Hirsutism medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hirsutism}} | {{Hirsutism}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{Ochuko}},{{RHN}} | ||
==Overview== | ==Overview== | ||
Pharmacologic medical therapies for hirsituism include [[oral contraceptives]], [[antiandrogen therapy|androgen receptor blockers]], [[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]], [[GnRH|gonadotrophin-releasing hormone]] ([[GnRH agonist]]), [[adrenal]] suppressive [[glucocorticoids]], [[insulin]]-sensitising agents, and biological modifiers of hair follicular growth. Treatment options are [[systemic therapy]] and [[topical|topical therapy]]. | |||
==Medical Therapy== | ==Medical Therapy== | ||
| Line 36: | Line 13: | ||
**[[Antiandrogen therapy|Androgen receptor blockers]] | **[[Antiandrogen therapy|Androgen receptor blockers]] | ||
**[[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]] | **[[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]] | ||
**[[GnRH| | **[[GnRH|Gonadotrophin-releasing hormone]] ([[GnRH agonist]]) | ||
**[[Adrenal]] suppressive [[glucocorticoids]] | **[[Adrenal]] suppressive [[glucocorticoids]] | ||
**[[Insulin]]-sensitising agents | **[[Insulin]]-sensitising agents | ||
| Line 45: | Line 22: | ||
*1. '''Adult''' | *1. '''Adult''' | ||
**1.1 '''Systemic therapy''' | **1.1 '''Systemic therapy''' | ||
*** Preferred regimen (1): [[Ethinyl estradiol]] 30 μg '''''PLUS''''' [[ | *** Preferred regimen (1): [[Ethinyl estradiol]] 30 μg '''''PLUS''''' [[norethindrone]] l mg PO daily over a 9-month period<ref name="pmid2136834">{{cite journal |vauthors=Murphy A, Cropp CS, Smith BS, Burkman RT, Zacur HA |title=Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women |journal=Fertil. Steril. |volume=53 |issue=1 |pages=35–9 |year=1990 |pmid=2136834 |doi= |url=}}</ref> | ||
*** Preferred regimen (2): [[Mestranol]] 100 μg '''''PLUS''''' [[ | *** Preferred regimen (2): [[Mestranol]] 100 μg '''''PLUS''''' [[norethindrone]] 2 mg PO daily for about 2 weeks<ref name="GivensAndersen1974">{{cite journal|last1=Givens|first1=James R.|last2=Andersen|first2=Richard N.|last3=Wiser|first3=Winfred L.|last4=Fish|first4=Stewart A.|title=Dynamics of Suppression and Recovery of Plasma FSH, LH, Androstenedione and Testosterone in Polycystic Ovarian Disease Using an Oral Contraceptive|journal=The Journal of Clinical Endocrinology & Metabolism|volume=38|issue=5|year=1974|pages=727–735|issn=0021-972X|doi=10.1210/jcem-38-5-727}}</ref> | ||
*** Preferred regimen (3): [[Ethinyl estradiol]] 30 μg '''''PLUS''''' [[ | *** Preferred regimen (3): [[Ethinyl estradiol]] 30 μg '''''PLUS''''' [[desogesterol]] 150 mcg PO daily for 4-7 months<ref name="pmid3156694">{{cite journal |vauthors=Dewis P, Petsos P, Newman M, Anderson DC |title=The treatment of hirsutism with a combination of desogestrel and ethinyl oestradiol |journal=Clin. Endocrinol. (Oxf) |volume=22 |issue=1 |pages=29–36 |year=1985 |pmid=3156694 |doi= |url=}}</ref> | ||
*** Preferred regimen (4): [[Spironolactone]] starting dose of 50 mg PO q12h; may be increased to 200 mg PO daily.