Hirsutism and hypertrichosis

Hirsutism is often used to describe androgen-dependent hair growth in women, with hypertrichosis being used for androgen-independent hair growth

Polycystic ovarian syndrome is the most common causes of hirsutism. Other causes include:

• Cushing's syndrome
• congenital adrenal hyperplasia
• androgen therapy
• obesity: thought to be due to insulin resistance
• adrenal tumour
• androgen secreting ovarian tumour
• drugs: phenytoin, corticosteroids

Assessment of hirsutism

• Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

Management of hirsutism

• advise weight loss if overweight
• cosmetic techniques such as waxing/bleaching - not available on the NHS
• consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism
• facial hirsutism: topical eflornithine
  • (Vaniqa® 11.5% cream) to apply thin layer BD
  • a potent and irreversible inhibitor of ornithine decarboxylase (ODC), an enzyme crucial in the biosynthesis of polyamines (putrescine, spermidine, spermine) which are essential for DNA stabilization, RNA transcription, Cell division, and Parasite replication.
  • Use: African sleeping sickness and excessive hair growth.
  • Contraindicated in pregnancy and breast-feeding and <19y

Causes of hypertrichosis

• drugs: minoxidil, ciclosporin, diazoxide