Medications and Hair Removal: The Complete Guide

Brand names throughout are Canadian where they differ. Generic names are in brackets so you can match whatever is printed on your own box.

The Question Nobody Answers Properly

Almost everyone fills in the medication line on an intake form the same way. Either they leave it blank because nothing feels relevant, or they write one thing and forget the other four.

Medication is the single most useful thing you can tell me and the thing I am told least often. It changes what your hair does, what your skin can survive, how you bleed, how you heal, and in a few specific cases whether I should be treating you at all.

So this is the long version, with actual names in it, so you can go and look at your own shelf rather than guessing.

One Thing I Will Never Do

I am not going to tell you to stop taking a prescribed medication, pause it, lower it, or time it around an appointment. Not once, not as a suggestion, not as a hint.

That is not me being cautious for the sake of it. Advising on medication is not within an esthetician's scope in Ontario, and the medication is almost always doing something more important than the hair removal is. Somebody prescribed it for a reason I do not know and am not qualified to weigh.

What I decide is when I will treat, what settings I use, which method I recommend, and whether I need your doctor's input first. Any conversation about the drug itself happens between you and the person who prescribed it.

If you read one thing here and take it to your prescriber as a question, that is exactly the right use of this article.

Group One: The Medications That Grow Hair

This is the group people arrive angry about, usually because nobody warned them. Look for these on your own labels:

• Minoxidil, oral (compounded tablets, or Loniten)
• Minoxidil, topical (Rogaine, Kirkland, Hers, Hims, compounded solutions)
• Cyclosporine (Neoral, Sandimmune)
• Phenytoin (Dilantin)
• Diazoxide (Proglycem)
• Acetazolamide (Diamox)
• Oral corticosteroids (prednisone, prednisolone, dexamethasone)
• Testosterone in any form (AndroGel, Testim, Delatestryl, Depo-Testosterone, Nebido, compounded creams)
• Anabolic steroids (nandrolone, oxandrolone, stanozolol)
• Danazol (Cyclomen)
• Androgenic progestins (norethindrone, levonorgestrel, medroxyprogesterone / Depo-Provera)
• Estrogen antagonists (clomiphene / Clomid, tamoxifen / Nolvadex)
• Prostaglandin analogues (latanoprost / Xalatan, bimatoprost / Lumigan and Latisse)
• Penicillamine (Cuprimine, Depen), interferon, streptomycin, psoralens (methoxsalen / Oxsoralen)

Minoxidil deserves its own paragraph because it is the one most likely to be walking through my door right now. Jimenez-Cauhe and colleagues, reviewing the adverse events of low-dose oral minoxidil in the Journal of Clinical Medicine in 2025, put hypertrichosis, meaning hair growing where you did not ask for it, at roughly 15 percent of people on the drug, a figure that matches the 1,404-patient multicentre study by Vañó-Galván and colleagues in the Journal of the American Academy of Dermatology in 2021. It is clearly dose related: for every 1 mg the dose goes up, the risk rises about 17.6 percent. Women develop it at much lower doses than men, averaging 1.4 mg against 4.1 mg. Temples and sideburns first, then upper lip, chin, forehead, between the brows, cheeks, arms. About 69 percent of affected people get it in two or more areas at once. Only about 4 percent need a dose change because of it, so most people manage it with hair removal, which is where I come in.

Topical minoxidil travels, and that catches people out. It runs down the forehead with sweat, transfers on a pillowcase, transfers on hands. Facial hair from topical minoxidil is often a spread problem rather than a dose problem, and where the hair appears tells you where the product is going.

Cyclosporine produces hypertrichosis in a small minority of patients at dermatology doses, appearing a month or two in, in a non-androgenic distribution meaning arms, fingers and face, and resolving over a few weeks once the drug stops. Transplant doses are much higher and so is the effect. I have seen precise percentages quoted for this one and I could not trace them back to a paper I can hand you, so I am giving you the shape rather than a number.

Prostaglandin analogues grow hair exactly where the liquid lands. Longer lashes are the selling point. Hair on the eyelid margin, along the lower lid and on the cheekbone where the drop ran is the part nobody mentions.

The Endless Battle Question

Electrolysis and laser both destroy follicles that already exist. Neither prevents a follicle currently producing fine vellus hair from being converted into one producing coarse terminal hair. If your drug is doing exactly that conversion, month after month, then I am clearing the room while somebody keeps opening the door.

The drugs where that is genuinely true: oral minoxidil, cyclosporine, phenytoin, diazoxide, testosterone and anabolic steroids, and long term systemic corticosteroids.

This does not mean I refuse to treat. It means the conversation before we start is different.

Short term medication, weeks or a few months: waiting is often the smarter buy. What we clear now may be replaced by what appears next.

Long term or permanent medication: treatment is entirely reasonable and often life-changing. What changes is the expectation. A course that would take twelve sessions on somebody else may take considerably more, and there may be a maintenance phase that does not end while the drug continues. That is a fair trade for a great many people, and I would far rather you decide that knowing the shape of it.

Hair that appeared after starting a drug that is coming off soon: ask your prescriber what they expect. Saleh and colleagues, writing in StatPearls, note that drug-induced hypertrichosis is usually reversible once the medication stops. Paying me to remove hair that was going to fall out anyway is a waste of your money, and I will tell you so.

Testosterone where the growth is the point: none of the above applies. We are simply working on the areas you want clear rather than fighting the drug.

The honest summary: I can win this fight on almost anybody. On some medications it takes longer and costs more, and you deserve to know that before the first appointment rather than at the tenth.