<ref name="pmid1826112">{{cite journal |vauthors=Shaw JC |title=Spironolactone in dermatologic therapy |journal=J. Am. Acad. Dermatol. |volume=24 |issue=2 Pt 1 |pages=236–43 |year=1991 |pmid=1826112 |doi= |url=}}</ref> | *** Preferred regimen (4): [[Spironolactone]] starting dose of 50 mg PO q12h; may be increased to 200 mg PO daily.<ref name="pmid1826112">{{cite journal |vauthors=Shaw JC |title=Spironolactone in dermatologic therapy |journal=J. Am. Acad. Dermatol. |volume=24 |issue=2 Pt 1 |pages=236–43 |year=1991 |pmid=1826112 |doi= |url=}}</ref> | ||
*** Alternative regimen (1): [[Cyproterone|Cyproterone Acetate]] 50-100 mg PO daily<ref name="pmid12749435">{{cite journal |vauthors=Lumachi F, Rondinone R |title=Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism |journal=Fertil. Steril. |volume=79 |issue=4 |pages=942–6 |year=2003 |pmid=12749435 |doi= |url=}}</ref> | *** Alternative regimen (1): [[Cyproterone|Cyproterone Acetate]] 50-100 mg PO daily<ref name="pmid12749435">{{cite journal |vauthors=Lumachi F, Rondinone R |title=Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism |journal=Fertil. Steril. |volume=79 |issue=4 |pages=942–6 |year=2003 |pmid=12749435 |doi= |url=}}</ref> | ||
*** Alternative regimen (2): [[Cyproterone|Cyproterone Acetate]] 2 mg '''''PLUS''''' [[ | *** Alternative regimen (2): [[Cyproterone|Cyproterone Acetate]] 2 mg '''''PLUS''''' [[ethinyl estradiol]] 35 μg PO daily<ref name="pmid14583927">{{cite journal |vauthors=Van der Spuy ZM, le Roux PA |title=Cyproterone acetate for hirsutism |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD001125 |year=2003 |pmid=14583927 |doi=10.1002/14651858.CD001125 |url=}}</ref> | ||
*** Alternative regimen (3): [[Finasteride]] 1-5 mg PO daily<ref name="pmid9854686">{{cite journal |vauthors=Faloia E, Filipponi S, Mancini V, Di Marco S, Mantero F |title=Effect of finasteride in idiopathic hirsutism |journal=J. Endocrinol. Invest. |volume=21 |issue=10 |pages=694–8 |year=1998 |pmid=9854686 |doi=10.1007/BF03350800 |url=}}</ref> | *** Alternative regimen (3): [[Finasteride]] 1-5 mg PO daily<ref name="pmid9854686">{{cite journal |vauthors=Faloia E, Filipponi S, Mancini V, Di Marco S, Mantero F |title=Effect of finasteride in idiopathic hirsutism |journal=J. Endocrinol. Invest. |volume=21 |issue=10 |pages=694–8 |year=1998 |pmid=9854686 |doi=10.1007/BF03350800 |url=}}</ref> | ||
*** Alternative regimen (4): [[Flutamide]] 125-250 mg PO q12h | *** Alternative regimen (4): [[Flutamide]] 125-250 mg PO q12h | ||
| Line 57: | Line 34: | ||
*** Alternative regimen (7): [[Rosiglitazone]] 4-8 mg PO daily | *** Alternative regimen (7): [[Rosiglitazone]] 4-8 mg PO daily | ||
*** Alternative regimen (8): [[Pioglitazone]] 10-30 mg PO daily<ref name="pmid23159176">{{cite journal |vauthors=Blume-Peytavi U |title=How to diagnose and treat medically women with excessive hair |journal=Dermatol Clin |volume=31 |issue=1 |pages=57–65 |year=2013 |pmid=23159176 |doi=10.1016/j.det.2012.08.009 |url=}}</ref> | *** Alternative