Jump to content

Hirsutism: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
Ddsov (talk | contribs)
15 edits
→Diagnosis: Ferriman Gallway score limits/ethnic variability
Ddsov (talk | contribs)
15 edits
→Diagnosis: Clinical definition of Hirsutism
Line 49: Line 49:


==Diagnosis==
==Diagnosis==
A complete physical evaluation should be done prior to initiating more extensive studies, the examiner should differentiate between widespread body hair increase and male pattern [[virilization]].<ref name=":0">{{Cite journal|last=Sachdeva|first=Silonie|date=2010|title=Hirsutism: Evaluation and treatment|journal=Indian Journal of Dermatology|volume=55|issue=1|pages=3–7|doi=10.4103/0019-5154.60342|pmc=2856356|pmid=20418968}}</ref> One method of evaluating hirsutism is the [[Ferriman-Gallwey score|Ferriman-Gallwey Score]] which gives a score based on the amount and location of hair growth on a woman.<ref name="pmid13892577">{{cite journal |vauthors=Ferriman D, Gallwey JD |title=Clinical assessment of body hair growth in women |journal=J. Clin. Endocrinol. Metab. |volume=21 |issue= 11|pages=1440–7 |date=November 1961 |pmid=13892577 |doi= 10.1210/jcem-21-11-1440|url=http://jcem.endojournals.org/cgi/pmidlookup?view=long&pmid=13892577}}</ref> The Ferriman-Gallwey Score has various cutoffs due to variable expressivity of hair growth based on ethnic background.<ref>{{Cite journal |last=Cheewadhanaraks |first=Sopon |last2=Peeyananjarassri |first2=Krantarat |last3=Choksuchat |first3=Chainarong |date=2004-05 |title=Clinical diagnosis of hirsutism in Thai women |url=https://pubmed.ncbi.nlm.nih.gov/15222512/ |journal=Journal of the Medical Association of Thailand = Chotmaihet Thangphaet |volume=87 |issue=5 |pages=459–463 |issn=0125-2208 |pmid=15222512}}</ref><ref>{{Cite journal |last=Escobar-Morreale |first=H. F. |last2=Carmina |first2=E. |last3=Dewailly |first3=D. |last4=Gambineri |first4=A. |last5=Kelestimur |first5=F. |last6=Moghetti |first6=P. |last7=Pugeat |first7=M. |last8=Qiao |first8=J. |last9=Wijeyaratne |first9=C. N. |last10=Witchel |first10=S. F. |last11=Norman |first11=R. J. |date=2012-03 |title=Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society |url=https://pubmed.ncbi.nlm.nih.gov/22064667/ |journal=Human Reproduction Update |volume=18 |issue=2 |pages=146–170 |doi=10.1093/humupd/dmr042 |issn=1460-2369 |pmid=22064667}}</ref>
Hirsutism is a clinical diagnosis of excessive androgenic, terminal hair growth.<ref>{{Cite journal |last=Ferriman |first=D. |last2=Gallwey |first2=J. D. |date=1961-11 |title=Clinical assessment of body hair growth in women |url=https://pubmed.ncbi.nlm.nih.gov/13892577/ |journal=The Journal of Clinical Endocrinology and Metabolism |volume=21 |pages=1440–1447 |doi=10.1210/jcem-21-11-1440 |issn=0021-972X |pmid=13892577}}</ref> A complete physical evaluation should be done prior to initiating more extensive studies, the examiner should differentiate between widespread body hair increase and male pattern [[virilization]].<ref name=":0">{{Cite journal|last=Sachdeva|first=Silonie|date=2010|title=Hirsutism: Evaluation and treatment|journal=Indian Journal of Dermatology|volume=55|issue=1|pages=3–7|doi=10.4103/0019-5154.60342|pmc=2856356|pmid=20418968}}</ref> One method of evaluating hirsutism is the [[Ferriman-Gallwey score|Ferriman-Gallwey Score]] which gives a score based on the amount and location of hair growth on a woman.<ref name="pmid13892577">{{cite journal |vauthors=Ferriman D, Gallwey JD |title=Clinical assessment of body hair growth in women |journal=J. Clin. Endocrinol. Metab. |volume=21 |issue= 11|pages=1440–7 |date=November 1961 |pmid=13892577 |doi= 10.1210/jcem-21-11-1440|url=http://jcem.endojournals.org/cgi/pmidlookup?view=long&pmid=13892577}}</ref> The Ferriman-Gallwey Score has various cutoffs due to variable expressivity of hair growth based on ethnic background.<ref>{{Cite journal |last=Cheewadhanaraks |first=Sopon |last2=Peeyananjarassri |first2=Krantarat |last3=Choksuchat |first3=Chainarong |date=2004-05 |title=Clinical diagnosis of hirsutism in Thai women |url=https://pubmed.ncbi.nlm.nih.gov/15222512/ |journal=Journal of the Medical Association of Thailand = Chotmaihet Thangphaet |volume=87 |issue=5 |pages=459–463 |issn=0125-2208 |pmid=15222512}}</ref><ref>{{Cite journal |last=Escobar-Morreale |first=H. F. |last2=Carmina |first2=E. |last3=Dewailly |first3=D. |last4=Gambineri |first4=A. |last5=Kelestimur |first5=F. |last6=Moghetti |first6=P. |last7=Pugeat |first7=M. |last8=Qiao |first8=J. |last9=Wijeyaratne |first9=C. N. |last10=Witchel |first10=S. F. |last11=Norman |first11=R. J. |date=2012-03 |title=Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society |url=https://pubmed.ncbi.nlm.nih.gov/22064667/ |journal=Human Reproduction Update |volume=18 |issue=2 |pages=146–170 |doi=10.1093/humupd/dmr042 |issn=1460-2369 |pmid=22064667}}</ref>


Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian [[Medical ultrasonography|ultrasound]], due to the high prevalence of [[polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]], as well as [[17α-hydroxyprogesterone]] (because of the possibility of finding nonclassic [[Congenital adrenal hyperplasia due to 21-hydroxylase deficiency|21-hydroxylase deficiency]]<ref name="pmid19338993">{{cite journal | vauthors = Di Fede G, Mansueto P, Pepe I, Rini GB, Carmina E | title = High prevalence of polycystic ovary syndrome in women with mild hirsutism and no other significant clinical symptoms | journal = Fertil. Steril. | volume = 94 | issue = 1 | pages = 194–7 | year = 2010 | pmid = 19338993 | doi = 10.1016/j.fertnstert.2009.02.056 | url = https://iris.unipa.it/bitstream/10447/36367/2/Fertility%20and%20Sterility%202010%2094%20194-7.pdf| hdl = 10447/36367 | hdl-access = free }}</ref>). Many women present with an elevated serum [[Dehydroepiandrosterone sulfate|dehydroepiandrosterone sulfate (DHEA-S)]] level. Levels greater than 700 μg/dL are indicative of [[adrenal gland]] dysfunction, particularly [[congenital adrenal hyperplasia due to 21-hydroxylase deficiency]]. However, [[Polycystic ovary syndrome|PCOS]] and [[Idiopathic disease|idiopathic]] hirsutism make up 90% of cases.<ref name=":0"/>
Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian [[Medical ultrasonography|ultrasound]], due to the high prevalence of [[polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]], as well as [[17α-hydroxyprogesterone]] (because of the possibility of finding nonclassic [[Congenital adrenal hyperplasia due to 21-hydroxylase deficiency|21-hydroxylase deficiency]]<ref name="pmid19338993">{{cite journal | vauthors = Di Fede G, Mansueto P, Pepe I, Rini GB, Carmina E | title = High prevalence of polycystic ovary syndrome in women with mild hirsutism and no other significant clinical symptoms | journal = Fertil. Steril. | volume = 94 | issue = 1 | pages = 194–7 | year = 2010 | pmid = 19338993 | doi = 10.1016/j.fertnstert.2009.02.056 | url = https://iris.unipa.it/bitstream/10447/36367/2/Fertility%20and%20Sterility%202010%2094%20194-7.pdf| hdl = 10447/36367 | hdl-access = free }}</ref>). Many women present with an elevated serum [[Dehydroepiandrosterone sulfate|dehydroepiandrosterone sulfate (DHEA-S)]] level. Levels greater than 700 μg/dL are indicative of [[adrenal gland]] dysfunction, particularly [[congenital adrenal hyperplasia due to 21-hydroxylase deficiency]]. However, [[Polycystic ovary syndrome|PCOS]] and [[Idiopathic disease|idiopathic]] hirsutism make up 90% of cases.<ref name=":0"/>

