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HIRSUTISM

This is a term to indicate hairs over the cheeks, chin, beard area, moustache area, abdomen, breasts and back.  It is divided into 2 groups one where there is an underlying problem with endocrine organs resulting in increased hormonal synthesis and the other where there is no underlying problem.

 Some patients have acne, and menstrual irregularities .  Menstrual irregularities may be loss of menstruation or irregular menstruation.  Sometimes there could be masculine features like temporal balding, deepening of voice, clitoral hypertrophy , amenorrhea.  Certain drugs like phenothiazines, androgen, minoxidil, diazoxide, steroids and  phenytoin can cause hirsutism.

The hormones that cause hirsutism can be produced either from the adrenals or ovaries or from the pituitary gland.  In most cases the problem is functional and there is no underlying defect.  Some times the ovaries can be enlarged with cysts in the ovaries.

Investigations

1. Serum testosterone
2. Serum andrestenedione
3. DHEA
4. DHEA sulphate
5. S. prolactin
6. FSH
7. LH

Abdominal  ultrasound scan

Your doctor may decide to do some, few or all or none of these tests depending on his clinical judge ment.

Treatment

 In all forms of hirsutism cosmetic physical measures of hair removal must be done as an initial step before medical treatment.  This improves the self esteem of patients and helps treatment.

1. Physical methods

Shaving – even though this is effective it will be resisted as a treatment due to “taboo” reasons and the 5o’clock shadow formation.  Shaving does not affect hair growth nor does it result in thicker hair.

2. Waxing – this is an effective treatment
3. Depilatories – barium sulphide is used as a cream to dissolve surface hair.
4. bleaching with hydrogen peroxide helps to make hair less noticeable.

    5. Electrolysis by cautery machine is an effective permanent treatment but may be costly.

     6.laser removal is very effective but can be very expensive.

 Medical treatment

1. Oral contraceptive with antiandrogens may be used.
2. Cimetidine
3. Cyproterone acetate
4. Spironolactone
5. Ketoconazole