Hirsutism refers to the excessive growth of hair in a male pattern among women after puberty. This condition primarily manifests in areas of the body that are influenced by androgens, such as the mustache and beard region, pubic hair, buttocks, and thighs. Due to its widespread occurrence, hirsutism is a frequent motive for seeking dermatological advice and treatment.
It affects a significant proportion of women in the United States, with estimates suggesting that nearly 10% of the female population is affected by this endocrine disorder. Besides its physical implications, hirsutism can have profound psychological effects on those experiencing it. This condition’s visible and often socially stigmatized nature can lead to emotional distress and mental anguish.
Individuals may feel self-conscious, experience low self-esteem, and suffer from anxiety or depression. Therefore, it becomes crucial to address the cosmetic concerns associated with hirsutism and identify the underlying cause, as it may indicate an underlying medical condition.
Epidemiology
The precise prevalence of hirsutism remains uncertain, with estimates varying widely. Hirsutism is believed to affect at least 10% of women, although some studies suggest that the prevalence may be even higher, exceeding 50%. The psychological impact of this condition varies depending on ethnic and socio-cultural factors. In certain societies where the absence of excessive hair is considered a crucial standard of female beauty, even mild hirsutism can be perceived as a significant disorder.
On the other hand, more pronounced hirsutism may be more accepted in other cultural contexts. Interestingly, hirsutism tends to be more commonly observed in individuals with darker skin tones. The reasons behind this association are not fully understood and may involve complex genetic and hormonal factors. Nonetheless, the prevalence of hirsutism can vary across different racial and ethnic groups.
While hirsutism is primarily seen in women, it can also occur in men, although it may be challenging to identify in this population. Men typically have a higher baseline level of body and facial hair, making distinguishing excessive hair growth associated with hirsutism harder. Hirsutism can serve as a sign of precocious puberty in children, indicating the need for medical evaluation and management.
Additionally, hirsutism has been observed in women who discontinue oral contraceptive pills and experience weight gain. Hormonal fluctuations and changes in androgen levels may contribute to the development of hirsutism in these cases. It is important to recognize that various factors can trigger or exacerbate hirsutism, necessitating a comprehensive approach to its diagnosis and treatment.
Anatomy
Pathophysiology
The pathophysiology of hirsutism involves various hormonal and genetic factors that influence hair growth patterns in individuals. The condition is typically characterized by increased hair growth in a male pattern, which is influenced by androgens, specifically testosterone and other related hormones.
Hirsutism is characterized as an androgen-dependent disorder arising from the interplay between circulating androgen levels and the sensitivity of hair follicles to these androgens. Testosterone, a male sex hormone, can be converted to a more potent androgen called dihydrotestosterone (DHT) within the skin through the action of a specific enzyme known as 5alpha-reductase.
This enzyme exists in two forms, termed isoenzymes: type 1 (located on chromosome 5) and type 2 (located on chromosome 2). Both of these isoenzymes are present within the skin and hair follicles. The skin and pilosebaceous follicles also possess androgen receptors (AR), which mediate the effects of androgens.
When considering the causes of hirsutism, it is important to rule out any external intake of androgens. In cases with no exogenous androgen exposure, hirsutism typically results from excessive production of androgens by the ovaries or adrenal glands or increased skin sensitivity to normal levels of circulating androgens. The latter case is often referred to as “idiopathic hirsutism.”
Etiology
The etiology of hirsutism encompasses various underlying factors that contribute to the development of excessive hair growth in women. These factors can be broadly categorized into endocrine (hormonal) and non-endocrine causes. Identifying the specific etiology is crucial for determining appropriate treatment approaches.
Endocrine Causes:
Hyperandrogenism: Certain medical conditions, such as congenital adrenal hyperplasia, adrenal tumors, and Cushing’s syndrome, can lead to increased production of androgens, resulting in hirsutism.
Ovarian Tumors: Androgen-secreting tumors of the ovaries, such as ovarian stromal tumors or granulosa cell tumors, can cause hirsutism by producing excessive androgens.
Thyroid Dysfunction: Imbalances in thyroid hormone levels, such as hypothyroidism or hyperthyroidism, can contribute to the development of hirsutism.
