Hirsutism - Signs, Treatment, Causes, Forms, Diagnosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Hirsutism

The content of the article:

1. Causes of hirsutism
2. Kinds
3. Signs

4. Diagnostics

   Analyzes for hirsutism

5. Treatment of hirsutism
6. Folk remedies for hirsutism
7. Consequences and complications
8. Prevention

Hirsutism is a condition manifested by excessive hair growth of androgen-dependent (that is, hypersensitive to androgens) areas of the skin of the face and body of a woman.

Hirsutism - excess body hair in women

Hirsutism is a widespread pathology. According to various sources, it is observed in 2-10% of women. In many cases, the pathological growth of pigmented coarse stem hair is mild and women do not seek medical attention. But hirsutism should not be viewed as a cosmetic problem. In fact, this condition indicates changes in hormonal balance that require appropriate treatment.

Hirsutism must be distinguished from hypertrichosis. These two pathologies are similar, in the International Classification of Diseases (ICD-10) they are included in the same group. However, there are differences between them. Hirsutism is diagnosed exclusively in women; hair growth occurs according to the male pattern. Hypertrichosis affects people of both sexes, with it, hair growth can be observed in any areas of the skin, and not only in androgen-dependent zones.

Causes of hirsutism

With hirsutism, under the influence of certain factors, the transformation of unpigmented soft and thin vellus hair into hard, long, pigmented rod hair occurs. These factors include:

• hereditary predisposition;
• hyperandrogenemia;
• idiopathic excess of androgens;
• taking certain medications.

The following conditions can cause increased androgen production (hyperandrogenism):

• disorders of ovarian function (hypothalamic amenorrhea, chronic anovulation, ovarian hyperthecosis, ovarian neoplasms, polycystic ovary syndrome);
• disorders of the adrenal gland function (adrenal tumors, acquired or congenital adrenal hyperplasia);
• disorders of the pituitary gland (prolactinoma, acromegaly, Itsenko-Cushing's syndrome).

The cause of hirsutism may lie in a genetic predisposition. In this case, pathological hair growth has been observed over several generations of women from a particular family or an entire ethnic group. For example, hirsutism is significantly more common in Mediterranean and Caucasian women than among Asians or indigenous women in Northern Europe.

Long-term use of certain drugs (carbamazepine, cyclosporine, interferon, streptomycin, androgens, progestins, anabolic agents, corticosteroids) can lead to the development of hirsutism.

The natural aging process of a woman should also be attributed to the causes of hirsutism. During the postmenopausal period, there is a change in the ratio of androgens and estrogens.

If, with hirsutism, analyzes and other types of examinations do not allow to identify the cause, then they speak of idiopathic androgen excess syndrome. Against the background of this syndrome, there is an increase in the sensitivity to the action of male sex hormones of the hair follicles and skin.

According to medical statistics, in 90% of cases, the development of hirsutism is caused by idiopathic androgen excess syndrome or polycystic ovary syndrome.

Kinds

There are several types of hirsutism, depending on the causes of excess hair growth:

• constitutional, or dermatological (idiopathic, familial hirsutism);
• neuroendocrine (pituitary, adrenal, ovarian hirsutism);
• exogenous, or iatrogenic (drug-induced hirsutism).

Hirsutism is often associated with other pathologies; respectively, distinguish:

• hirsutism itself;
• hirsutism with ovulatory disorders;
• hirsutism with virilization symptoms;
• hirsutism, combined with piloseborrheic hyperactive complex (acne, acne).

Signs

The main clinical sign of hirsutism is the development of male type of hair growth in women, in which pigmented and coarse hair grows on the face, around the areola of the mammary glands, on the back, buttocks, inner thighs, and abdomen. The balance of hormones in hirsutism is disturbed, and the level of androgens rises. This leads to the appearance of such symptoms:

• hair loss (alopecia);
• increased greasiness of hair and skin;
• violations of menstrual function, up to amenorrhea.

Manifestations of hirsutism

Hirsutism caused by hyperandrogenism is often combined with the development of signs of virilization, that is, the appearance in women of the following features inherent in men:

• rough low voice;
• increase in muscle mass;
• bald patches on the temples;
• increased sex drive;
• android obesity (the accumulation of adipose tissue occurs mainly in the armpits and abdomen);
• a decrease in the volume of the mammary glands.

Against the background of hyperandrogenism, gradual changes also occur on the part of the external genital organs:

• reduction of the labia;
• enlargement of the clitoris;
• cessation of secretion of the glands of the vestibule of the vagina.

The severity of the manifestations of hirsutism is determined using several tests. For example, to assess the degree of hair growth, a point scale is used, in which the absence of hair growth in a skin area is estimated at 0 points, and a well-developed hairline at 4 points.

The severity of hirsutism

In clinical practice, another scale for assessing the severity of hirsutism is more often used, taking into account the following parameters:

1. Hormone number is the sum of points characterizing hair growth over the upper lip, chin, chest, back, abdomen, hips and shoulders.
2. Indifferent number - the sum of points obtained when assessing the qualitative and quantitative hair growth on the legs and forearms.
3. The hirsute number is the result of the addition of the hormonal and indifferent numbers. Normally, the hirsut number should not exceed 12 points.