Group Two: The Medications That Reduce Hair

These work in the same direction I do, and there is a real strategic point buried in here. Look for these:

• Spironolactone (Aldactone)
• Finasteride (Propecia, Proscar), dutasteride (Avodart)
• Bicalutamide (Casodex)
• Cyproterone acetate (Androcur, and the cyproterone in Diane-35)
• Flutamide (Euflex)
• Metformin (Glucophage, Glumetza)
• Combined oral contraceptives, particularly drospirenone-containing (Yasmin, Yaz) and Diane-35
• Estradiol (Estrace, EstroGel, Climara, Divigel) and other feminizing hormone therapy
• GnRH agonists (leuprolide / Lupron)
• Eflornithine cream (Vaniqa)

What the evidence actually shows. Moghetti and colleagues, writing in the Journal of Clinical Endocrinology and Metabolism in 2000, ran a double blind placebo controlled trial of spironolactone at 100 mg daily, flutamide at 250 mg daily and finasteride at 5 mg daily for six months. Reductions in Ferriman-Gallwey hirsutism score: 41.0 percent for spironolactone, 38.9 percent for flutamide, 31.6 percent for finasteride. Placebo went the other way, up 5.4 percent.

Three things worth pulling out. The drugs performed comparably. The timescale was six months, not six weeks. And the placebo group got slightly worse, which tells you what untreated hormonal hair growth does on its own.

Why sequencing matters. An antiandrogen reduces new terminal conversion and thins existing hair somewhat. It does not remove a follicle already committed. So the drug shrinks the pipeline while electrolysis or laser empties the reservoir. Running both is usually better than either alone.

One caution. Antiandrogens thin hair, and laser needs pigment and calibre to work. Hair that has gone finer under medication may respond less well to laser than it would have before. Electrolysis does not have that problem, since it does not care what colour or thickness the hair is.

Gender-affirming hormone therapy reduces body hair meaningfully and facial hair much less so, which is why facial hair usually needs electrolysis or laser regardless of how well the hormones are working. Rainbow Health Ontario, in the primary care guidelines Ontario prescribers actually work from, gives thinning and slowed growth of body and facial hair an expected onset of six to twelve months with maximum effect beyond three years, and then says the part that brings people to me: complete removal of facial and body hair requires electrolysis, laser, or both. Response varies enormously and depends heavily on genetics and the age therapy started. If you are working toward surgery that requires clearance of a donor or graft site, the timeline is not negotiable and the sessions are numerous. Start that conversation early rather than close to a surgical date.

Metformin and insulin sensitisers work indirectly. Lowering circulating insulin raises sex hormone binding globulin, which binds more free testosterone, which reduces the androgen signal reaching the follicle. Set out in more detail in the piece on PMOS and again in the diabetes guide.

Eflornithine slows facial hair growth rather than removing it. Hamzavi and colleagues at the University of British Columbia, writing in the Journal of the American Academy of Dermatology in 2007, found eflornithine cream combined with laser outperformed laser alone for facial hirsutism, and the benefit fades within about eight weeks of stopping the cream. It is a suppressant, not a treatment, and hair returns when it stops.

Group Three: The Medications That Make Hair Fall Out

Worth its own section, because when scalp hair sheds during a course of treatment people connect the two, and they are almost never connected.

Telogen effluvium, the diffuse kind, becomes visible two to four months after starting the drug and recovers within about six months of stopping, with visible regrowth in three to six. Look for these:

• Anticoagulants (warfarin / Coumadin, heparin, apixaban / Eliquis, rivaroxaban / Xarelto)
• Beta blockers (metoprolol / Lopressor, propranolol / Inderal, atenolol / Tenormin)
• ACE inhibitors (ramipril / Altace, lisinopril / Zestril, perindopril / Coversyl)
• Valproic acid (Depakene, Epival)
• Lithium (Carbolith, Lithane)
• Carbamazepine (Tegretol)
• Statins (atorvastatin / Lipitor, rosuvastatin / Crestor, simvastatin / Zocor)
• Antithyroid drugs (methimazole / Tapazole, propylthiouracil)
• Retinoids (isotretinoin, acitretin / Soriatane)
• Oral contraceptives and hormone replacement
• Interferons, cimetidine (Tagamet), NSAIDs

I have taken the percentages off the anticonvulsants in that list. They are widely repeated online and I could not trace them to a primary study I can hand you. What is well established is the ordering: valproate sheds more hair than lithium, which sheds more than carbamazepine.

Anagen effluvium is the abrupt kind, mainly chemotherapy, appearing within days to weeks and taking 12 to 18 months to recover cosmetically. Gold and colchicine also cause it.

GLP-1 medications produce shedding through the metabolic route rather than by attacking follicles, covered in the diabetes guide.

If your scalp is shedding while your legs are clearing, those are two unrelated events sharing a calendar. Neither is evidence about the other, and neither is my doing.

Group Four: The Skin You Cannot Wax

This group produces actual injuries, and it is why the medication question on the form is not a formality. Look for these:

• Isotretinoin (Accutane, Epuris, Clarus, Absorica)
• Acitretin (Soriatane)
• Topical tretinoin (Retin-A, Stieva-A, Renova)
• Adapalene (Differin, and in Tactuo / Epiduo)
• Tazarotene (Tazorac)
• Retinol and retinaldehyde in any over-the-counter night cream or serum
• Topical corticosteroids (hydrocortisone, betamethasone / Betaderm and Diprosone, mometasone / Elocom, clobetasol / Dermovate, triamcinolone)
• Oral corticosteroids (prednisone)
• AHAs and BHAs (glycolic, lactic, mandelic, salicylic acid in toners, pads and cleansers)
• Benzoyl peroxide (Benzagel, PanOxyl, and in Clindoxyl and Epiduo)
• Hydroquinone

Isotretinoin. The big one. It changes the structure of the epidermis and the strength of the bond holding it down, which makes skin vulnerable to mechanical force in a way that is not visible and not obvious to the person living in it.

