contraceptives.
  • There is a specific anti androgen combined pill- Dianette, containing cyproterone acetate, which is specifically licensed to treat acne and hirsutism, but it also has a greater risk of thrombosis (blood clots) than routine combined hormonal contraceptives.

In extreme cases, a woman may be referred to an endocrinologist who may, after investigation, prescribe spironolactone (a heart failure drug which can help with hirsutism) or other androgen blockers.

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Who benefits from Vaniqa?

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

• Have moderate to severe hirsutism.

• Are not suitable for, or do not wish to take, oral medication for hirsutism, though Vaniqa can be used alongside all other treatments for hirsutism.

• Have tried oral medication for hirsutism and it has failed or caused side effects.

• Are having other treatments such as laser 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.

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Can Vaniqa be used by men?

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

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

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

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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 after at least 5 minutes once 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. Keep using Vaniqa cream for at least 4 months.

• After 4 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 only 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.

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Can you use too much Vaniqa?

Try to use a thin layer of cream only. Using extra will not give better results and it is expensive - so use sparingly!

If you inadvertently swallow Vaniqa by mouth, you are strongly advised to telephone 111 or visit NHS 111 online if in the UK.

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Is it dangerous to use Vaniqa long term?

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 eflornithine get into your blood stream. Many women have used Vaniqa safely for years with benefit.

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Can you be allergic to Vaniqa?

Allergy to Vaniqa is very rare but if you have known allergies to skin cream ingredients then carefully check the list of other ingredients in the patient information leaflet.

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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 barbae – barber's rash – bumps/lumps in the shaving area caused by skin irritation/ingrowing hairs
• Stinging/burning/tingling skin
• Skin rash

Other potential side effects are listed in the patient information leaflet.

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Can children use Vaniqa?

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

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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.

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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 4 months before making a decision about effectiveness of the treatment.

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

No. Because Vaniqa is a local treatment only, it will not affect your contraceptive pill. It is important to wash hands thoroughly after applying Vaniqa before handling a condom as the cream could damage a latex condom.

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Can I use Vaniqa if I am pregnant or breastfeeding?

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

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How long after starting Vaniqa should I see a benefit?

It may take 8 weeks or longer to see any benefit from Vaniqa. A 4-month trial of treatment is recommended. After 4 months, if there is no improvement, you should stop using Vaniqa.

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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.

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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.

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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 or so, but at present (November 2021) there is still no generic version licensed for sale in the UK.

How to order Vaniqa