HIRSUTISM (UNWANTED AND EXCESSIVE HAIRINESS IN WOMEN): CAUSES; SIGNS AND SYMPTOMS; AND TREATMENT

OVERVIEW

Hirsutism is a condition in which unwanted and excessive hairs develop in women just the way it does in men. Women with this condition have coarse, pigmented hairs (i.e. hair with the same colour as scalp hair) in areas where they are supposed to grow fine hairs or no hair at all. These areas include the chin, above the lips, chest, back, abdomen, sideburn area, around the nipples and even on the buttocks. Causes of Hirsutism include: Polystic Ovary Syndrome (PCOS), Cushing's syndrome, Congenital Adrenal Hyperplasia, tumours in the ovaries or adrenal glands, certain medications and obesity. Treatment of Hirsutism include: using medications and hair removal procedures

Hirsutism: Unwanted hairs on the chin

Women with this condition are said to be Hirsute

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CAUSES

Hirsutism can be caused by either an increased level of the male sex hormones (androgens) or an oversensitivity of the hair follicles to them. Normally, when women reaches puberty, their ovaries (the pair of reproductive organs that produce eggs and sex hormones in females) begin to produce both the female sex hormones (oestrogen and progesterone) and androgens (testosterone, dihydrotestosterone). The male hormones stimulate hair growth (in areas such as the armpits and pubic region), increase in size and intensify the growth and pigmentation of hair. However, the level of androgens is lower compared to the female hormones. That is the balance!

But in hirsute women, the level of androgens become much higher.

Other significant courses of hirsutism are

1. Polycystic Ovary Syndrome (PCOS): This is a condition in which women have a number of small cysts (fluid-filled sacs) around the edge of their ovaries. It is a common cause of Hirsutism and results from imbalances in the sex hormones. In addition to hirsutism, women with PCOS often have acne, balding near the front of the head, menstrual irregularities, infertility, obesity, diabetes and high cholesterol levels
2. Cushing's syndrome: This occurs when the body is exposed to high levels of the hormone, Cortisol. This may be due to prolonged usage of medications such as prednisone. It can also develop when the adrenal glands make too much cortisol.
3. Congenital Adrenal Hyperplasia: This is an inherited disorder where people lack the enzyme, 21-alpha-hydroxylase, that the adrenal glands need to make their hormones (cortisol and aldosterone). While this is happening, the body produces more androgens, causing the male characteristics to appear early, inappropriately or abnormally.
4. Tumours in the ovaries or adrenal glands: In rare cases, an androgen-secreting tumour forms in the ovaries or adrenal glands. This can cause Hirsutism
5. Medications: Some medications can induce Hirsutism. A classic example is Danazol, a drug used to treat women with endometriosis. Others include: phenytoin, epanutin, cyclosporin and minoxdil
6. Insulin resistance
7. Obesity

In rare cases, a woman with hirsutism will have normal levels of androgens and the specific cause of the unwanted hair growth can not be identified. This is known as Idiopathic Hirsutism

Hirsutism: Unwanted and excess hairs on the chest and nipples of women

THE HAMSTER FACE DISEASE

SIGNS AND SYMPTOMS

Apart from hirsutism, this high level causes other signs and symptoms (medically known as Virilization*) such as the following to manifest

• Deepening of voice
• Balding
• Oily skin
• Acne
• Decrease in breast size
• Enlargement of the clitoris
• Increase in muscle mass

*Virilization: This is a term used in medicine and biology which refers to the biological development of differences in sex/gender, i.e. changes that make a male body different from a female body. Androgens are solely responsible for virilization*

TREATMENT

The treatment of hirsutism requires patience because hair follicles have a life cycle of 6months. So it may take several months before significant difference in hair growth can be seen.

1. Hair removal procedures
   
   
   • Electrolysis: This involves inserting a tiny needle into each hair follicle. A pulse of current is then emitted through the needle to destroy the follicles. Electrolysis is best suited for treatment of small areas, although larger areas may be treated with multiple sessions overtime. It is safe and effective, but can be painful and often expensive
   • Laser hair removal: This procedure involves using a concentrated beam of light (laser) to generate heat inside the hair follicles, destroying their ability to produce hairs. it is expensive, effective, faster and less painful than electrolysis. However, there may be some skin redness and swelling after the procedure. It also carries a risk of burns and skin discoloration.
     
2. Medication
   
   
   • Birth control pills/oral contraceptives: Birth control pills or other hormonal contraceptives which contain the hormones oestrogen and progestin treat hirsutism by lowering the levels of androgens. They are usually the first choice for the treatment of hitsutism and the improvement it presents is usually high in most women
   • Anti-androgens: These medications act by directly decreasing androgen production, reducing its effects on the hair follicles or blocking it from attaching to their receptors in the body. However, anti-androgens can cause birth defects, so an effective form of birth control should be strictly used by sexually active women who take them to prevent them from getting pregnant. Examples of anti-androgens are spironolactone, finasteride and cyproterone acetate
   • Topical creams: This involves the use of prescribed and nedicated creams specifically for excessive facial hairs in women. They are applied directly to the areas of excessive hair growth to slow their growth. However, they do not remove hairs permanently and once their usage is discontinued, the hairs return. Example of a topical cream that improves hirsutism is Eflornithine hydrochloride (Vaniqua)
   For women who are obese, losing weight may reduce androgen levels and improve Hirsutism
    

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