#21 Hirsutism | Dr. SHABARI ARUMUGAM
What is Hirsutism?
What causes Hirsutism?
How to approach Hirsutism?
What is the role of Laser in Hirsutism?
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What is hirsutism?
Hirsutism refers to excessive growth of dark, thick and coarse hair in an individual (usually female) in a male pattern. Commonly affected areas are upper lips, chin, central chest, midline of the stomach, lower back, buttocks and front of thighs. Hirsutism affects approximately 5 - 10% of women.
What causes hirsutism?
Hirsutism can be caused by an increased androgen production, increased skin sensitivity to androgens, or both. Androgens are often thought of as exclusively 'male hormones' but, in fact both men and women produce them; men usually in greater amounts than women.
- In premenopausal women, the most common cause of hirsutism is due to polycystic ovary syndrome (PCOS).
- Sometimes, no apparent underlying cause found in about a quarter of women.
- Rarely, hirsutism can be caused by medications such as steroids, and other hormonal disorders.
- Extremely rarely, hirsutism can be caused by tumours that secrete androgens. In such cases the hirsutism will be severe and appear in a very short period.
Most women develop more facial or body hair gradually as they get older, especially after the menopause.
Your dermatologist may request some hormone tests, possibly an ultrasound of the pelvis (to look for PCOS) and may occasionally refer you to an endocrinologist (specialist in hormonal disorders).
When should you approach Dermatologist ?
It is important to see your doctor if your hirsutism is associated with any of the following:
- If you are cosmetically worried
- Developing quickly (over 1-2 years), or before puberty;
- Accompanied by menstrual problems;
- Associated with features suggesting an increase in androgens such as thinning of the scalp hair, baldness, or deepening of the voice;
- Accompanied by obesity or diabetes.
How can hirsutism be treated?
When there is an underlying hormonal disorder, the treatment is of the underlying disease.
Treatments for hirsutism where there is no underlying cause or in association with PCOS include:
Physical treatments
• Electrolysis.
An electrical current is passed into a hair follicle through a needle. The aim is to destroy the hair root permanently. Electrolysis is relatively expensive and time-consuming. Before you have electrolysis, check that the operator is properly qualified, and registered with the Institute of Electrolysis. Check that the practitioner uses new, disposable (not simply re-sterilised) needles. Equipment designed for electrolysis at home are not recommended. Scarring is a potential side effect of this treatment.
• Laser and intense pulsed light (IPL) treatments:
These treatments also aim to destroy the hair root permanently. Laser treatment and IPL are expensive and several treatments are given over a period of months. This form of hair reduction must be done at a special clinic by an operator who is properly qualified. Check that they are registered Dermatologists. It is better to take the route of a referral from your medical practitioner to a specialist. Possible side effects include redness, darkening or lightening of the skin, and scarring. Total compliance during the treatment plan is required; this will include no sun bathing (or fake tanning) and cessation of all forms of hair removal, with the exception of shaving.
Medical treatments
• Eflornithine cream.
This cream works by slowing hair growth. It is not a depilatory cream. It has recently been accepted for use in women for whom other medical treatments cannot be used or have been ineffective. It can be applied after any regular hair removal techniques, such as the self-care or physical methods described in the preceding paragraphs. It is left on the skin to inhibit hair growth. The cream takes two to three months of regular use to have an effect. Continued treatment is needed to maintain beneficial effects. Side effects are usually mild and include burning or stinging of the skin and acne.
Anti-androgens.
Your Dermatologist may prescribe these to block the action of the androgens that can cause hirsutism. Anti-androgens usually take 4- 6 months to have an effect. Hair growth will then slow, and the hairs will gradually become thinner and less noticeable; the problem, however, tends to return when medication is stopped.
Anti-androgens include:
• Oral contraceptives.
Some low-dose combined pills may help, and one has been designed specifically to have an anti-androgenic activity. Side effects include spotting (bleeding between periods), tender breasts, nausea and headaches, especially in the first few months. The oral contraceptive pill is not suitable for everyone.
• Cyproterone.
Combined with an oral contraceptive this can help women with hirsutism. Larger doses of cyproterone can be used for more severe hirsutism. Side effects include weight gain, depression, blood clotting in veins of legs and loss of libido.
• Spironolactone.
It works as an anti-androgen but also increases the amount of urine that is passed - in other words it is also a water tablet (diuretic). Spironolactone (50 to 200 mg daily) can slowly reduce excessive hair growth. Side effects include tender breasts, irregular menstruation and liver damage.
• Finasteride.
It appears to be as effective as spironolactone, but is not licensed for treating hirsutism. Its usage should be restricted to postmenopausal women.
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