The published guidance is blunt. The American Academy of Dermatology tells patients plainly not to wax while taking isotretinoin and for six months after stopping, and the product monograph says the same.

Worth being precise about what that rule rests on. It is patient-education guidance plus the drug label plus case reports. Neither of the two procedural consensus documents I rely on below evaluated waxing at all. So unlike the laser clearance further down, the six-month wax figure is a label-and-case-report position rather than a graded one. It is also the one I am least inclined to argue with, because the failure mode is scarring.

The case that makes it real was published by Ramot and Zlotogorski in Cutis in 2021: a fourteen year old on isotretinoin, dose raised from 40 mg to 60 mg daily, waxed three weeks later. She was left with widespread linear erosions on her shins and thighs corresponding exactly to where the wax had been applied. The skin came away with the strip.

The detail from that paper that should worry you more than the case does. The same authors surveyed fifty-four dermatologists and found only four per cent were aware this could happen. If most dermatologists do not know, the odds that the person holding the wax pot knows are not good.

That is the mechanism in one sentence. Wax does not know your skin is fragile. It grips the surface and pulls, and if the surface is not holding on properly, the surface is what comes off.

This covers hot wax, cold wax, sugaring, epilator strips, and by the same logic threading and aggressive tweezing over an area. Anything that grips skin and pulls.

What it does not cover, and this surprises people: laser hair removal is a different question entirely. Waldman and colleagues, writing in Dermatologic Surgery in 2017 for the American Society for Dermatologic Surgery guidelines task force, found insufficient evidence to justify delaying hair removal lasers and lights in anyone currently taking isotretinoin or within six months of finishing it. That is a grade B recommendation. Mysore and colleagues, writing for the Association of Cutaneous Surgeons of India in the Journal of Cutaneous and Aesthetic Surgery the same year, reached the same conclusion on the same reasoning: laser targets melanin in the follicle, collagen is not the target, and there is no mechanical force on the epidermis at all.

What those guidelines do still counsel delaying is fully ablative non-fractional resurfacing and full-face mechanical dermabrasion. Deep chemical peels they had too little data on to recommend anything either way, which is not the same as counselling delay. None of the three is anything I do.

Nothing published since has weakened that clearance. A 2026 updated review in the Dermatology Online Journal argues the remaining restrictions are too tight rather than too loose.

My own position is more conservative than the guidelines and I will say why. I will discuss laser during isotretinoin, I will want to know your dose and how long you have been on it, I will patch test and wait longer than usual to read the result, and I will start well below where I otherwise would. The evidence supports treating. The evidence does not oblige me to treat at full confidence on somebody whose skin is chemically altered, and there is no prize for speed.

Topical retinoids. Same mechanism, smaller scale, confined to where you apply it. Off the area five to seven days before waxing. This is far and away the most common cause of a lip wax lifting skin, and the person it happens to nearly always says they forgot the cream counted.

Being straight about that number. There is no published case series on waxing over tretinoin or adapalene the way there is for isotretinoin. The five-to-seven-day figure is convention rather than evidence, and what sits behind it is my own count of lip waxes that lifted rather than somebody's data.

Acids and benzoyl peroxide thin and loosen the surface layer by design. Off the area three to five days before waxing.

Topical corticosteroids thin skin faster than most people expect. Niculet and colleagues, writing in Clinical, Cosmetic and Investigational Dermatology in 2020, found that atrophic change begins three to fourteen days after treatment starts, that short-term atrophy reverses, and that striae, once formed, are permanent damage. Worth noting that a 2015 review in Drug Safety puts the emphasis on chronic rather than acute use, so a single short course is a different proposition from months of a potent steroid. If you have been using a steroid cream on an area you want waxed, tell me and show me.

Long term oral corticosteroids produce fragile skin, easy bruising, purpura and slower wound healing, all at once. Doctor's note situation, not a judgement call I make in the room.

Ageing skin on any of the above. Thin skin plus a steroid plus a blood thinner plus seventy-five years is a combination where a wax strip can genuinely tear, and I would rather do that area with something that does not pull.

Group Five: Bleeding and Bruising

• Warfarin (Coumadin)
• Direct oral anticoagulants (apixaban / Eliquis, rivaroxaban / Xarelto, dabigatran / Pradaxa, edoxaban / Lixiana)
• Antiplatelets (clopidogrel / Plavix, ticagrelor / Brilinta, prasugrel / Effient)
• Low dose aspirin taken for cardiac reasons (Aspirin 81, Entrophen)
• Injectable heparins (enoxaparin / Lovenox, dalteparin / Fragmin)
• Regular NSAIDs (ibuprofen, naproxen, diclofenac), which have a mild antiplatelet effect
• SSRIs, which mildly increase bruising through platelet serotonin

Sterex, whose training standard I work to, lists blood thinning medication as a total contraindication to electrolysis, alongside haemophilia and pacemakers. That is the standard I am trained and insured to, and I hold it.

