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Hirsutism

Definition


Disease: Hirsutism Hirsutism
Category: Dermatological diseases
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Disease Definition:

The amount of a person's body hair is determined by his/her genetic makeup. A person may have a condition called hirsutism in case she is a woman and develops excessive amounts of coarse and pigmented hair on areas of her body where men typically grow hair, such as the face, chest and back. Hirsutism is a condition of unwanted, male-pattern hair growth in women.    

Hirsutism may be caused by an ethnic or family trait, or it could be due to excess male hormones called androgens, the key hormone of which is testosterone.

Many women with hirsutism could be treated with a combination of self-care and medical therapies.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Coarse and pigmented body hair that appears on places of the body where hair is not commonly found in women such as the face, chest and back, is the major sign of hirsutism. Other signs and symptoms may be noticed in case hirsutism is caused by excessively high androgen levels.

Some of the signs and symptoms of hirsutism may be:

 

  • Balding
  • Coarse and pigmented body hair, usually on the face, chest and back
  • Increased muscle mass
  • Decreased breast size
  • A deepening voice
  • Enlargement of the clitoris
  • Acne


A woman should make an appointment to see her doctor in case she notices any of these:

 

  • Gradually developing unwanted hair growth and irregular periods
  • Unwanted hair growth that appears to be worsened by a medication
  • Rapidly growing, unwanted hair on locations such as the upper lip, cheeks, chin, midchest, inner thighs or low back.
  • Male features, such as a deepening voice, balding, decreased breast size and increased muscle mass.


A similar condition that isn't considered hirsutism, is when women approaching menopause or in the early years of menopause develop coarse chin or other unwanted facial hair. To distinguish between stray hairs that usually develop at menopause and unwanted excess hair that results from another disorder, a doctor should be consulted.


PRENATAL CARE:
A woman should talk to her doctor in case she's taking medications for hirsutism and would like to have a baby. Women are advised not to become pregnant in case they're taking certain medications to treat hirsutism. A woman may have a condition called polycystic ovary syndrome in case she has hirsutism and irregular periods. This syndrome could cause reduced fertility. A woman with this condition should discuss plans for a healthy pregnancy with her doctor.

Causes:

The body is covered with fine, colorless hairs called vellus hairs up until puberty. When a person begins to mature sexually, androgens, which are the male sex hormones, help vellus hairs on certain areas of the body to become dark, curlier and coarser hairs, which are called terminal hairs. Excess androgens or an increased sensitivity of hair follicles to androgens could cause hirsutism (unwanted terminal hair growth in women).

Only about half the women with mild hirsutism have high androgen levels. Usually, severe hirsutism is due to high androgen levels. Some of the factors that could cause high androgen levels include:

Polycystic ovary syndrome:
The most common identifiable cause of hirsutism is polycystic ovary syndrome. It is caused by an imbalance of sex hormones, which could cause irregular periods, infertility, obesity and in some cases, multiple cysts on the ovaries.

Congenital adrenal hyperplasia:
Congenital adrenal hyperplasia is an inherited condition, which is marked by the abnormal production of steroid hormones, such as androgen and cortisol, by the adrenal glands.

Cushing's syndrome:
When someone's body is exposed to high levels of the hormone cortisol, which is a steroid hormone involved in the body's response to stress, Cushing's syndrome occurs. It could develop when the adrenal glands, which are small hormone-secreting glands that are located just above the kidneys, make too much cortisol. It could also develop from taking cortisol-like medications over a long period. Hirsutism could be due to increased levels of cortisol, which disrupt the balance of sex hormones in the body.

Medications:
Hirsutism could be caused by some medications. Danazol, which is a drug that is used to treat women with endometriosis, could cause hirsutism.

Tumors:
In some rare cases, hirsutism may be caused by an androgen-secreting tumor in the adrenal glands or the ovaries.

Idiopathic Hirsutism, which means that there's no identifiable cause of the disorder, is when excessive hair grows in women with normal androgen levels, regular menstrual periods and no other underlying conditions. In certain ethnic populations, idiopathic hirsutism is more common.

Complications

Complications:

Hirsutism itself doesn't cause physical complications, while the underlying cause of a hormonal imbalance can.

Sometimes, hirsutism could be emotionally distressing. Some women may feel less "feminine" or self-conscious about unwanted hair.

Treatments:

Usually, using a combination of self-care methods, hair removal therapies and taking medications is how hirsutism is treated.

Some of the hair-removal therapies may include:

Electrolysis:
This procedure could be painful; however, to reduce the discomfort, some numbing creams could be spread on the skin. In this procedure, a tiny needle is inserted into each hair follicle, and a pulse of electric current is emitted in order to damage the follicle and eventually destroy it. This will result in permanent hair removal. Lightening or darkening of the treated skin, and in some cases scarring are some of the side effects of this therapy.

Laser therapy:
In laser therapy, a beam of highly concentrated light (laser) will be passed over the skin in order to disable the hair follicles and prevent the growth of hair. Based on the size of the area that is being treated, individual sessions could last from a few minutes to a few hours. After this expensive treatment, some people may go on for long periods of time without experiencing regrowth, while others may need occasional touch ups to remain hair-free. This method could be uncomfortable. Redness and swelling could be caused by laser therapy, in addition to color changes in the skin and burns.

Some of the medical therapies for hirsutism may include:

Topical creams:
A prescription cream could be used to treat excessive facial hair in women. One example is eflornithine, which is applied directly to the affected area of the face and helps slow the growth of new hair. However, it doesn't get rid of existing hair. Some of its side effects may be a skin rash, stinging or tingling. This cream could take up to two months to work, and within eight weeks of discontinuing the medication, hair growth will return to its pretreatment levels.

Oral contraceptives:
By inhibiting androgen production by the ovaries, birth control pills or other hormonal contraceptives that contain the hormones estrogen and progestin could treat hirsutism. In women who don't want to become pregnant, taking oral contraceptives is a common treatment for hirsutism.

Anti-androgens:
One of the most commonly used anti-androgens for treating hirsutism is spironolactone. Anti-androgens block androgens from attaching to their receptors in the body.

A woman may be recommended seeing a dermatologist, in case her doctor isn't able to find a medication that works well. After beginning a medication for hirsutism, it will take up to a month before she notices a significant difference in hair growth.

Prognosis:

Not Available

Expert's opinion

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