regimen (8): [[Pioglitazone]] 10-30 mg PO daily<ref name="pmid23159176">{{cite journal |vauthors=Blume-Peytavi U |title=How to diagnose and treat medically women with excessive hair |journal=Dermatol Clin |volume=31 |issue=1 |pages=57–65 |year=2013 |pmid=23159176 |doi=10.1016/j.det.2012.08.009 |url=}}</ref> | ||
*** Alternative regimen (9): [[Leuprolide]] 7.5 mg IM '''''PLUS''''' [[ | *** Alternative regimen (9): [[Leuprolide]] 7.5 mg IM '''''PLUS''''' [[estradiol]] 25-50 µg [[transdermal]] monthly<ref name="pmid22335316">{{cite journal |vauthors=Bode D, Seehusen DA, Baird D |title=Hirsutism in women |journal=Am Fam Physician |volume=85 |issue=4 |pages=373–80 |year=2012 |pmid=22335316 |doi= |url=}}</ref> | ||
*** Alternative regimen (10): [[Prednisone]] 5-10 mg PO daily<ref name="pmid22064667">{{cite journal |vauthors=Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, Pugeat M, Qiao J, Wijeyaratne CN, Witchel SF, Norman RJ |title=Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society |journal=Hum. Reprod. Update |volume=18 |issue=2 |pages=146–70 |year=2012 |pmid=22064667 |doi=10.1093/humupd/dmr042 |url=}}</ref> | *** Alternative regimen (10): [[Prednisone]] 5-10 mg PO daily<ref name="pmid22064667">{{cite journal |vauthors=Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, Pugeat M, Qiao J, Wijeyaratne CN, Witchel SF, Norman RJ |title=Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society |journal=Hum. Reprod. Update |volume=18 |issue=2 |pages=146–70 |year=2012 |pmid=22064667 |doi=10.1093/humupd/dmr042 |url=}}</ref> | ||
**1.2 '''Topical Therapy''' | **1.2 '''Topical Therapy''' | ||
| Line 63: | Line 40: | ||
*** Preferred regimen (2): [[Finasteride]] 0.25% or 0.5% cream topical daily<ref name="pmid22658123">{{cite journal |vauthors=Farshi S, Mansouri P, Rafie F |title=A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism |journal=J Cosmet Laser Ther |volume=14 |issue=4 |pages=193–9 |year=2012 |pmid=22658123 |doi=10.3109/14764172.2012.699680 |url=}}</ref> | *** Preferred regimen (2): [[Finasteride]] 0.25% or 0.5% cream topical daily<ref name="pmid22658123">{{cite journal |vauthors=Farshi S, Mansouri P, Rafie F |title=A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism |journal=J Cosmet Laser Ther |volume=14 |issue=4 |pages=193–9 |year=2012 |pmid=22658123 |doi=10.3109/14764172.2012.699680 |url=}}</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
Revision as of 19:30, 9 October 2017
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Hirsutism Microchapters |
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Medical Therapy |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2],Rasam Hajiannasab M.D.[3]
Overview
Pharmacologic medical therapies for hirsituism include oral contraceptives, androgen receptor blockers, 5-alpha reductase inhibitors, gonadotrophin-releasing hormone (GnRH agonist), adrenal suppressive glucocorticoids, insulin-sensitising agents, and biological modifiers of hair follicular growth. Treatment options are systemic therapy and topical therapy.