Non-endocrine Causes:
Genetic Predisposition: Hirsutism can also have a genetic component, with certain families showing a higher prevalence of excessive hair growth.
Weight and Insulin Resistance: Obesity and insulin resistance can contribute to hormonal imbalances and elevated androgen levels, leading to hirsutism.
Idiopathic Hirsutism: In some cases, the underlying cause of hirsutism remains unknown. Idiopathic hirsutism is diagnosed when there is no identifiable endocrine abnormality or excessive androgen production, but the hair follicles are more sensitive to normal levels of androgens.
Genetics
Prognostic Factors
Hirsutism can have considerable adverse consequences on an individual’s well-being, and women with hirsutism caused by malignancies often face a poor prognosis. Moreover, postmenopausal women experiencing hirsutism are at an increased risk of developing osteoporosis and fractures, which can significantly impact their health.
Clinical History
Clinical History
The presence of coarse, dark hair on areas such as the face, chest, abdomen, back, and arms is evident. The hair growth has been progressively increasing over the past few years. Other than the excessive hair growth, the patient may not have any significant symptoms.
No specific skin changes, scalp abnormalities, voice changes, or changes in libido may be noticed. Patients may sometimes notice changes in their menstrual cycle, libido and have a history of PCOS.
Physical Examination
Physical Examination
Hirsutism is characterized by terminal (thick and pigmented) hair in androgen-sensitive body areas. These areas include the upper lip, chin, cheeks, chest, abdomen, back, and inner thighs. The hair growth may follow a male pattern, such as a “beard” or “mustache” appearance. The hair in hirsutism tends to be thicker, darker, and more noticeable than vellus (fine and light-colored) hair.
The texture of the hair may resemble that of male facial hair. The hair growth in hirsutism typically occurs in a pattern that is not typical for women. It may involve areas where women normally have minimal hair or no hair growth, such as the face and chest. In hirsutism, there is excessive hair growth without signs of virilization.
Virilization refers to developing masculine physical characteristics, such as a deepening voice, balding, or clitoromegaly (enlarged clitoris). The absence of these signs helps differentiate hirsutism from more severe conditions like virilizing tumors or congenital adrenal hyperplasia.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Combined oral contraceptive pills are commonly prescribed as a first-line treatment for hirsutism. They can help regulate hormone levels, reduce androgen production, and slow hair growth. Medications such as spironolactone or cyproterone acetate can block the effects of androgens on hair follicles, reducing hair growth.
These medications are often combined with oral contraceptives for enhanced effectiveness. Prescription eflornithine creams can be applied directly to the affected areas to slow hair growth. In cases where hirsutism is associated with conditions like polycystic ovary syndrome (PCOS), maintaining a healthy weight through a balanced diet and regular exercise can help improve hormonal balance.
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Hirsutism refers to the excessive growth of hair in a male pattern among women after puberty. This condition primarily manifests in areas of the body that are influenced by androgens, such as the mustache and beard region, pubic hair, buttocks, and thighs. Due to its widespread occurrence, hirsutism is a frequent motive for seeking dermatological advice and treatment.
It affects a significant proportion of women in the United States, with estimates suggesting that nearly 10% of the female population is affected by this endocrine disorder. Besides its physical implications, hirsutism can have profound psychological effects on those experiencing it. This condition’s visible and often socially stigmatized nature can lead to emotional distress and mental anguish.
Individuals may feel self-conscious, experience low self-esteem, and suffer from anxiety or depression. Therefore, it becomes crucial to address the cosmetic concerns associated with hirsutism and identify the underlying cause, as it may indicate an underlying medical condition.
The precise prevalence of hirsutism remains uncertain, with estimates varying widely. Hirsutism is believed to affect at least 10% of women, although some studies suggest that the prevalence may be even higher, exceeding 50%. The psychological impact of this condition varies depending on ethnic and socio-cultural factors. In certain societies where the absence of excessive hair is considered a crucial standard of female beauty, even mild hirsutism can be perceived as a significant disorder.