I am going to separate two things the industry runs together, because you deserve to know which you are getting. The surgical literature does not say what my training body says. Reviewing anticoagulants and antiplatelets in Mohs micrographic surgery, Modiri and Davis report that the current recommendation is to continue these medications through surgery, because the absolute increase in bleeding complications is minimal even on multiple agents while the thrombotic risk of stopping them is not. Aspirin alone shows no significant increase. Direct oral anticoagulants come in at a 1.3 per cent complication rate against 0.7 per cent for everyone else, which is not a statistically significant difference.

Mohs surgery cuts tissue out of you. An epilation probe does not. So my position here is a practitioner's caution rather than a clinical necessity, and your prescriber may well tell you it is more caution than your situation needs. I would still rather have the note, and that is a decision about my insurance and my nerve rather than a claim about your blood.

The reason is specific to what electrolysis is. A probe enters a follicle, a controlled injury happens at the base of it, and the skin has to close afterward. Impair clotting and every one of those small events takes longer to close, bleeds more, bruises more, and gives bacteria a longer window.

Waxing on anticoagulants is a bruising question rather than a bleeding one, and it is manageable on most people with care and a conversation.

Laser is the method least affected, since nothing punctures and nothing is pulled.

Pacemakers and implanted cardiac devices belong here by association, since the people on cardiac medication are often the people with the devices. Electrolysis passes current through tissue. A pacemaker or implanted defibrillator is a total contraindication, and so is a cochlear implant. Not negotiable, not settings-dependent. Laser and waxing are unaffected.

Group Six: Light Sensitivity and Laser

This is where a lot of clinic advice is copied from other clinic advice, so let me be precise about what is known. Look for these:

• Tetracyclines, though not all of them equally: doxycycline (Doxycin, Apprilon) and tetracycline. See the note below on minocycline.
• Fluoroquinolones (ciprofloxacin / Cipro, levofloxacin / Levaquin, moxifloxacin / Avelox)
• Sulfonamides (sulfamethoxazole-trimethoprim / Septra, Bactrim)
• Antifungals (griseofulvin, voriconazole / Vfend, itraconazole / Sporanox)
• Amiodarone (Cordarone)
• Thiazide diuretics (hydrochlorothiazide, usually hidden inside combination pills such as Diovan HCT, Avalide, Zestoretic)
• Furosemide (Lasix), diltiazem (Cardizem, Tiazac), quinidine
• Atorvastatin (Lipitor)
• NSAIDs, particularly piroxicam (Feldene) and ketoprofen, also naproxen and topical diclofenac (Voltaren gel)
• Phenothiazines (chlorpromazine, prochlorperazine / Stemetil)
• Psoralens, retinoids, BRAF inhibitors (vemurafenib / Zelboraf)
• St John's Wort, which people never report because it came from a health food shop

Minocycline is the exception in that first line, and the class label is lazier than the evidence. Blakely, Drucker and Rosen, writing in Drug Safety in 2019 out of Women's College Hospital and the University of Toronto, describe doxycycline as one of the best-documented photosensitisers in medicine, with reaction rates of three, twenty and forty-two per cent at single doses of 100, 150 and 200 mg. The same review says minocycline, in the same drug class, is not generally considered a significant cause of photosensitivity. Minocycline's problem in my room is a different one entirely, and it is further down this page under pigment.

The part nobody explains. Drug-induced photosensitivity has an action spectrum, and the same 2019 review is the source for it. The wavelengths responsible are predominantly UVA, 320 to 400 nanometres, with some compounds also reacting in the visible range, and occasionally UVB at 290 to 320.

Laser hair removal does not operate anywhere near there. Alexandrite runs at 755 nm, diode at 810 nm, Nd:YAG at 1064 nm. All three sit well outside the range that drives phototoxic drug reactions.

I should be straight about the status of that argument. Nobody has run a study putting people on doxycycline under a hair removal laser and counting what happened. I looked. What is established is the action spectrum. The step from there to "so 755 nanometres is fine" is my reasoning rather than somebody else's data, and it is exactly why I still patch test rather than simply proceeding.

IPL is a different device and a fairer worry. Intense pulsed light is not a laser. It emits a broad band, roughly 500 to 1200 nm depending on the filter, and the lower end of that overlaps the visible range where some photosensitising compounds do react.

So the honest position is that the risk is not identical across devices, and treating "you are on doxycycline" as an automatic blanket no for every light-based treatment is not supported by the physics.

What I do anyway, and why. Photosensitising drugs are usually taken by people getting more sun exposure than they realise, and skin that has taken subclinical UV damage responds differently to laser regardless of wavelength. Sun-reactive skin is the real risk in front of me. So on a photosensitiser I patch test, I read it at 48 hours rather than glancing at it, and I go conservative. I do not cancel on principle.

A separate and more serious issue: drug-induced pigmentation. Amiodarone and minocycline can deposit pigment in the skin, typically blue-grey and often on sun-exposed areas. Hydroxychloroquine and some chemotherapy agents do similar things. This is not photosensitivity. It is a competing chromophore, meaning there is pigment sitting in your skin that will absorb laser energy meant for the follicle. That changes the risk of a burn and the risk of a lasting pigment change. If you are on long term amiodarone or minocycline and there is any discolouration on the area, tell me. That one genuinely does change my answer.

Group Seven: The Medications You Should Be On

Every group above is about a drug creating a problem. This one is the reverse, and it gets almost no attention anywhere.

If you have a diagnosed condition that flares or spreads, and somebody has prescribed you something for it, being on that medication is often what makes you treatable. Not being on it is the contraindication.

Here is why this matters more in a hair removal room than almost anywhere else. Waxing lifts the surface layer off. Electrolysis opens a follicle. Laser puts heat into skin. Every one of those creates a brief opening in the barrier, over an area, with a warm humid environment and a lot of follicles. That is a good day for anything opportunistic that is already present.

