Hirsutism medical therapy

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Hirsutism Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hirsutism from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

CT

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Treatment

Medical Therapy

Pharmacological therapy
Non-pharmacological therapy

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: ; Ogheneochuko Ajari, MB.BS, MS [2] Rasam Hajiannasab M.D.[3]

Overview

Many women with unwanted hair seek methods of hair removal to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.

Medical Therapy

Pharmacologic Treatment

Hormonal Therapy

If a tumor of ovaries or adrenal glands is the underlying cause of hirsutism, surgery may be the treatment option.

  • Parenteral long acting gonadotropin-releasing hormone analogues [2] combined with OCPs containing estrogen and progestin for severe hirsutism not respinding to OCPs and antiandrogen e.g Leuprolide.

Adrenal Suppression

  • Oral glucocorticoids : In patients with CAH eg Prednisone or Dexamethasone.
  • Metformin for infertile women with PCOS.

Antiandrogens

  • Finestride: A 5α-reductase inhibitor, 2.5mg daily. (this is rarely used because it causes fatal hepatitis with a high risk of being teratogenic.
  • Eflornithine hydrochloride cream (Vaniqa): Applied twice daily to the face.

Non-Pharmacologic Treatment

  • Cosmetic therapy : Bleaching, shaving, depilating agents, plucking, waxing treatments.
  • Electrosurgical methods include electrosurgical epilation and Laser therapy which can remove unwanted hair for some women specially for women with dark hair and light skin.[3]

Light-source-assisted hair reduction (photoepilation) is a common method in the treatment of unwanted hair and is more effective than shaving, waxing and electrolysis.[4]

Skin/hair color  Choice of photoepilation device
Light skin/dark hair  Relatively short wavelength 
Dark skin/dark hair  Relatively long wavelength or IPL(intense pulsed light)
Light/white hair  IPL + radiofrequency

References

  1. Rosenfield, Robert L. (2005). "Hirsutism". New England Journal of Medicine. 353 (24): 2578–2588. doi:10.1056/NEJMcp033496. ISSN 0028-4793.
  2. Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B; et al. (2010). "Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature". Exp Clin Endocrinol Diabetes. 118 (5): 291–7. doi:10.1055/s-0029-1225351. PMID 20198556.
  3. Franks, Stephen (2012). "The investigation and management of hirsutism". Journal of Family Planning and Reproductive Health Care. 38 (3): 182–186. doi:10.1136/jfprhc-2011-100175. ISSN 1471-1893.
  4. Dierickx CC, Grossman MC, Farinelli WA, Anderson RR (1998). "Permanent hair removal by normal-mode ruby laser". Arch Dermatol. 134 (7): 837–42. PMID 9681347.

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