On the other hand, more pronounced hirsutism may be more accepted in other cultural contexts. Interestingly, hirsutism tends to be more commonly observed in individuals with darker skin tones. The reasons behind this association are not fully understood and may involve complex genetic and hormonal factors. Nonetheless, the prevalence of hirsutism can vary across different racial and ethnic groups.
While hirsutism is primarily seen in women, it can also occur in men, although it may be challenging to identify in this population. Men typically have a higher baseline level of body and facial hair, making distinguishing excessive hair growth associated with hirsutism harder. Hirsutism can serve as a sign of precocious puberty in children, indicating the need for medical evaluation and management.
Additionally, hirsutism has been observed in women who discontinue oral contraceptive pills and experience weight gain. Hormonal fluctuations and changes in androgen levels may contribute to the development of hirsutism in these cases. It is important to recognize that various factors can trigger or exacerbate hirsutism, necessitating a comprehensive approach to its diagnosis and treatment.
The pathophysiology of hirsutism involves various hormonal and genetic factors that influence hair growth patterns in individuals. The condition is typically characterized by increased hair growth in a male pattern, which is influenced by androgens, specifically testosterone and other related hormones.
Hirsutism is characterized as an androgen-dependent disorder arising from the interplay between circulating androgen levels and the sensitivity of hair follicles to these androgens. Testosterone, a male sex hormone, can be converted to a more potent androgen called dihydrotestosterone (DHT) within the skin through the action of a specific enzyme known as 5alpha-reductase.
This enzyme exists in two forms, termed isoenzymes: type 1 (located on chromosome 5) and type 2 (located on chromosome 2). Both of these isoenzymes are present within the skin and hair follicles. The skin and pilosebaceous follicles also possess androgen receptors (AR), which mediate the effects of androgens.
When considering the causes of hirsutism, it is important to rule out any external intake of androgens. In cases with no exogenous androgen exposure, hirsutism typically results from excessive production of androgens by the ovaries or adrenal glands or increased skin sensitivity to normal levels of circulating androgens. The latter case is often referred to as “idiopathic hirsutism.”
The etiology of hirsutism encompasses various underlying factors that contribute to the development of excessive hair growth in women. These factors can be broadly categorized into endocrine (hormonal) and non-endocrine causes. Identifying the specific etiology is crucial for determining appropriate treatment approaches.
Endocrine Causes:
Hyperandrogenism: Certain medical conditions, such as congenital adrenal hyperplasia, adrenal tumors, and Cushing’s syndrome, can lead to increased production of androgens, resulting in hirsutism.
Ovarian Tumors: Androgen-secreting tumors of the ovaries, such as ovarian stromal tumors or granulosa cell tumors, can cause hirsutism by producing excessive androgens.
Thyroid Dysfunction: Imbalances in thyroid hormone levels, such as hypothyroidism or hyperthyroidism, can contribute to the development of hirsutism.
Non-endocrine Causes:
Genetic Predisposition: Hirsutism can also have a genetic component, with certain families showing a higher prevalence of excessive hair growth.
Weight and Insulin Resistance: Obesity and insulin resistance can contribute to hormonal imbalances and elevated androgen levels, leading to hirsutism.
Idiopathic Hirsutism: In some cases, the underlying cause of hirsutism remains unknown. Idiopathic hirsutism is diagnosed when there is no identifiable endocrine abnormality or excessive androgen production, but the hair follicles are more sensitive to normal levels of androgens.
Hirsutism can have considerable adverse consequences on an individual’s well-being, and women with hirsutism caused by malignancies often face a poor prognosis. Moreover, postmenopausal women experiencing hirsutism are at an increased risk of developing osteoporosis and fractures, which can significantly impact their health.
Clinical History
The presence of coarse, dark hair on areas such as the face, chest, abdomen, back, and arms is evident. The hair growth has been progressively increasing over the past few years. Other than the excessive hair growth, the patient may not have any significant symptoms.
No specific skin changes, scalp abnormalities, voice changes, or changes in libido may be noticed. Patients may sometimes notice changes in their menstrual cycle, libido and have a history of PCOS.
