Abstract
Hirsutism is the presence in women of terminal hair in patterns and sequence similar
to those that develop in the normal post-pubertal male. It is a distressing endocrine
and cosmetic condition associated with significant psychological morbidity. Hyperandrogenism
is the underlying disease in most cases and polycystic ovarian syndrome is the commonest
cause. There is a strong familial component and a high degree of hereditability. Thorough
history-taking and physical examination are pivotal to establishing cause. Initial
assessment should exclude underlying serious disease, establish change in sexuality,
and assess impact on fertility. Physical examination should include assessment of
the severity of hirsutism using the modified Ferriman–Gallway score. A sympathetic
approach is vital for successful management. Treatment includes lifestyle modification,
mechanical/cosmetic measures, and pharmacological treatment, including androgen suppressors,
peripheral androgen blockers, and biological modifiers of hair follicular growth.
In general, treatment is combination therapy, and pre-treatment psychological preparation
is essential to establish realistic treatment goals. Therapy should be long-term and
continuous because hirsutism tends to recur if treatment is withdrawn.
Keywords
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Further reading
- Idiopathic hirsutism.Endocr Rev. 2000; 21: 347-362
- Efficacy of second versus third generation oral contraceptives in the treatment of hirsutism.Contraception. 2003; 67: 349
- Unwanted facial hair: affects, effects and solutions.Dermatology. 2007; 215: 139-146
- Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone.J Clin Endocrinol Metab. 1999; 84: 1470-1474
- New dimensions I Hirsutism.Lasers Med Sci. 2006; 21: 126-133
- Fertil Steril. 2004; 81: 19-25
Schrode K, Huber F, Staszak J, Altaan DJ, Shander D, Morton J. The Eflornithine Study Group. Randomised double-blind vehicle-controlled safety and efficacy of eflornithine 155 cream in the treatment of women with excessive facial hair, 58th Annual Meeting, American Academy of Dermatology: abstract P291, 2000.
- Hair patterns: hirsuties and androgenic alopecia.in: Dawber R. Diseases of the hair and scalp. Blackwell Science, Oxford1997: 67-122
- Hirsutism in clinical gynecologic endocrinology and infertility.7th edn. Lippincott Williams and Wilkins, London2004
- Sexual hormones in human skin.Horm Metab Res. 2007; 39: 85-95
- Biology of hair growth.Semin Reprod Endocrinol. 1986; 4: 131-141
- Physical methods for the management of hirsutism.Curtis. 1990; 45: 19-26
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© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
