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HIRSUTISM

AT-A-GLANCE

  • Hirsutism is defined as terminal body hair growth in women in a male distribution.

  • Women with a Ferriman-Gallwey score of 8 or higher are considered hirsute.

  • Women with mild to moderate hirsutism and regular menstrual cycles are most likely diagnosed with idiopathic hirsutism; hormone testing is not necessary.

  • Hormone testing is necessary in women with moderate to severe hirsutism and all women with hirsutism and irregular menstrual cycles or signs of virilisation.

INTRODUCTION

Hirsutism is a condition in which excessive hair in women grows in a male pattern distribution. It has a significant psychosocial impact on the affected individual as well as a number of medical consequences for the skin. The main driving factors are the higher-than-normal androgen levels, either in circulation or locally, and an increased sensitivity of the hair follicle to androgens. This condition differs from hypertrichosis in which the excess hair has a more generalized distribution and independent of androgens. Hirsutism may result from various causes, with polycystic ovarian syndrome (PCOS), nonclassical congenital adrenal hyperplasia (CAH), and adrenal or ovarian tumors being among the major causes, or hirsutism may be idiopathic.

Hirsutism can cause the affected individual embarrassment, leading to social withdrawal and even depression.1,2 A recent study has identified that patients view their condition as more severe than do their clinicians, which is associated with a negative effect on their quality of life.3 The authors suggest that treatment be guided by the level of patient’s distress with the hair growth.

EPIDEMIOLOGY

The prevalence of hirsutism is unknown. Approximately 5% to 15% of the female population of reproductive age is thought to be affected by hirsutism, and it is one of the most common complaints of patients presenting to dermatology offices.4,5 The variability in concentration of hair follicles is influenced by ethnicity and strong family inheritance. Asians, with lower hair concentration, are much less likely to present with hirsutism resulting from an androgen excess state compared with their Mediterranean counterparts.6 As a result, the cut-off value for diagnosis of hirsutism varies among different ethnic populations. The prevalences of hirsutism were estimated to be 38% in Greece, 21.2% in Australia, 10.8% in Iran, 10.5% in India, 8.3% in Turkey, 7.1% in Spain, and 2% in Thailandand.7,8 A study of North American women with hirsutism identified that 25% to 33% of white women have terminal hairs on the upper lip and periareolar area, as well as the linear alba, with normal androgen levels. The degree of facial and body terminal hair was similar in black and white women in North America with a prevalence of 4.3% and 5.4%, ­respectively.9 Hirsutism may also be influenced by age. Most of the patients are women of reproductive age, and the growth pattern is heaviest at a younger age compared with older age.10

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