Hirsutism medical therapy
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Hirsutism Microchapters |
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Diagnosis |
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Treatment |
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Medical Therapy |
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Case Studies |
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Hirsutism medical therapy On the Web |
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Risk calculators and risk factors for Hirsutism medical therapy |
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
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
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
Overview
Many women with unwanted hair seek methods of hair removal to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.
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.