Hirsutism,Excessive hair growth

Hirsutism (Excessive Hair Growth)

Definition
Hirsutism refers to the excessive growth of coarse, dark hair in women in areas where men typically grow hair, such as the face, chest, abdomen, or back. It is caused by increased androgen activity or sensitivity of hair follicles to circulating androgens.

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Causes

• Polycystic Ovary Syndrome (PCOS): The most common cause, associated with hormonal imbalance and insulin resistance.

• Idiopathic hirsutism: No underlying endocrine disorder; often familial.

• Adrenal disorders: Congenital adrenal hyperplasia, adrenal tumors.

• Ovarian tumors: Rare but can produce androgens.

• Cushing’s syndrome: Excess cortisol production leading to androgen excess.

• Medications: E.g., danazol, anabolic steroids, phenytoin, minoxidil, cyclosporine.

• Obesity: Increases insulin resistance, enhancing androgen activity.

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Symptoms

• Unwanted thick, coarse hair on the face (chin, upper lip, sideburns).

• Hair growth on the chest, abdomen, back, or thighs.

• Associated symptoms depending on cause:

  • Acne, oily skin.

  • Menstrual irregularities.

  • Voice deepening, clitoromegaly (in severe androgen excess).

  • Weight gain, infertility (in PCOS).

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Diagnosis

• Medical history and physical examination (pattern, onset, progression).

• Ferriman-Gallwey scoring system to assess severity.

• Blood tests: Serum testosterone, DHEAS, LH/FSH, prolactin, cortisol, 17-hydroxyprogesterone.

• Imaging: Pelvic ultrasound (to detect PCOS or ovarian tumors), adrenal CT/MRI if indicated.

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Treatment

1. Lifestyle Measures

   • Weight reduction (in PCOS, improves insulin sensitivity and lowers androgen levels).

   • Exercise and healthy diet to regulate hormones.

2. Hair Removal Methods

   • Shaving, waxing, threading (temporary).

   • Depilatory creams (may irritate skin).

   • Electrolysis (permanent, but slow).

   • Laser hair removal (effective, best in dark hair and light skin).

3. Pharmacological Treatments (for women not planning pregnancy)

   • Oral contraceptives (combined estrogen-progestin pills): Suppress ovarian androgen production.

   • Anti-androgens:

     • Spironolactone (50–100 mg twice daily) – blocks androgen receptors.

     • Finasteride (2.5–5 mg daily) – inhibits conversion of testosterone to dihydrotestosterone (DHT).

     • Flutamide (250 mg daily) – potent anti-androgen, but risk of liver toxicity.

   • Insulin sensitizers (Metformin, 500–1000 mg twice daily): Useful in PCOS with insulin resistance.

   • Topical eflornithine cream (Vaniqa): Slows facial hair growth.

4. Surgical/Other Treatments

   • Ovarian/adrenal tumor removal if present.

   • Cosmetic dermatology support for long-term management.

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Precautions

• Anti-androgen drugs must not be used during pregnancy (risk of feminization of male fetus).

• Regular monitoring of liver and kidney function when on systemic anti-androgens.

• Contraception is strongly advised when using spironolactone, finasteride, or flutamide.

• Be cautious with cosmetic treatments if skin is sensitive.

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Drug Interactions

• Spironolactone: Interacts with ACE inhibitors, ARBs, and potassium supplements (risk of hyperkalemia).

• Oral contraceptives: Reduced effectiveness with enzyme-inducing drugs (e.g., rifampicin, certain antiepileptics).

• Finasteride: No major drug interactions, but contraindicated in pregnancy handling.

• Flutamide: Can interact with hepatotoxic drugs, increasing risk of liver injury.

• Metformin: Interacts with alcohol and cationic drugs (e.g., cimetidine), increasing risk of lactic acidosis.

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Prognosis

• Hirsutism is usually manageable but often requires long-term treatment.

• Results from medical therapy typically take 6–12 months to show noticeable improvement.

• Addressing the underlying cause (e.g., PCOS, adrenal or ovarian disorder) is crucial for optimal outcomes.