Hirsutism medical therapy: Difference between revisions

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__NOTOC__
__NOTOC__
{{Hirsutism}}
{{Hirsutism}}
{{CMG}}; {{AE}}{{Ochuko}},{{RHN}}
{{CMG}}; {{AE}}{{EG}}


==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]].
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==
*Pharmacologic medical therapies for hirsituism include:<ref name="pmid20418968">{{cite journal| author=Sachdeva S| title=Hirsutism: evaluation and treatment. | journal=Indian J Dermatol | year= 2010 | volume= 55 | issue= 1 | pages= 3-7 | pmid=20418968 | doi=10.4103/0019-5154.60342 | pmc=2856356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20418968  }} </ref>  
*Pharmacologic medical therapies for hirsituism include:<ref name="pmid20418968">{{cite journal| author=Sachdeva S| title=Hirsutism: evaluation and treatment. | journal=Indian J Dermatol | year= 2010 | volume= 55 | issue= 1 | pages= 3-7 | pmid=20418968 | doi=10.4103/0019-5154.60342 | pmc=2856356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20418968  }} </ref>  
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*** Preferred regimen (1): [[Eflornithine|Eflornithine hydrochloride]] 13.9% cream topical q12h<ref name="pmid18252793">{{cite journal |vauthors=Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA |title=Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline |journal=J. Clin. Endocrinol. Metab. |volume=93 |issue=4 |pages=1105–20 |year=2008 |pmid=18252793 |doi=10.1210/jc.2007-2437 |url=}}</ref>  
*** Preferred regimen (1): [[Eflornithine|Eflornithine hydrochloride]] 13.9% cream topical q12h<ref name="pmid18252793">{{cite journal |vauthors=Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA |title=Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline |journal=J. Clin. Endocrinol. Metab. |volume=93 |issue=4 |pages=1105–20 |year=2008 |pmid=18252793 |doi=10.1210/jc.2007-2437 |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>
*** 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>


{| class="wikitable"
{| class="wikitable"
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|25 mg
|25 mg
|-
|-
|rowspan="2" |[[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]]
| rowspan="2" |[[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]]
|[[Finasteride]]  
|[[Finasteride]]  
|1-5 mg
|1-5 mg
|rowspan="2" |
| rowspan="2" |
*Type II inhibitor of the [[5-alpha-reductase|5α-reductase enzyme]]
*Type II inhibitor of the [[5-alpha-reductase|5α-reductase enzyme]]
*Reduces the conversion of [[testosterone]] into [[dihydrotestosterone]]
*Reduces the conversion of [[testosterone]] into [[dihydrotestosterone]]
|rowspan="2" |
| rowspan="2" |
*[[Feminisation]] of the male fetus
*[[Feminisation]] of the male fetus
*[[Liver dysfunction]]
*[[Liver dysfunction]]
|rowspan="2" |
| rowspan="2" |
-
-
|-
|-
Line 197: Line 194:
|10-30 mg
|10-30 mg
|}
|}
==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 agonist]]<nowiki/>s :An  alternative to [[oral contraceptives]]<ref name="Rosenfield2005">{{cite journal|last1=Rosenfield|first1=Robert L.|title=Hirsutism|journal=New England Journal of Medicine|volume=353|issue=24|year=2005|pages=2578–2588|issn=0028-4793|doi=10.1056/NEJMcp033496}}</ref>
If a [[tumor]] of [[ovaries]] or [[adrenal gland]]<nowiki/>s is the underlying cause of hirsutism, surgery may be the treatment option.
* Parenteral long acting gonadotropin-releasing hormone analogues <ref name="pmid20198556">{{cite journal| author=Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B et al.| title=Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature. | journal=Exp Clin Endocrinol Diabetes | year= 2010 | volume= 118 | issue= 5 | pages= 291-7 | pmid=20198556 | doi=10.1055/s-0029-1225351 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20198556  }} </ref> 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.<ref name="Franks2012">{{cite journal|last1=Franks|first1=Stephen|title=The investigation and management of hirsutism|journal=Journal of Family Planning and Reproductive Health Care|volume=38|issue=3|year=2012|pages=182–186|issn=1471-1893|doi=10.1136/jfprhc-2011-100175}}</ref>
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.<ref name="pmid9681347">{{cite journal |vauthors=Dierickx CC, Grossman MC, Farinelli WA, Anderson RR |title=Permanent hair removal by normal-mode ruby laser |journal=Arch Dermatol |volume=134 |issue=7 |pages=837–42 |year=1998 |pmid=9681347 |doi= |url=}}</ref>
{| class="wikitable"
!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]]
|}<ref name="pmid14660273">{{cite journal |vauthors=Goh CL |title=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 |journal=J Dermatolog Treat |volume=14 |issue=4 |pages=243–7 |year=2003 |pmid=14660273 |doi=10.1080/09546630310004171 |url=}}</ref>


==References==
==References==

Latest revision as of 22:59, 7 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

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

Hirsutism

Group Medicine Dosage Mechanism of action Side effect Notes
Oral Contraceptive Pills (OCPs) Ethinyl estradiol/
Norethindrone
30 μg /
1.0 mg
Mestranol/norethindrone 100 μg / 2mg
Ethinyl estradiol/
desogestrel
30 μg /
150 mcg
Antiandrogens Spironolactone 100-200 mg
Cyproterone Acetate 50-100 mg

-

Cyproterone Acetate/
ethinyl estradiol
2 mg /
35 μg
Flutamide 125-250 mg
Bicalutamide 25 mg
5-alpha reductase inhibitors Finasteride 1-5 mg

-

Dutasteride 0.5 mg
Gonadotrophin-releasing hormone (GnRH agonist) Leuprolide 7.5 mg
Adrenal suppressive glucocorticoids Prednisone 5-10 mg

-

Insulin-sensitising agents Metformin 500-1000 mg
  • These are best choices for hirsutism along with insulin resistance
  • It is not suggested to prescribe these drugs just for hirsutism
Rosiglitazone 4-8 mg
Pioglitazone 10-30 mg

References

  1. Sachdeva S (2010). "Hirsutism: evaluation and treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.
  2. 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.
  3. 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.
  4. 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.
  5. Shaw JC (1991). "Spironolactone in dermatologic therapy". J. Am. Acad. Dermatol. 24 (2 Pt 1): 236–43. PMID 1826112.
  6. Lumachi F, Rondinone R (2003). "Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism". Fertil. Steril. 79 (4): 942–6. PMID 12749435.
  7. 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.
  8. 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.
  9. Castelo-Branco C, Cancelo MJ (2010). "Comprehensive clinical management of hirsutism". Gynecol. Endocrinol. 26 (7): 484–93. doi:10.3109/09513591003686353. PMID 20218823.
  10. 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.
  11. 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.
  12. Bode D, Seehusen DA, Baird D (2012). "Hirsutism in women". Am Fam Physician. 85 (4): 373–80. PMID 22335316.
  13. 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.
  14. 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.
  15. 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.

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