Hirsutism

HIRSUTISM FOR UNDERGRADUATE

1. HIRSUTISM. DR SALINI MANDAL B.G. ASST PROFESSOR DEPT OF OBG FMHMC

2. Hirsutism is the excessive growth of androgen dependent sexual hair (terminal hair) in facial and central part of the body that worries the patient

3. Virilism is defined as the presence of any one or more of the following features—deepening of the voice, temporal balding, amenorrhea, enlargement of clitoris ( clitoromegaly ) and breast atrophy. It is a more severe form of androgen excess. Virilism may be due to adrenal hyperplasia or tumors of adrenal or ovary.

4. Sebaceous glands and hair follicles. Both are sensitive to androgens. The sebaceous glands are more sensitive to androgens than the hair follicles. Hyperstimulation of the sebaceous glands leads first to oily skin and subsequent infection results in acne.

5. History- Onset and progression Physical examination Assess the severity of hirsutism (+/- virilisation ) Acertain the underlying cause Investigations Treatment CLINICAL APPROACH TO A PATIENT WITH HIRSUTISM

6. Onset and progression Most of the causes begins in early adolescence Presentation may be late depending upon the cause Rapid progression – androgen secreting tumors THE GUIDELINES TO PINPOINT DIAGNOSIS

7. Principles of management To remove excess hair To suppress or neutralise the action of androgen To remove the source of excess androgen MANAGEMENT

8. PRINCIPLES OF TREATMENT OF HIRSUTISM Best results are achieved by combination treatment including antiandrogens , suppression. Goal should be to reduce the time spent mechanically removing unwanted hair. The choice of drug depends mainly on its tolerability by each individual patient.

9. Drugs - ( depending upon the site of production of excess androgens) OCPS Progestrogens Antiandrogens Spironolactone Dexamethasone GnRH Analogues Combined approach TO SUPPRESS THE EXCESS ANDROGEN ACTION

10. COSMETIC TREATMENT Bleaching - can cause irritation, purities, skin discoloration Shaving - Shaving does not lead to worsening of hirsutism and is a good short-term solution for facial hair. - Does not affect the rate or duration of anagen phase, or diameter of hair - But yields a blunt tip – illusion of thicker hair Plucking, Waxing - scarring, folliculitis , hyperpigmentation Depilatory creams - Irritant dermatitis Electrolysis - painful, erythema , inflammation, scarring Laser

11. Removal of the source Adrenal or ovarian tumour – surgically treated Cushing disease – Adrenalectomy Radiation to pituitary Removal of ACTH producing tumor Iatrogenic cases – Offending drug to be stopped