HIRSUTISM

By Gary M. White, MD

Hirsutism Excessive hair on the abdomen in a young woman.


Hirsutism may be broadly defined as excessive terminal hair in a woman in the androgen-sensitive areas, e.g., upper lip, cheeks, chin, breasts, and lower abdomen. Various causes include polycystic ovary syndrome, nonclassic adrenal hyperplasia, and adrenal or ovarian tumors, but many women have idiopathic hirsutism. 

Clinical

Excessive terminal hair is seen on the upper lip, cheeks, and chin in a woman with hirsutism. The breasts, lower abdomen, and elsewhere may also be affected.

Differential Diagnosis

Causes of excessive hair in a woman:

Workup

One may obtain a DHEAS, free testosterone and prolactin.

Treatment

This section describes the treatment of idiopathic hirsutism. Women with hormonal abnormalities should be referred to a specialist. Shaving the affected area has the fewest side effects but is usually psychologically objectionable to the patient. She should be reassured that shaving will not cause the hair to grow faster or become darker. Other treatment options include bleaching, waxing, electrolysis, depilatories, and plucking. Medical intervention includes spironolactone, cyproterone, flutamide and finasteride. The combination of spironolactone (100 mg/day) plus finasteride (5 mg/day) was shown to be very effective in one study. Patients should be warned that plucking can induce ingrown hairs that mimic acne lesions. For a more extensive discussion of the use of spironolactone see acne in a woman.

The application of eflornithine hydrochloride 13.9% topical cream (BID) is useful in ameliorating unwanted facial hair growth. A study of 594 women found a 23% reduction in hair length and a 26% reduction in hair mass [Int J Dermatol 2007;46:94-8]. Its use after laser hair removal augments the hair reduction [JEADV 2016;30;314].

A variety of lasers can cause a permanent reduction in hair counts. Multiple treatments may produce a sustained response. The best candidates are those with light skin and dark hair. Risks of the laser include erythema and swelling, blistering, and crusting.

Additional Pictures

Hirsutism Hirsutism

Hirsutism Hirsutism

Hirsutism, Ingrown Hairs and PFB in a woman.
Hirsutism, Ingrown Hairs and Pseudofolliculitis Barbae in a woman

References

Undiagnosed hirsutism associated Mayer-Rokitansky-Küster-Hauser syndrome in dermatology OPD. Indian J Dermatol 2014;59:623-5

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