Cold sores and genital herpes. Trauma and heat both reactivate HSV. Lip waxing, facial laser and bikini or Brazilian work are the three that come up. Reis and Videira Santos, writing in Sexually Transmitted Diseases in 2021, documented perianal HSV-2 reactivation in a man after a single alexandrite hair removal session. Vaghela and colleagues, in the Journal of Clinical and Aesthetic Dermatology the same year, recommend antiviral prophylaxis routinely before CO2 resurfacing and for any aesthetic procedure that breaches the skin, though they do not address hair removal, which is a gap rather than a clearance.

If you get cold sores and you have been prescribed valacyclovir (Valtrex), acyclovir (Zovirax) or famciclovir (Famvir), tell me, and ask your prescriber whether they want you to take it around the appointment. That is their call and their prescription, not mine. What I will do is decline to treat an area with an active lesion on it, every time, because working over one spreads it across the area and onto my equipment.

Fungal infections. Tinea, athlete's foot, jock itch, fungal folliculitis. Wax and a spatula move fungus across an area beautifully, and a treatment over an active patch can turn one small problem into a large one. If you have been prescribed terbinafine (Lamisil), fluconazole (Diflucan), ketoconazole shampoo (Nizoral), clotrimazole (Canesten) or ciclopirox (Loprox), finish the course and let it clear before we work there.

Bacterial folliculitis and recurrent ingrowns. If you get infected ingrowns and somebody has given you cephalexin (Keflex), mupirocin (Bactroban), topical clindamycin (Dalacin T) or a chlorhexidine wash (Hibiclens), use it as directed. Treating over active folliculitis spreads it, and it makes the aftercare period considerably worse than it needed to be.

Eczema, psoriasis and rosacea. The maintenance medication is what keeps the area calm, and calm skin is treatable skin. An active flare is not. This is the group where people most often stop their controller because things looked fine, flare two weeks later, and arrive for an appointment I then have to move.

Hidradenitis suppurativa. Underarm and groin work on unmanaged HS is a poor idea. Managed HS is a different conversation, and laser is actually part of how it gets managed, which is set out in full in the hidradenitis suppurativa guide.

Biologics and immunosuppressants specifically. Choi and colleagues, writing for the medical board of the National Psoriasis Foundation in the Journal of the American Academy of Dermatology in 2016, found sufficient evidence to support continuing infliximab, adalimumab, etanercept, methotrexate and ciclosporin straight through low-risk operations, which are a far bigger insult to the skin than anything I do. My own position is more cautious than that, and it should be labelled as caution rather than as evidence: there is no literature at all on hair removal in patients on biologics or JAK inhibitors, so I want the prescriber's written agreement and I hold my infection control to a higher standard than usual.

The line I have to hold on all of this. I am not telling anybody to start a medication, and I am not telling you that you have any of these things. If something on your skin has never been looked at, the answer is a doctor, not me. What I am saying is narrower and it is this: if you have already been diagnosed and already been prescribed something, tell me, and be on it. The people who run into trouble in a treatment room are almost never the ones with a condition. They are the ones with a condition that stopped being managed.

Supplements, and Why They Absolutely Count

Almost nobody lists these. People write down their prescriptions and treat everything from the health food aisle as though it does not exist. Several of them do exactly what a prescription drug does, and two of them matter enough that I will change what I do.

The useful way to split this is what you swallow versus what you put on the skin, because they cause different problems.

Ingestible

The bleeding and bruising group. These have real antiplatelet activity, and Ang-Lee, Moss and Yuan, writing in JAMA in 2001, set preoperative discontinuation times for them:

• Garlic in supplement doses, stop 7 days before a procedure
• Ginseng, stop 7 days
• Ginkgo biloba, stop 36 hours
• St John's Wort, stop 5 days, mostly for interactions
• Fish oil and omega-3, vitamin E, turmeric and curcumin, ginger, feverfew, all associated with easier bruising

Those numbers come from surgical guidance rather than from hair removal, so treat them as context rather than instruction. What they mean for me is simple: if you bruise easily on electrolysis and you cannot work out why, the answer is often in a bottle nobody wrote down. Whether you pause anything is a question for your pharmacist.

The hair-growing group. DHEA and anything marketed as a testosterone booster. DHEA is an androgen precursor and it does what androgens do. Products in this category also have a long-documented problem with ingredients that are not on the label. High dose vitamin A and cod liver oil sit in the same family as the retinoids and carry some of the same skin effects at high enough intake.

Biotin, the one people ask about most. It will not grow your body hair and there is no good evidence it grows scalp hair in anybody who is not deficient. Yelich and colleagues, writing in the Journal of Clinical and Aesthetic Dermatology in 2024, found the entire randomised evidence base to be one double blind placebo controlled trial from 1966 in forty-six women, which showed no significant difference against placebo at four weeks. What it does do is interfere with laboratory immunoassays at the 5 to 10 mg doses found in hair and nail supplements, throwing off thyroid tests, testosterone, pregnancy and HIV assays, and troponin, where it can produce falsely low results on the test used to diagnose a heart attack. The FDA issued safety communications about this in 2017 and again in 2019. Stop it at least two days before any blood work. That has nothing to do with me and everything to do with you, which is why I am putting it in.

The genuinely useful group. Iron, zinc and vitamin D correct shedding when you are actually deficient, and do nothing at all when you are not. Testing first, supplementing second. Collagen does not affect body hair.

