Hirsutism
Hirsutism: Excerpt from Professional Guide to Diseases (Eighth Edition)
A distressing disorder usually found in women and children, hirsutism is the excessive growth of body hair, typically in an adult male distribution pattern. This condition commonly occurs spontaneously but may also develop as a secondary disorder of various underlying diseases. It must always be distinguished from hypertrichosis. The prognosis varies with the cause and effectiveness of treatment.
Causes
Idiopathic hirsutism probably stems from a hereditary trait because the patient usually has a family history of the disorder. Causes of secondary hirsutism include endocrine abnormalities related to pituitary dysfunction (acromegaly or precocious puberty), adrenal dysfunction (Cushing’s disease, congenital adrenal hyperplasia, or Cushing’s syndrome), or ovarian lesions (such as polycystic ovary syndrome or ovarian neoplasm); prolactinoma; and iatrogenic factors (such as the use of minoxidil, androgenic steroids, testosterone, diazoxide, glucocorticoids, and hormonal contraceptives). Other kinds of hirsutism have been reported. (See Hypertrichosis.)
Signs and symptoms
Hirsutism typically produces enlarged hair follicles as well as enlargement and hyperpigmentation of the hairs themselves. Excessive facial hair growth is the complaint for which most patients seek medical help. Generally, hirsutism involves appearance of thick, pigmented hair in the beard area, upper back, shoulders, sternum, axillae, and pubic area. Frontotemporal scalp hair recession is often a coexisting condition. Patterns of hirsutism vary widely, depending on the patient’s race and age. Elderly women commonly show increased hair growth on the chin and upper lip. In secondary hirsutism, signs of masculinization may appear — deepening of the voice, increased muscle mass, increased size of genitalia, menstrual irregularity, and decreased breast size.
Diagnosis
A family history of hirsutism, absence of menstrual abnormalities or signs of masculinization, and a normal pelvic examination strongly suggest idiopathic hirsutism. Tests for secondary hirsutism depend on associated symptoms that suggest an underlying disorder. About 90% of women with hirsutism have an elevated free testosterone level.
Treatment
At the patient’s request, treatment for idiopathic hirsutism consists of eliminating excess hair by scissors, shaving, or depilatory creams, or removal of the entire hair shaft with tweezers or wax. However, removal with laser is the most effective method. Bleaching with hydrogen peroxide may also be satisfactory. Electrolysis can destroy hair bulbs permanently, but it works best when only a few hairs need to be removed. (A history of keloid formation contraindicates this procedure.) Hirsutism due to elevated androgen levels may require low-dose dexamethasone or prednisone, hormonal contraceptives, or androgen receptor–competitive inhibitors — such as spironolactone, cyproterone acetate, or cimetidine — however, these drugs vary in effectiveness.
Treatment for secondary hirsutism varies, depending on the nature of the underlying disorder.
Special considerations
Care for patients with idiopathic hirsutism focuses on emotional support and patient teaching; care for patients with secondary hirsutism depends on the treatment for the underlying disease.
❑ Provide emotional support by being sensitive to the patient’s feelings about her appearance.
❑ Watch for signs of contact dermatitis in patients being treated with depilatory creams, especially elderly people. Also, watch for infection of hair follicles after hair removal with tweezers or wax.
❑ Suggest consulting a cosmetologist about makeup or bleaching agents.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Hypertrichosis
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- "Professional Guide to Diseases (Eighth Edition)" (2005)
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- "Differential Diagnosis in Primary Care" (2007)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Hirsutism (Professional Guide to Signs & Symptoms (Fifth Edition))
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