Medical Therapy
- Pharmacologic medical therapies for hirsituism include:[1]
- Oral contraceptives
- Androgen receptor blockers
- 5-alpha reductase inhibitors
- Gonadotrophin-releasing hormone (GnRH agonist)
- Adrenal suppressive glucocorticoids
- Insulin-sensitising agents
- Biological modifiers of hair follicular growth
Hirsutism
- 1. Adult
- 1.1 Systemic therapy
- Preferred regimen (1): Ethinyl estradiol 30 μg PLUS norethindrone l mg PO daily over a 9-month period[2]
- Preferred regimen (2): Mestranol 100 μg PLUS norethindrone 2 mg PO daily for about 2 weeks[3]
- Preferred regimen (3): Ethinyl estradiol 30 μg PLUS desogesterol 150 mcg PO daily for 4-7 months[4]
- Preferred regimen (4): Spironolactone starting dose of 50 mg PO q12h; may be increased to 200 mg PO daily.[5]
- Alternative regimen (1): Cyproterone Acetate 50-100 mg PO daily[6]
- Alternative regimen (2): Cyproterone Acetate 2 mg PLUS ethinyl estradiol 35 μg PO daily[7]
- Alternative regimen (3): Finasteride 1-5 mg PO daily[8]
- Alternative regimen (4): Flutamide 125-250 mg PO q12h
- Alternative regimen (5): Bicalutamide 25 mg PO daily[9]
- Alternative regimen (6): Metformin 500-1000 mg PO q12h[10]
- Alternative regimen (7): Rosiglitazone 4-8 mg PO daily
- Alternative regimen (8): Pioglitazone 10-30 mg PO daily[11]
- Alternative regimen (9): Leuprolide 7.5 mg IM PLUS estradiol 25-50 µg transdermal monthly[12]
- Alternative regimen (10): Prednisone 5-10 mg PO daily[13]
- 1.2 Topical Therapy
- Preferred regimen (1): Eflornithine hydrochloride 13.9% cream topical q12h[14]
- Preferred regimen (2): Finasteride 0.25% or 0.5% cream topical daily[15]
- 1.1 Systemic therapy
Medical Therapy
Pharmacologic Treatment
Hormonal Therapy
- Oral contraceptives : Suppresses free testosterone level eg Yasmin which contains 30 microgram of estradiol and 3mg of drospirenone or Yaz (20microgram of estradiol and 3mg of drospirenone).
- Gonadotropin-releasing hormone agonists :An alternative to oral contraceptives[16]
If a tumor of ovaries or adrenal glands is the underlying cause of hirsutism, surgery may be the treatment option.
- Parenteral long acting gonadotropin-releasing hormone analogues [17] combined with OCPs containing estrogen and progestin for severe hirsutism not respinding to OCPs and antiandrogen e.g Leuprolide.
Adrenal Suppression
- Oral glucocorticoids : In patients with CAH eg Prednisone or Dexamethasone.
- Metformin for infertile women with PCOS.
Antiandrogens
- Finasteride: A 5α-reductase inhibitor, 2.5mg daily. (this is rarely used because it causes fatal hepatitis with a high risk of being teratogenic.
- Eflornithine hydrochloride cream (Vaniqa): Applied twice daily to the face.
Non-Pharmacologic Treatment
- Cosmetic therapy : Bleaching, shaving, depilating agents, plucking, waxing treatments.
- Electrosurgical methods include electrosurgical epilation and Laser therapy which can remove unwanted hair for some women specially for women with dark hair and light skin.[18]
Light-source-assisted hair reduction (photoepilation) is a common method in the treatment of unwanted hair and is more effective than shaving, waxing and electrolysis.[19]
| Skin/hair color | Choice of photoepilation device |
|---|---|
| Light skin/dark hair | Relatively short wavelength |
| Dark skin/dark hair | Relatively long wavelength or IPL(intense pulsed light) |
| Light/white hair | IPL + radiofrequency |
References
- ↑ Sachdeva S (2010). "Hirsutism: evaluation and treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.
- ↑ Murphy A, Cropp CS, Smith BS, Burkman RT, Zacur HA (1990). "Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women". Fertil. Steril. 53 (1): 35–9. PMID 2136834.
- ↑ Givens, James R.; Andersen, Richard N.; Wiser, Winfred L.; Fish, Stewart A. (1974). "Dynamics of Suppression and Recovery of Plasma FSH, LH, Androstenedione and Testosterone in Polycystic Ovarian Disease Using an Oral Contraceptive". The Journal of Clinical Endocrinology & Metabolism. 38 (5): 727–735. doi:10.1210/jcem-38-5-727. ISSN 0021-972X.