Revision as of 17:42, 12 September 2022

"Hirsute" redirects here. For the botanical term, see Indumentum.
Hirsutism
Barbara van Beck, as depicted in an engraving by G. Scott.
SpecialtyDermatology, endocrinology
TreatmentBirth control pills, antiandrogens, insulin sensitizers[1]
Hirsutism depicted in a patient with PCOS and non-classical adrenal hyperplasia

Hirsutism is excessive body hair on parts of the body where hair is normally absent or minimal. The word is from early 17th century: from Latin hirsutus meaning "hairy".[2] It may refer to a "male" pattern of hair growth that may be a sign of a more serious medical condition,[3] especially if it develops well after puberty.[4] Cultural stigma against hirsutism can cause much psychological distress and social difficulty.[5] Discrimination based on facial hirsutism often leads to the avoidance of social situations and to symptoms of anxiety and depression.[6]

Hirsutism is usually the result of an underlying endocrine imbalance, which may be adrenal, ovarian, or central.[7] It can be caused by increased levels of androgen hormones. The amount and location of the hair is measured by a Ferriman-Gallwey score. It is different from hypertrichosis, which is excessive hair growth anywhere on the body.[3]

Treatments may include birth control pills that contain estrogen and progestin, antiandrogens, or insulin sensitizers.[1]

Hirsutism affects between 5–15% of women across all ethnic backgrounds.[8] Depending on the definition and the underlying data, approximately 40% of women have some degree of facial hair.[9]

Causes

See also: Hyperandrogenism § Causes

Causes of hirsutism not related to hyperandrogenism include:

Diagnosis

Hirsutism is a clinical diagnosis of excessive androgenic, terminal hair growth.[15] A complete physical evaluation should be done prior to initiating more extensive studies, the examiner should differentiate between widespread body hair increase and male pattern virilization.[16] One method of evaluating hirsutism is the Ferriman-Gallwey Score which gives a score based on the amount and location of hair growth on a woman.[17] The Ferriman-Gallwey Score has various cutoffs due to variable expressivity of hair growth based on ethnic background.[18][19]

Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian ultrasound, due to the high prevalence of polycystic ovary syndrome (PCOS), as well as 17α-hydroxyprogesterone (because of the possibility of finding nonclassic 21-hydroxylase deficiency[20]). Many women present with an elevated serum dehydroepiandrosterone sulfate (DHEA-S) level. Levels greater than 700 μg/dL are indicative of adrenal gland dysfunction, particularly congenital adrenal hyperplasia due to 21-hydroxylase deficiency. However, PCOS and idiopathic hirsutism make up 90% of cases.[16]

Treatment

Treatment of hirsutism is indicated when hair growth causes patient distress. The two main approaches to treatment are pharmacologic therapies targeting androgen production/action, and direct hair removal methods including electrolysis and photoepilaiton. These may be used independently or in combination.[21]


Medications consist mostly of antiandrogens, drugs that block the effects of androgens like testosterone and dihydrotestosterone (DHT) in the body, and include:[12]