Physical Examination
Hirsutism is characterized by terminal (thick and pigmented) hair in androgen-sensitive body areas. These areas include the upper lip, chin, cheeks, chest, abdomen, back, and inner thighs. The hair growth may follow a male pattern, such as a “beard” or “mustache” appearance. The hair in hirsutism tends to be thicker, darker, and more noticeable than vellus (fine and light-colored) hair.
The texture of the hair may resemble that of male facial hair. The hair growth in hirsutism typically occurs in a pattern that is not typical for women. It may involve areas where women normally have minimal hair or no hair growth, such as the face and chest. In hirsutism, there is excessive hair growth without signs of virilization.
Virilization refers to developing masculine physical characteristics, such as a deepening voice, balding, or clitoromegaly (enlarged clitoris). The absence of these signs helps differentiate hirsutism from more severe conditions like virilizing tumors or congenital adrenal hyperplasia.
Combined oral contraceptive pills are commonly prescribed as a first-line treatment for hirsutism. They can help regulate hormone levels, reduce androgen production, and slow hair growth. Medications such as spironolactone or cyproterone acetate can block the effects of androgens on hair follicles, reducing hair growth.
These medications are often combined with oral contraceptives for enhanced effectiveness. Prescription eflornithine creams can be applied directly to the affected areas to slow hair growth. In cases where hirsutism is associated with conditions like polycystic ovary syndrome (PCOS), maintaining a healthy weight through a balanced diet and regular exercise can help improve hormonal balance.
medtigo
Hirsutism
Updated :
September 5, 2023
Hirsutism refers to the excessive growth of hair in a male pattern among women after puberty. This condition primarily manifests in areas of the body that are influenced by androgens, such as the mustache and beard region, pubic hair, buttocks, and thighs. Due to its widespread occurrence, hirsutism is a frequent motive for seeking dermatological advice and treatment.
It affects a significant proportion of women in the United States, with estimates suggesting that nearly 10% of the female population is affected by this endocrine disorder. Besides its physical implications, hirsutism can have profound psychological effects on those experiencing it. This condition’s visible and often socially stigmatized nature can lead to emotional distress and mental anguish.
Individuals may feel self-conscious, experience low self-esteem, and suffer from anxiety or depression. Therefore, it becomes crucial to address the cosmetic concerns associated with hirsutism and identify the underlying cause, as it may indicate an underlying medical condition.
The precise prevalence of hirsutism remains uncertain, with estimates varying widely. Hirsutism is believed to affect at least 10% of women, although some studies suggest that the prevalence may be even higher, exceeding 50%. The psychological impact of this condition varies depending on ethnic and socio-cultural factors. In certain societies where the absence of excessive hair is considered a crucial standard of female beauty, even mild hirsutism can be perceived as a significant disorder.
On the other hand, more pronounced hirsutism may be more accepted in other cultural contexts. Interestingly, hirsutism tends to be more commonly observed in individuals with darker skin tones. The reasons behind this association are not fully understood and may involve complex genetic and hormonal factors. Nonetheless, the prevalence of hirsutism can vary across different racial and ethnic groups.
While hirsutism is primarily seen in women, it can also occur in men, although it may be challenging to identify in this population. Men typically have a higher baseline level of body and facial hair, making distinguishing excessive hair growth associated with hirsutism harder. Hirsutism can serve as a sign of precocious puberty in children, indicating the need for medical evaluation and management.
Additionally, hirsutism has been observed in women who discontinue oral contraceptive pills and experience weight gain. Hormonal fluctuations and changes in androgen levels may contribute to the development of hirsutism in these cases. It is important to recognize that various factors can trigger or exacerbate hirsutism, necessitating a comprehensive approach to its diagnosis and treatment.
The pathophysiology of hirsutism involves various hormonal and genetic factors that influence hair growth patterns in individuals. The condition is typically characterized by increased hair growth in a male pattern, which is influenced by androgens, specifically testosterone and other related hormones.
Hirsutism is characterized as an androgen-dependent disorder arising from the interplay between circulating androgen levels and the sensitivity of hair follicles to these androgens. Testosterone, a male sex hormone, can be converted to a more potent androgen called dihydrotestosterone (DHT) within the skin through the action of a specific enzyme known as 5alpha-reductase.
