Hirsutism and hypertrichosis

hirsutism is often used to describe androgen-dependent hair growth in women (and children), with hypertrichosis being used for androgen-independent hair growth Polycystic ovarian syndrome is the most common causes of hirsutism. Other causes include:

1. Cushing's syndrome
2. congenital adrenal hyperplasia
3. androgen therapy
4. obesity: due to peripheral conversion oestrogens to androgens
5. adrenal tumour
6. androgen secreting ovarian tumour
7. drugs: phenytoin

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 - contraindicated in pregnancy and breast-feeding

Causes of hypertrichosis

• drugs: minoxidil, ciclosporin, diazoxide
• congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
• porphyria cutanea tarda