- ↑ Dewis P, Petsos P, Newman M, Anderson DC (1985). "The treatment of hirsutism with a combination of desogestrel and ethinyl oestradiol". Clin. Endocrinol. (Oxf). 22 (1): 29–36. PMID 3156694.
- ↑ Shaw JC (1991). "Spironolactone in dermatologic therapy". J. Am. Acad. Dermatol. 24 (2 Pt 1): 236–43. PMID 1826112.
- ↑ Lumachi F, Rondinone R (2003). "Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism". Fertil. Steril. 79 (4): 942–6. PMID 12749435.
- ↑ Van der Spuy ZM, le Roux PA (2003). "Cyproterone acetate for hirsutism". Cochrane Database Syst Rev (4): CD001125. doi:10.1002/14651858.CD001125. PMID 14583927.
- ↑ Faloia E, Filipponi S, Mancini V, Di Marco S, Mantero F (1998). "Effect of finasteride in idiopathic hirsutism". J. Endocrinol. Invest. 21 (10): 694–8. doi:10.1007/BF03350800. PMID 9854686.
- ↑ Castelo-Branco C, Cancelo MJ (2010). "Comprehensive clinical management of hirsutism". Gynecol. Endocrinol. 26 (7): 484–93. doi:10.3109/09513591003686353. PMID 20218823.
- ↑ Paparodis R, Dunaif A (2011). "The Hirsute woman: challenges in evaluation and management". Endocr Pract. 17 (5): 807–18. doi:10.4158/EP11117.RA. PMID 21856600.
- ↑ Blume-Peytavi U (2013). "How to diagnose and treat medically women with excessive hair". Dermatol Clin. 31 (1): 57–65. doi:10.1016/j.det.2012.08.009. PMID 23159176.
- ↑ Bode D, Seehusen DA, Baird D (2012). "Hirsutism in women". Am Fam Physician. 85 (4): 373–80. PMID 22335316.
- ↑ Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, Pugeat M, Qiao J, Wijeyaratne CN, Witchel SF, Norman RJ (2012). "Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society". Hum. Reprod. Update. 18 (2): 146–70. doi:10.1093/humupd/dmr042. PMID 22064667.
- ↑ Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA (2008). "Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline". J. Clin. Endocrinol. Metab. 93 (4): 1105–20. doi:10.1210/jc.2007-2437. PMID 18252793.
- ↑ Farshi S, Mansouri P, Rafie F (2012). "A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism". J Cosmet Laser Ther. 14 (4): 193–9. doi:10.3109/14764172.2012.699680. PMID 22658123.
- ↑ Rosenfield, Robert L. (2005). "Hirsutism". New England Journal of Medicine. 353 (24): 2578–2588. doi:10.1056/NEJMcp033496. ISSN 0028-4793.
- ↑ Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B; et al. (2010). "Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature". Exp Clin Endocrinol Diabetes. 118 (5): 291–7. doi:10.1055/s-0029-1225351. PMID 20198556.
- ↑ Franks, Stephen (2012). "The investigation and management of hirsutism". Journal of Family Planning and Reproductive Health Care. 38 (3): 182–186. doi:10.1136/jfprhc-2011-100175. ISSN 1471-1893.
- ↑ Dierickx CC, Grossman MC, Farinelli WA, Anderson RR (1998). "Permanent hair removal by normal-mode ruby laser". Arch Dermatol. 134 (7): 837–42. PMID 9681347.
- ↑ Goh CL (2003). "Comparative study on a single treatment response to long pulse Nd:YAG lasers and intense pulse light therapy for hair removal on skin type IV to VI--is longer wavelengths lasers preferred over shorter wavelengths lights for assisted hair removal". J Dermatolog Treat. 14 (4): 243–7. doi:10.1080/09546630310004171. PMID 14660273.