Other methods

See also

References

  1. ^ a b c Barrionuevo, P; Nabhan, M; Altayar, O; Wang, Z; Erwin, PJ; Asi, N; Martin, KA; Murad, MH (1 April 2018). "Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis". The Journal of Clinical Endocrinology and Metabolism. 103 (4): 1258–1264. doi:10.1210/jc.2017-02052. PMID 29522176.
  2. ^ "hirsute adjective - Definition, pictures, pronunciation and usage notes | Oxford Advanced Learner's Dictionary at OxfordLearnersDictionaries.com". www.oxfordlearnersdictionaries.com. Retrieved 2021-07-22.
  3. ^ a b "Merck Manuals online medical Library". Merck & Co. Retrieved 2011-03-04.
  4. ^ Sachdeva S (2010). "Hirsutism: Evaluation and Treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ^ Barth JH, Catalan J, Cherry CA, Day A (September 1993). "Psychological morbidity in women referred for treatment of hirsutism". J Psychosom Res. 37 (6): 615–9. doi:10.1016/0022-3999(93)90056-L. PMID 8410747.
  6. ^ Jackson J, Caro JJ; Caro G, Garfield F; Huber F, Zhou W; Lin CS, Shander D & Schrode K (2007). "The effect of eflornithine 13.9% cream on the bother and discomfort due to hirsutism". International Journal of Dermatology. 46 (9). the Eflornithine HCl Study Group: 976–981. doi:10.1111/j.1365-4632.2007.03270.x. PMID 17822506. S2CID 25986442.
  7. ^ Blume-Peytavi U, Hahn S. "Medical treatment of hirsutism. Dermatol Ther. 2008 Sep-Oct; 21(5): 329-39. Review". {{cite journal}}: Cite journal requires |journal= (help)
  8. ^ Azziz R. (May 2003). "The evaluation and management of hirsutism". Obstet Gynecol. 101 (5 pt 1): 995–1007. doi:10.1016/s0029-7844(02)02725-4. PMID 12738163.
  9. ^ Blume-Peytavi U, Gieler U, Hoffmann R, Shapiro J (2007). "Unwanted Facial Hair: Affects, Effects and Solutions". Dermatology (Basel). 215 (2): 139–146. doi:10.1159/000104266. PMID 17684377. S2CID 9589835.
  10. ^ Somani N, Harrison S, Bergfeld WF (2008). "The clinical evaluation of hirsutism". Dermatol Ther. 21 (5): 376–91. doi:10.1111/j.1529-8019.2008.00219.x. PMID 18844715. S2CID 34029116.
  11. ^ Legro, Richard S.; Arslanian, Silva A.; Ehrmann, David A.; Hoeger, Kathleen M.; Murad, M. Hassan; Pasquali, Renato; Welt, Corrine K. (December 2013). "Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 98 (12): 4565–4592. doi:10.1210/jc.2013-2350. ISSN 0021-972X. PMC 5399492. PMID 24151290.
  12. ^ a b c d Unluhizarci K, Kaltsas G, Kelestimur F (2012). "Non polycystic ovary syndrome-related endocrine disorders associated with hirsutism". Eur J Clin Invest. 42 (1): 86–94. doi:10.1111/j.1365-2362.2011.02550.x. PMID 21623779. S2CID 23701817.
  13. ^ Chellini PR, Pirmez R, Raso P, Sodré CT (2015). "Generalized Hypertrichosis Induced by Topical Minoxidil in an Adult Woman". Int J Trichology. 7 (4): 182–3. doi:10.4103/0974-7753.171587. PMC 4738488. PMID 26903750.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  14. ^ Dawber RP, Rundegren J (2003). "Hypertrichosis in females applying minoxidil topical solution and in normal controls". J Eur Acad Dermatol Venereol. 17 (3): 271–5. doi:10.1046/j.1468-3083.2003.00621.x. PMID 12702063. S2CID 23329383.
  15. ^ Ferriman, D.; Gallwey, J. D. (1961-11). "Clinical assessment of body hair growth in women". The Journal of Clinical Endocrinology and Metabolism. 21: 1440–1447. doi:10.1210/jcem-21-11-1440. ISSN 0021-972X. PMID 13892577. {{cite journal}}: Check date values in: |date= (help)
  16. ^ a b Sachdeva, Silonie (2010). "Hirsutism: Evaluation and treatment". Indian Journal of Dermatology. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  17. ^ Ferriman D, Gallwey JD (November 1961). "Clinical assessment of body hair growth in women". J. Clin. Endocrinol. Metab. 21 (11): 1440–7. doi:10.1210/jcem-21-11-1440. PMID 13892577.
  18. ^ Cheewadhanaraks, Sopon; Peeyananjarassri, Krantarat; Choksuchat, Chainarong (2004-05). "Clinical diagnosis of hirsutism in Thai women". Journal of the Medical Association of Thailand = Chotmaihet Thangphaet. 87 (5): 459–463. ISSN 0125-2208. PMID 15222512. {{cite journal}}: Check date values in: |date= (help)
