Hirsutism (Excess Hair)

Alternative names :- Hypertrichosis, Excessive or unwanted hair in women

A distressing disorder usually found in women and children, hirsutism is the excessive growth of body hair. typically in an adult male distribution pattern. This condition commonly occurs spontaneously but may also develop as a secondary disorder of various underlying diseases. It must always be distinguished from hypertrichosis. The prognosis varies with the cause and the effectiveness of treatment.

What causes Hirsutism ?

Idiopathic or familial hirsutism probably stems from a hereditary trait because the patient usually has a family history of the disorder. Causes of secondary hirsutism include endocrine abnormalities related to pituitary dysfunction (acromegaly, precodous puberty), adrenaldysfunction (Cushing's disease, congenital adrenal hyperplasia, or Cushing's syndrome), or ovarian lesions (such as polycystic ovary syndrome); and iatrogenic factors (such as the use of minoxidil, androgenic steroids, testosterone, diazoxide, glucocorticoids, and oral contraceptives).

Rare causes include:

• Tumor or cancer of the adrenal gland.
• Tumor or cancer of the ovary
• Hyperthecosis

Signs and symptoms of Hirsutism

Hirsutism typically produces enlarged hair follicles as well as enlargement and hyperpigmentation of the hairs themselves. Excessive facial hair growth is the complaint for which most patients seek medical help. Generally, hirsutism involves the appearance of thick, pigmented hair in the beard area, upper back. shoulders, sternum, axillae, and pubic area. Frontotemporal scalp hair recession is often a coexisting condition. Patterns of hirsutism vary greatly, depending on the patient's race and age. Elderly women commonly show increased hair growth on the chin and upper lip. In secondary hirsutism, signs of masculinization may appear deepening of the voice, increased muscle mass, increased size of genitalia, menstrual irregularity, and decreased breast size.

Diagnosis information

A family history of hirsutism, absence of menstrual abnormalities, signs of masculinization, and a normal pelvic examination strongly suggest idiopathic hirsutism. Tests for secondary hirsutism depend on associated symptoms that suggest an underlying disorder. About 90% of women with hirsutism have an elevated free testosterone level.

Treatment of Hirsutism

At the patient's request, treatment of idiopathic hirsutism consists of eliminating excess hair by scissors, shaving, or depilatory creams, or removal of the entire hair shaft with tweezers or wax. Bleaching the hair with hydrogen peroxide may also provide satisfactory results. Electrolysis can destroy hair bulbs permanently, but it works best when only a few hairs need to be removed. (A patient history of keloid formation contraindicates this procedure.) Hirsutism caused by elevated androgen levels may require low-dose dexamethasone or prednisone, oral contraceptives, or androgen receptor-competitive inhibitors, such as spironolactone, cyproterone acetate, or ctmetidine; however, these drugs vary in effectiveness. Treatment of secondary hirsutism depends on the underlying disorder.

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Home Care

There are a variety of ways to remove unwanted hair:

• Bleaching - lightening hair to make it less noticeable.
• Hair removal - shaving, plucking, waxing, or chemical depilation.
• Electrolysis - using electrical current to damage individual hair follicles so they do not grow back. This is expensive and requires multiple treatments.
• Waxing - needs to be repeated every six weeks. The warm wax hardens on the skin and as it is stripped off, the hairs are pulled out with it from the roots.
• Weight loss - in overweight women, weight loss can decrease male hormone levels and reduce hair growth.

Birth control pills and anti-androgen medications can also help reduce hair growth. A doctor must prescribe these medications.

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Special considerations or prevention

Care for patients with idiopathic hirsutism focuses on emotional support and patient teaching; care for patients with secondary hirsutism depends on the treatment of the underlying disease:

• Provide emotional support and be sensitive to the patient; It's feelings about her appearance.
• Watch for signs of contact dermatitis in patients being treated with depilatory creams, especially elderly patients. Also watch for infection of hair follicles after hair removal with tweezers or wax.
• Suggest consulting a cosmetologist about makeup or bleaching agents.