2009 article
Key content:
- Hirsutism is a distressing condition affecting 5–15% of women.
- It is usually associated with an underlying endocrine disorder: in 70–80%
of women with hirsutism this is polycystic ovary syndrome. - Management depends upon the cause but combines lifestyle changes and
cosmetic, physical and medical treatments. - It takes 9–12 months for hormonal treatments to take their maximum effect.
Introduction
Hirsutism is the presence of terminal (coarse) hairs
in females in a male-like pattern,
affecting 5–15% of women surveyed.
It is extremely distressing,
especially in young women , both psychosocial and emotional, of
adulthood.
Hirsutism is usually associated with, or a sign of, an underlying endocrine disorder. It can
also be an isolated condition, referred to as idiopathic hirsutism.
Normal hair growth
Of the 50 million hair follicles present on the human body, 100 000–150 000 are found on the
scalp.
The only parts of the body lacking hair follicles are the palms of the hands, the soles of the
feet and the lips.
Few hair follicles form after birth and after the age of 40 years hair follicles decrease in
number.
There are three types of hair:
• lanugo, a soft hair densely covering the fetus,
which is shed in the first 4 months postpartum
- vellus hair, which is soft, longer than lanugo hair (2 cm), nonpigmented and which covers the body.
- terminal hair, which is longer still, pigmented and which makes up the hair of the eyebrows,
scalp and axillary and pubic areas.
The three phases of hair growth- consist of anagen, the active growing phase
- catagen, the
involuting phase, when the hair stops growing
and - telogen, the resting phase, when the hair is shed.
In humans, the reason why hair appears to grow continuously is because of disharmony in the phases of hair growth; thus while some hairs are in
anagen, others are resting (telogen).
The overall length of the hair is determined by the duration of the anagen phase.
Regulation of hair growth
The regulation of hair growth is multifactorial.
Androgens are the most important hormones
regulating hair type, growth and distribution.
The main circulating androgen, testosterone, is converted in the hair follicle by the enzyme 5-reductase to its more potent form, dihydrotestosterone. Other, weaker androgens, such as androstenedione and dehydroepiandrosterone, are metabolised in the skin to testosterone and dihydrotestosterone, stimulating hair growth.
Aetiology
The causes of hirsutism can be divided broadly
into
1)androgen excess, 2) non androgen factors and 3) idiopathic causes.
| androgen excess | non androgen factors | idiopathic causes |
| 1. Polycystic ovary syndrome accounting for 70–80% of women with hirsutism. Insulin increases androgen levels directly by increasing androgen production by the ovarian theca cells and indirectly by reducing hepatic synthesis of sex hormone binding globulin. 2. Androgen-secreting tumours tumors of the ovary or the adrenal glands. n 1 in 300 and 1 in 1000 hirsute women. 3. Nonclassic congenital adrenal hyperplasia autosomal recessive condition is found in 1.5–2.5% of hyperandrogenic women. Other causes thyroid dysfunction, acromegaly, Cushing syndrome and hyperprolactinemia | unknown mechanisms of action | These women have no detectable hormonal abnormalities, normal menses, normal ovarian appearance and no evidence of adrenal or ovarian tumours. more recent studies quote a prevalence of 6–7% |
Evaluation
This must include an in-depth history.
The extent, type and pattern of the hair growth can be established by physical examination.
presence of abnormalities, such as signs of virilisation, thyroid enlargement, galactorrhoea,
pelvic/abdominal masses, cushingoid features, obesity and signs of systemic illness should also be established.
In 1961, Ferriman and Gallwey10 described a method for assessing the degree of hirsutism.
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