This enzyme exists in two forms, termed isoenzymes: type 1 (located on chromosome 5) and type 2 (located on chromosome 2). Both of these isoenzymes are present within the skin and hair follicles. The skin and pilosebaceous follicles also possess androgen receptors (AR), which mediate the effects of androgens.
When considering the causes of hirsutism, it is important to rule out any external intake of androgens. In cases with no exogenous androgen exposure, hirsutism typically results from excessive production of androgens by the ovaries or adrenal glands or increased skin sensitivity to normal levels of circulating androgens. The latter case is often referred to as “idiopathic hirsutism.”
The etiology of hirsutism encompasses various underlying factors that contribute to the development of excessive hair growth in women. These factors can be broadly categorized into endocrine (hormonal) and non-endocrine causes. Identifying the specific etiology is crucial for determining appropriate treatment approaches.
Endocrine Causes:
Hyperandrogenism: Certain medical conditions, such as congenital adrenal hyperplasia, adrenal tumors, and Cushing’s syndrome, can lead to increased production of androgens, resulting in hirsutism.
Ovarian Tumors: Androgen-secreting tumors of the ovaries, such as ovarian stromal tumors or granulosa cell tumors, can cause hirsutism by producing excessive androgens.
Thyroid Dysfunction: Imbalances in thyroid hormone levels, such as hypothyroidism or hyperthyroidism, can contribute to the development of hirsutism.
Non-endocrine Causes:
Genetic Predisposition: Hirsutism can also have a genetic component, with certain families showing a higher prevalence of excessive hair growth.
Weight and Insulin Resistance: Obesity and insulin resistance can contribute to hormonal imbalances and elevated androgen levels, leading to hirsutism.
Idiopathic Hirsutism: In some cases, the underlying cause of hirsutism remains unknown. Idiopathic hirsutism is diagnosed when there is no identifiable endocrine abnormality or excessive androgen production, but the hair follicles are more sensitive to normal levels of androgens.
Hirsutism can have considerable adverse consequences on an individual’s well-being, and women with hirsutism caused by malignancies often face a poor prognosis. Moreover, postmenopausal women experiencing hirsutism are at an increased risk of developing osteoporosis and fractures, which can significantly impact their health.
Clinical History
The presence of coarse, dark hair on areas such as the face, chest, abdomen, back, and arms is evident. The hair growth has been progressively increasing over the past few years. Other than the excessive hair growth, the patient may not have any significant symptoms.
No specific skin changes, scalp abnormalities, voice changes, or changes in libido may be noticed. Patients may sometimes notice changes in their menstrual cycle, libido and have a history of PCOS.
Physical Examination
Hirsutism is characterized by terminal (thick and pigmented) hair in androgen-sensitive body areas. These areas include the upper lip, chin, cheeks, chest, abdomen, back, and inner thighs. The hair growth may follow a male pattern, such as a “beard” or “mustache” appearance. The hair in hirsutism tends to be thicker, darker, and more noticeable than vellus (fine and light-colored) hair.
The texture of the hair may resemble that of male facial hair. The hair growth in hirsutism typically occurs in a pattern that is not typical for women. It may involve areas where women normally have minimal hair or no hair growth, such as the face and chest. In hirsutism, there is excessive hair growth without signs of virilization.
Virilization refers to developing masculine physical characteristics, such as a deepening voice, balding, or clitoromegaly (enlarged clitoris). The absence of these signs helps differentiate hirsutism from more severe conditions like virilizing tumors or congenital adrenal hyperplasia.
Combined oral contraceptive pills are commonly prescribed as a first-line treatment for hirsutism. They can help regulate hormone levels, reduce androgen production, and slow hair growth. Medications such as spironolactone or cyproterone acetate can block the effects of androgens on hair follicles, reducing hair growth.
These medications are often combined with oral contraceptives for enhanced effectiveness. Prescription eflornithine creams can be applied directly to the affected areas to slow hair growth. In cases where hirsutism is associated with conditions like polycystic ovary syndrome (PCOS), maintaining a healthy weight through a balanced diet and regular exercise can help improve hormonal balance.
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