Saw palmetto is sold as a natural DHT blocker. The evidence is thin and inconsistent, and it is nowhere near an antiandrogen in the pharmaceutical sense. Take it if you like, do not build a hair plan around it.

Topical

Topicals act where you put them, which means they matter to the treatment area specifically rather than to you generally. Somebody using retinol only on their face is a different question from somebody using it on their chest.

• Retinol and retinaldehyde night creams. The most common cause of a lip wax going wrong. Off the area 5 to 7 days.
• Acid toners, exfoliating pads and peel serums. Glycolic, lactic, mandelic, salicylic. Off the area 3 to 5 days.
• Benzoyl peroxide washes. Same category, and they also bleach towels and bedding, which is unrelated and worth knowing.
• Hydroquinone. Tell me, particularly before laser.
• Essential oils, particularly tea tree and lavender, common sensitisers and a frequent cause of a reaction people blame on the wax.
• Antiperspirant on the day of underarm treatment, which should come off before we start rather than after.

Self tanner deserves its own line and almost nobody mentions it, though the received advice on it is wrong and I was repeating it. The DHA in self tanner develops colour in the outermost skin layer, and that colour is a chromophore. The question is which wavelengths it absorbs.

Graves, Lloyd and Ross, writing in the Journal of Drugs in Dermatology in 2016, actually measured it. Absorption rises between roughly 300 and 700 nanometres, with peaks at 480 and 630, and their measurement did not extend into the near infrared at all. Their clinical advice is to be cautious with KTP at 532 nm, pulsed dye at 585 to 595 nm and IPL at 400 to 1200 nm, and to wait seven to ten days.

Apply the same logic I applied to photosensitising drugs and the answer changes. That band does not reach alexandrite at 755, diode at 810 or Nd:YAG at 1064. It does reach IPL, which is the one device I already treat differently. I still want the colour gone before I treat you, and here is the honest reason: a fake tan makes it harder for me to read your real skin tone and set a sensible fluence, and an uneven one hides what your skin is doing underneath. That is a reason about my eyes rather than about the laser's target.

Numbing creams are the most dangerous thing on this page, and I have been underselling them. Lidocaine and prilocaine (EMLA, Maxilene) get used before laser and electrolysis, and over a large area, applied thickly, especially under plastic wrap, they are absorbed enough to poison you.

Caré and colleagues, writing in the International Journal of Legal Medicine in 2019, described three women poisoned by lidocaine-prilocaine cream applied before laser hair removal. One had used 140 grams where sixty is the maximum, and all three exceeded the 600 square centimetre limit. Presentations included cardiac toxicity, neurological toxicity and methaemoglobinaemia. The US Food and Drug Administration issued a public health advisory in 2007, reiterated in 2009, after reports including the deaths of two women who applied numbing cream to their legs before laser hair removal.

The specific things that advisory tells you not to do are apply it heavily, apply it over a large area, cover it with plastic wrap, or put heat on it. If you want numbing, we discuss the area and the amount, and it does not get covered. There is more on this in the numbing cream post.

The rule for all of it: if it goes on the area, it counts, and if you swallow it daily, it counts. Bring the bottles or photograph the labels.

Depilatory Creams: The One Everybody Uses And Nobody Declares

Nair, Veet, Magic Shave and every store-brand equivalent. These belong in a medication article rather than a hair removal one, and the reason is that they are not really a hair removal method. They are a controlled chemical burn that you are trusted to stop at the right moment.

What they actually are. The active ingredients are thioglycolate salts, usually calcium or potassium thioglycolate, held at a strongly alkaline pH by calcium or sodium hydroxide. The exact figure quoted around the industry does not trace to a source I can hand you, so take the alkalinity as the point rather than the number. That alkalinity breaks the disulfide bonds holding keratin together, and hair is mostly keratin. So is the outer layer of your skin. The product does not know the difference. It is dissolving both, and the instructions exist to make sure you rinse it off while it is still ahead on the hair.

Why an alkaline burn is the dangerous kind. Acid burns cause coagulation necrosis, which forms a crust that blocks further penetration and largely stops the injury. Alkali burns cause liquefaction necrosis: they denature protein and also saponify fats, meaning they turn the fat in your skin into soap. That process removes the barrier rather than creating one, so an alkali burn keeps going deeper for as long as the chemical is present and beyond.

That is the whole reason this section exists. A depilatory burn does not announce itself, self-limit, or stop when you decide you have had enough. Chemical burns from these products are well documented in the medical literature, including on genital skin, and there is a published case of a severe irritant reaction in an adolescent who waxed and then used a depilatory cream in sequence.

The manufacturer's own instructions, which almost nobody follows:

• Patch test 24 hours before, every single time, including if you have used it fifty times before. Their stated reason is that body chemistry changes. That is correct and it is why previous tolerance proves nothing.
• Ten minutes is the absolute maximum, and most formulas are far shorter. Body cream is checked at 3 minutes, face cream at 5, sensitive bikini formula at 6.
• At least 72 hours between applications.
• Skin dry and clear of oil, lotion and makeup first.
• Body formulas are not face formulas. Men's body products are explicitly not for the face.
• Bikini formulas are for use near the genitals, not on them.

What is normal and what is not. A slight tingle while it works is normal and the manufacturer says so. Everything below is not:

• Burning, or stinging that builds rather than settles
• Intense itching
• Redness that is still there hours later rather than fading
• Skin that feels slippery or soapy, which is saponification and is a sign of a real alkali burn
• Blanched white patches
• Blistering, weeping, or crusting
• Pain that arrives later rather than during

If any of that happens: rinse immediately with a lot of lukewarm running water and keep rinsing far longer than feels necessary, because the chemical is still working while it is on you. Do not try to neutralise it with vinegar, lemon juice or anything else. Adding an acid to an alkali burn on skin makes it worse, not better. Blistering, an area larger than a palm, or anything on the genitals is a same-day medical visit rather than a wait-and-see.

