Hirsutism is excessive hairiness in the male type in women, manifested by the appearance of a mustache and beard, excessive growth of hair on the trunk and extremities, mainly associated with an increase in the concentration of androgens (male hormones) in the blood.
Hirsutism is often combined with a menstrual cycle and infertility. In the future, there may be an increase in muscle mass, an increase in the clitoris, alopecia at the temples, coarsening of the voice and increased sexual desire. In addition, there may be signs of defemination (for example, reducing the size of the mammary glands and stopping the formation of vaginal lubrication.
Causes of hirsutism.
Premature puberty, menopause.
Idiopathic hirsutism (idiopathic syndrome of androgen excess) is poorly understood, but often observed condition characterized by a slight hirsutism, acne and irregular menstruation without significant hormonal abnormalities.
Drug administration (phenytoin, hexachlorobenzene, glucocorticoids, progestins, anabolic drugs, androgens.
Disorders of adrenal origin (congenital or acquired hyperplasia of the adrenal cortex, adrenal gland tumors.
Disorders of ovarian origin (polycystic ovary, androblastoma, granulose-cellular tumor, pregnant lutea, hypertecosis, chronic anovulation, hypothalamic amenorrhea.
Disorders of pituitary origin (Syndrome Itenko Cushing, acromegaly.
Genetic and chromosomal abnormalities.
Diagnosis of hirsutism is carried out by an endocrinologist with the use of special research methods.
Testosterone serum. The content of total testosterone is less than 200 ng / ml (decreases when taking oral contraceptives or prednisolone) is usually due to polycystic ovary. The concentration of total testosterone more than 200 ng / ml suggests the presence of a tumor.
Dehydroepiandrosterone sulfate (DHEAS) serum is the index of the secretory activity of the adrenal glands. Concentration above 700 ng / ml, decreasing when taking dexamethasone, indicates hyperplasia of the adrenal cortex. The increased content of DHEAS, which does not decrease with the use of dexamethasone, allows us to presume a tumor of the adrenal glands.
Androstenedione serum: an increase in the content of androstenedione indicates a disease of the ovaries.
17-Hydroxyprogesterone serum increases when a variety of enzymes are deficient (for example, 21-hydroxylase, observed with congenital hyperplasia of the adrenal cortex.
Cortisol: an increase in the concentration of cortisol in the serum occurs with the syndrome of Itenko Kushing.
Gonadotropins: a relative increase in the ratio of luteinizing hormone (LH) / follicle-stimulating hormone (FSH) indicates polycystic ovary.
Photo: manifestations of hirsutism on the face.
Treatment of hirsutism.
Removal of tumors of the ovaries or adrenal glands.
Stop taking drugs that promote hair growth.
Suppression of androgen formation in the adrenal glands by prednisolone or dexamethasone.
Treatment of Isenko Cushing syndrome, hypothyroidism or acromegaly.
Drug therapy of hirsutism is carried out after exclusion of tumors secreting androgens.
Oral contraceptives with anti-androgenic properties (eg, diane-35, janin) are the drugs of choice for idiopathic or ovarian-associated hirsutism. The concentration of testosterone in the blood decreases for 1 3 months, which is accompanied by an improvement. If contraindications to oral contraceptives are prescribed medroxyprogesterone at a dose of 150 mg intramuscularly every 3 months. Contraindications for all drugs are pregnancy.
Antiandrogenic drugs (prescribed with ineffectiveness of oral contraceptives) are less effective and cause more side effects. Spironolactone (100 200 mg / day): the therapeutic effect develops slowly, side effects increase in the volume of urination, lowering of arterial pressure, uterine bleeding; contraindicated in pregnancy. Cyproterone (50 mg / day): usually the drug is taken with estrogen; in the treatment of bleeding breakthrough, a decrease in sexual desire and depression; contraindicated in pregnancy.
Ketoconazole in a dose of 400 mg / day; contraindicated in pregnancy.
To noticeably reduce excess hair growth, it may take 6 to 12 months of treatment. With long-term treatment of hirsutism, the prognosis for stopping the growth of new hair is good, and with regard to the elimination of existing hair, a doubtful one. The goal of treating hirsutism is to stop the process of growing new hair, rather than removing old ones. After the appearance of coarse dark hair, a decrease in the content of androgens will not affect the nature of the hair. Treatment of hirsutism does not completely rid of excessive hair growth, although it will slow down their growth rate.
Shaving of hair is undesirable, tk. this will lead to the need for daily shaving. Chemicals for epilation often cause skin irritation, in the future, their daily use may also be necessary. Epilation with wax provides a longer lasting effect compared to shaving and chemicals. With moderate hirsutism effectively discoloration of the hair. It is undesirable to pluck out long hair, as this often leads to the formation of scars.
Radical additional measure of electrolysis, causing the destruction of hair bulbs (shortcomings of high cost, soreness and a long procedure.
The best remote results are provided by the combination of hormonal and additional methods of treating hirsutism.