This scale is mainly used by specialists to assess the effectiveness of the treatment of hirsutism, since it has a high degree of subjectivity.

Diagnostics

Diagnosis of hirsutism begins with the collection of anamnesis (onset of the disease, features of menstrual function, medications taken).

Given that the balance of hormones in hirsutism is disturbed, a number of laboratory tests are performed to determine the cause of excess hair growth.

Analyzes for hirsutism

The following analyzes are carried out:

1. For total testosterone (the norm is 0.24–2.7 nmol / l). An increase in concentration occurs with ovarian tumors, and a decrease is usually observed while taking oral contraceptives or prednisolone.
2. On DEA-S (dehydroepiandrosterone sulfate). Normally, its amount in women is 2700-11,000 nmol / l. An increase indicates an increase in the secretory function of the adrenal cortex due to a tumor process, and a decrease can be observed against the background of adrenal hyperplasia or prolonged use of dexamethasone.
3. For androstenedione (the norm is 75–205 ng / dl). It increases with some pathologies of the ovaries.
4. On 17-hydroxyprogesterone (the norm is 0.2-8.7 nmol / l). An increase is caused by congenital adrenal hyperplasia.
5. For cortisol (the norm is 138-635 nmol / l). Excess values are noted against the background of Itsenko-Cushing syndrome.
6. For gonadotropins. With polycystic ovaries, the content of luteinizing hormone increases in relation to follicle-stimulating hormone (normally the ratio should not exceed 2.5).

Analyzes for hirsutism are deciphered only by an endocrinologist, since the concentration of hormones in the blood depends on many factors (age, time of day, phase of the menstrual cycle).

To diagnose hirsutism, a woman donates blood to the level of hormones

In addition to laboratory diagnostics, instrumental examination is performed to establish the causes of hirsutism, including:

• computed or magnetic resonance imaging of the brain, abdominal organs;
• ultrasound scanning of the ovaries and adrenal glands;
• diagnostic laparoscopy (with suspicion of tumor processes in the abdominal cavity).

Treatment of hirsutism

A mild degree of hirsutism, not accompanied by menstrual dysfunction and infertility, does not need specific therapy. To remove unwanted hair, mechanical, chemical or laser depilation is used.

In all other cases, treatment of hirsutism is mandatory. It is aimed at eliminating the primary etiological factor (acromegaly, Itsenko-Cushing's syndrome, hypothyroidism, adrenal or ovarian tumor).

Drug therapy for hirsutism is prescribed only after a complete examination and exclusion of the presence of tumors that secrete androgens. It includes the appointment of drugs that have antiandrogenic effects, which not only lower the level of testosterone in the body, but also reduce the sensitivity of hair follicles to it. The course of treatment is at least three months. Repeated courses are carried out if necessary. Against the background of therapy, the growth of new hair stops, but the number of existing ones does not decrease.

As part of the complex treatment of hirsutism, physical activity is shown

Treatment of hirsutism with antiandrogenic drugs is contraindicated during pregnancy and lactation.

Hirsutism is often associated with obesity. In this case, a low-calorie diet with restriction of carbohydrates, regular moderate physical activity is prescribed.

In the treatment of hirsutism, cosmetological methods are also widely used to remove or lighten hair:

• lightening hair with hydrogen peroxide solution;
• shaving;
• hair removal (mechanical, chemical, laser, electrical).

Folk remedies for hirsutism

Excessive hair growth occurs against the background of rather complex hormonal pathologies. Folk remedies for hirsutism are not able to affect the hormonal balance, but can be used in consultation with your doctor to remove unwanted hair. These tools include:

1. Unripe walnut juice. The green nut fruit is cut in half. The juice released on the cut is abundantly lubricated with the hair. After a few procedures, they fall out.
2. Datura decoction (henbane). For cooking, take 150 g of dried raw materials and pour 1 liter of cold water, boil over low heat until about 1 glass of broth remains. The broth is cooled and filtered, then the areas of the skin with increased hair growth are wiped 2-3 times a day. Datura decoction should be used with caution, as it is poisonous and can cause severe poisoning when ingested.
3. Lemon juice. Squeeze the juice from half a large lemon, add 3 tablespoons of granulated sugar and 1 glass of cold water. The mixture must be cooked until thickened over low heat, then cooled and applied to the area of the skin covered with hair, wait a few minutes and rinse.

Folk remedies for hirsutism help fight increased hair growth

Consequences and complications

With severe hirsutism, serious psychological complexes can form, self-confidence is lost, social adaptation worsens, and disharmony arises in intimate and family life.

Prevention

It is impossible to prevent the development of familial forms of hirsutism. Prevention of neuroendocrine forms of hirsutism consists in the timely detection and treatment of diseases that can cause excessive hair growth. To prevent drug hirsutism, it is necessary to take pharmaceuticals only as directed and under the supervision of a physician.

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Elena Minkina Doctor anesthesiologist-resuscitator About the author

Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.

Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!