Where it goes wrong most often. Leaving it on longer because the hair is coarse and it "is not working yet." Using it on skin already compromised by a retinoid, an acid toner, benzoyl peroxide or a recent sunburn, which is stacking two chemical exfoliants and is by far the most common cause of a burn I hear about. Using it on the same day as waxing or shaving. Using a body formula on the face. Using it on broken skin, moles, warts, or over an active flare of anything.

How it interacts with what I do, which is the practical part:

• Before laser, it is fine, and this surprises people. A depilatory dissolves hair at and just below the surface. It does not pull the root out. The hair shaft inside the follicle stays where it is, which is exactly the pigment target the laser needs. That puts it in the same category as shaving rather than the same category as waxing. The catch is the skin, not the hair. Do not use it in the 72 hours before a session, and do not come in with any redness left on the area. If in doubt, shave instead.
• Before electrolysis, no. I need hair I can see and grasp, so a depilatory means waiting for regrowth exactly as shaving does.
• Before waxing, no, and not the day after either. Wax on skin that has just been chemically thinned is how you get a lift.
• After any treatment, leave it alone until the area has completely settled. Skin that has been waxed, lasered or worked with a probe is not skin to put a strongly alkaline product on.
• If you are on a retinoid, isotretinoin, an acid, benzoyl peroxide or a topical steroid, do not use these at all on that area. That combination is the single most reliable way to injure yourself at home, and every one of those products is in Group Four above for the same underlying reason.

Who should probably not use them at all: anyone on isotretinoin or within six months of it, anyone with eczema, psoriasis or active dermatitis on the area, anyone with a history of allergic contact dermatitis to them, and anyone whose skin scars or pigments easily, since a depilatory burn on darker skin can leave post-inflammatory hyperpigmentation that outlasts the hair by many months.

None of that is a moral position. Depilatories are cheap, fast, painless when used properly, and genuinely useful between appointments for people who cannot shave without bumps. They just need to be treated as the chemical product they are rather than as a lotion.

And tell me if you use them. Not because I mind, and I do not, though because a faint uniform redness across a treatment area changes what I am willing to do that day, and I would rather know it came from a tube on Tuesday than spend the appointment wondering.

Tell Me What, How Long, and What Your Skin Does

Three separate pieces of information, and most people give me one.

What. The actual name, not "a blood pressure pill" or "the little white one." Photograph the label. Twenty seconds, and it removes all the guesswork.

How long. This is the piece nobody thinks to offer and it changes my read completely.

• Under three months on something new: things may still be moving. Drug-induced hair growth is often still arriving. Telogen shedding has not yet shown up, since that runs two to four months behind. Skin effects may not have settled. I will usually start smaller and reassess sooner.
• Three months to a year: the picture is forming and mostly reliable.
• Over a year and stable: the most straightforward version of you to plan around. What your skin does now is what it will do in six months.
• Recently stopped: tell me anyway. Isotretinoin has a six month tail. Steroid-thinned skin takes time to recover. Drug-induced hypertrichosis takes weeks to fall out. Stopping the drug does not immediately reset the skin.
• Recently changed dose: the isotretinoin case above happened three weeks after a dose increase. A dose change is a new medication as far as your skin is concerned.

What your skin does. Any of these, tell me before we book rather than at the door:

• Eczema, psoriasis, lichen planus or vitiligo. These matter for a specific reason: they can Koebnerise, meaning new lesions appear at sites of skin trauma. Waxing and electrolysis are skin trauma. That does not automatically mean no, and it definitely means we discuss it and test a small area first.
• Rosacea on the area, which Sterex lists as a total contraindication for electrolysis while active.
• Dermographism, meaning your skin welts where it is scratched. Also a total contraindication.
• Keloid or hypertrophic scarring history, anywhere on you, not just on the area.
• Melasma, which laser can worsen.
• Cold sores, recurring folliculitis, recurrent ingrowns, or anything fungal.
• Pseudofolliculitis barbae, meaning shaving bumps, which is a reason to move toward permanent removal rather than a reason to avoid it.
• Anything that has changed, on the area or near it. I am not going to tell you what it is, and I will tell you it is worth showing a doctor.
• How you healed last time, from anything. A previous wax, a previous laser session, a cut, a piercing, a surgery. How your skin actually behaved tells me more than any list can.

How Long to Wait

Two categories, and it matters that they do not get mixed up.

Things I set, because they are about your skin and my equipment:

• Topical retinoids, off the area 5 to 7 days before waxing
• AHA, BHA or benzoyl peroxide, off the area 3 to 5 days before waxing
• Self tanner, off the area and faded, 7 to 10 days before laser, for the reason given above rather than the one everybody repeats
• Depilatory cream, at least 72 hours before laser and with no redness remaining, and not at all before waxing or electrolysis
• Topical steroid on the area, until the skin has visibly recovered, guided by whoever prescribed it
• After microdermabrasion, 4 to 6 weeks, and considerably longer after medical dermabrasion
• Sunburn or a fresh tan on the area, healed and settled before laser
• After a laser session, no waxing on that area for the rest of the cycle
• Active infection of any kind, cleared and finished before we work on the area

Things I never set, because they are prescription medicines:

• Isotretinoin. The six month figure for waxing comes from the AAD and the drug label. It is not my number and I am not the one who decides when your course ends. What I decide is that I will not wax you until six months after your prescriber says you finished. Laser is a separate question and the guidelines clear it, as set out above.
• Antibiotics and other photosensitisers. Whether and when you stop is between you and the prescriber. What I do is patch test and reduce settings while you are on them.
• Anticoagulants. Nobody stops a blood thinner for a beauty appointment. If your doctor is planning a break for a genuine medical reason, that conversation starts with them.
• Steroids, immunosuppressants, anticonvulsants, hormone therapy. Same rule.
• Supplements. The numbers above come from surgical guidance and they are there so you can ask your pharmacist an informed question, not so I can tell you to stop anything.