  19. ^ Escobar-Morreale, H. F.; Carmina, E.; Dewailly, D.; Gambineri, A.; Kelestimur, F.; Moghetti, P.; Pugeat, M.; Qiao, J.; Wijeyaratne, C. N.; Witchel, S. F.; Norman, R. J. (2012-03). "Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society". Human Reproduction Update. 18 (2): 146–170. doi:10.1093/humupd/dmr042. ISSN 1460-2369. PMID 22064667. {{cite journal}}: Check date values in: |date= (help)
  20. ^ Di Fede G, Mansueto P, Pepe I, Rini GB, Carmina E (2010). "High prevalence of polycystic ovary syndrome in women with mild hirsutism and no other significant clinical symptoms" (PDF). Fertil. Steril. 94 (1): 194–7. doi:10.1016/j.fertnstert.2009.02.056. hdl:10447/36367. PMID 19338993.
  21. ^ Martin, Kathryn A; Anderson, R Rox; Chang, R Jeffrey; Ehrmann, David A; Lobo, Rogerio A; Murad, M Hassan; Pugeat, Michel M; Rosenfield, Robert L (2018-03-07). "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society* Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 103 (4): 1233–1257. doi:10.1210/jc.2018-00241. ISSN 0021-972X.
  22. ^ Karakurt F, Sahin I, Güler S, et al. (April 2008). "Comparison of the clinical efficacy of flutamide and spironolactone plus ethinyloestradiol/cyproterone acetate in the treatment of hirsutism: a randomised controlled study". Adv Ther. 25 (4): 321–8. doi:10.1007/s12325-008-0039-5. PMID 18389188. S2CID 23641936.
  23. ^ a b c d e Somani N, Turvy D (2014). "Hirsutism: an evidence-based treatment update". Am J Clin Dermatol. 15 (3): 247–66. doi:10.1007/s40257-014-0078-4. PMID 24889738. S2CID 45234892.
  24. ^ Bentham Science Publishers (September 1999). Current Pharmaceutical Design. Bentham Science Publishers. pp. 712–717.
  25. ^ Giorgetti R, di Muzio M, Giorgetti A, Girolami D, Borgia L, Tagliabracci A (2017). "Flutamide-induced hepatotoxicity: ethical and scientific issues". Eur Rev Med Pharmacol Sci. 21 (1 Suppl): 69–77. PMID 28379593.
  26. ^ Adam Ostrzenski (2002). Gynecology: Integrating Conventional, Complementary, and Natural Alternative Therapy. Lippincott Williams & Wilkins. pp. 86–. ISBN 978-0-7817-2761-7.
  27. ^ a b c d Ulrike Blume-Peytavi; David A. Whiting; Ralph M. Trüeb (26 June 2008). Hair Growth and Disorders. Springer Science & Business Media. pp. 181–, 369–. ISBN 978-3-540-46911-7.
  28. ^ Kenneth L. Becker (2001). Principles and Practice of Endocrinology and Metabolism. Lippincott Williams & Wilkins. pp. 1196, 1208. ISBN 978-0-7817-1750-2.
  29. ^ a b c d van Zuuren, Esther J; Fedorowicz, Zbys; Carter, Ben; Pandis, Nikolaos (2015-04-28). "Interventions for hirsutism (excluding laser and photoepilation therapy alone)". Cochrane Database of Systematic Reviews (4): CD010334. doi:10.1002/14651858.CD010334.pub2. ISSN 1465-1858. PMC 6481758. PMID 25918921.
  30. ^ a b Williams H, Bigby M, Diepgen T, Herxheimer A, Naldi L, Rzany B (22 January 2009). Evidence-Based Dermatology. John Wiley & Sons. pp. 529–. ISBN 978-1-4443-0017-8.
  31. ^ a b Erem C (2013). "Update on idiopathic hirsutism: diagnosis and treatment". Acta Clinica Belgica. 68 (4): 268–74. doi:10.2143/ACB.3267. PMID 24455796. S2CID 39120534.
  32. ^ a b Müderris II, Bayram F, Ozçelik B, Güven M (February 2002). "New alternative treatment in hirsutism: bicalutamide 25 mg/day". Gynecological Endocrinology. 16 (1): 63–6. doi:10.1080/gye.16.1.63.66. PMID 11915584. S2CID 6942048.
  33. ^ a b Ekback, Maria Palmetun (2017). "Hirsutism, What to do?" (PDF). International Journal of Endocrinology and Metabolic Disorders. 3 (3). doi:10.16966/2380-548X.140. ISSN 2380-548X.
  34. ^ Taylor SI, Dons RF, Hernandez E, Roth J, Gorden P (December 1982). "Insulin resistance associated with androgen excess in women with autoantibodies to the insulin receptor". Ann. Intern. Med. 97 (6): 851–5. doi:10.7326/0003-4819-97-6-851. PMID 7149493.
Look up hirsutism in Wiktionary, the free dictionary.
Retrieved from "https://en.wikipedia.org/enwiki/w/index.php?title=Hirsutism&oldid=1109936991"