There is no medication on earth where the right sequence is "stop the drug so I can do the treatment." The sequence is always "the drug is what it is, so here is the treatment that fits around it."

The Absolutely Not List

Short, and I hold it.

• Electrolysis with a pacemaker, implanted defibrillator or cochlear implant. Total contraindication.
• Electrolysis on anticoagulant therapy without your prescriber's written agreement. My caution rather than the surgical evidence, as set out above, and I hold it anyway.
• Waxing or any epilation while on isotretinoin, or within six months of finishing it.
• Anything over an active cold sore, fungal patch, folliculitis, or any current infection.
• Anything at all on skin that is currently broken, ulcerated, blistered or actively inflamed, whatever the cause.
• Anything on an area where a topical steroid has produced visible atrophy or striae, until a doctor says otherwise.
• Laser over a fresh tan, or drug-induced pigmentation that has not been assessed.
• Any treatment on an area where a depilatory cream has left redness, blistering or broken skin, and no depilatory at all on anyone on isotretinoin or a topical retinoid.
• Any treatment during an active flare of a condition being managed with immunosuppressants, or during a course of antibiotics for an active infection.

Everything else is a conversation rather than a wall.

When I Need a Note From Your Doctor

I ask for a note when the decision is genuinely medical rather than technical, meaning the question is about your body rather than my machine:

• Anticoagulant or antiplatelet therapy, where you want electrolysis
• Long term systemic corticosteroids
• Immunosuppressant therapy of any kind, including biologics and post-transplant regimens
• Any implanted electronic device, where you want any electrical treatment
• Poorly controlled diabetes, particularly with neuropathy or circulation involvement
• Active autoimmune disease under treatment, including lupus
• A history of keloid scarring
• Psoriasis, vitiligo or lichen planus on or near the treatment area
• Cancer treatment currently underway, or recently finished, which has its own page at cancer and hair removal
• Any medication where you are not sure and would rather your doctor said so than me

What the note needs to say. Not much. Doctors are busy and a vague request gets a vague answer, so ask for something specific:

My patient [name] has asked about [electrolysis / laser hair removal / waxing] on [area]. They are currently taking [medication and dose]. Please confirm whether you have any objection to this treatment, and note any precautions you would want the practitioner to observe.

A note that says "no objection" is enough. A note that says "no objection, avoid the lower legs, watch for delayed healing" is better, and I will work to it exactly.

What I do not need. Your diagnosis, your history, your chart, your lab results. I am not entitled to any of it and I do not want it. The question I need answered is narrow, and your doctor answering it narrowly is the correct outcome.

If your doctor says no. Then it is no, and I will not go looking for a second opinion or work around it. I will tell you what alternatives exist that the objection does not cover, which is often more than people expect.

A Note On Being Told Things

None of this goes anywhere. It is not shared, it is not sold, it does not leave the file.

I have also heard all of it. Nobody has ever told me a medication that made me think less of them, and the ones people are most reluctant to name are the ones I am most used to working around.

The only version of this that goes badly is the one where I find out afterward.

Bottom Line

Medication changes what your hair does and what your skin can take, and both of those are my problem to work around rather than yours to solve.

Some drugs grow hair faster than I can remove it, and the fix is a realistic plan rather than a refusal. Some make skin too fragile to wax, and isotretinoin is the one that produces real injuries. Some affect bleeding, which matters for electrolysis more than anything else. Some interact with light, though far less broadly than the internet suggests. And some are the reason I can treat you at all, which is why an unmanaged condition is a bigger problem in this room than a managed one.

Supplements count. Topicals count. The night cream counts. So does the tube of Nair under the sink, which is a pH 12 chemical burn you are trusted to stop on time.

Almost none of it stops treatment. Nearly all of it changes the method, the settings, the timeline or the order.

I will never ask you to stop a medication, and I would be suspicious of anybody in this industry who did. What I ask is that you tell me what you are on, how long you have been on it, and what your skin already does, before rather than after.

Photograph the labels. That is the whole ask.

One condition from Group Seven now has its own guide. Hidradenitis suppurativa comes up often enough, and is handled badly often enough, that a paragraph was not sufficient. The full version covers every hair removal method against the trial evidence, the biologics and JAK inhibitors most HS clients take, and exactly what I will and will not treat. It is here: hidradenitis suppurativa and hair removal.

Two more that need their own page rather than a line here. Testosterone, estradiol, antiandrogens and spironolactone all appear above, and not one of them is a barrier to treatment. What they change is the timeline, the method order and what your hair is going to do next, which is a longer conversation than a medication list can hold. For trans men it is in the phalloplasty and metoidioplasty guide, and for trans women in the facial and donor site guide.

If this is your situation, these go together. the pain map, every area ranked, what I look at before I treat anything, how often you should actually exfoliate, sun exposure and laser and burns, hyperpigmentation and scarring, and how to avoid them.

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