Hirsutism

Question 1

What is the difference between hypertrichosis and hirsutism?

Answer 1

Hirsutism is androgen-dependent hair growth

Hypertrichosis is androgen-independent hair growth.

Question 2

What is the most common cause of hirsutism?

Answer 2

PCOS

Question 3

What are some other causes of hirsutism?

Answer 3

• Cushing’s syndrome
• Congenital adrenal hyperplasia
• Androgen therapy
• Obesity: due to peripheral conversion oestrogens to androgens
• Adrenal tumour
• Androgen secreting ovarian tumour
• Drugs: phenytoin

Question 4

What is the assessment system for hirsutism?

Answer 4

Ferriman-Gallwey scoring system

• 9 body areas are assigned a score of 0-4.
• >15 is considered to indicate moderate or severe hirsutism.

Question 5

What are some causes of hypertrichosis?

Answer 5

• Drugs: minoxidil, ciclosporin, diazoxide
• Congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
• Porphyria cutanea tarda (AD - porphyrins produce Heme - cannot produce heme)
• Anorexia nervosa

Question 6

How should you manage hirsutism?

Answer 6

1. Advise weight loss if overweight
2. Cosmetic techniques such as waxing/bleaching - not available on the NHS
3. 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
4. Facial hirsutism: topical eflornithine - contraindicated* in *pregnancy* and *breast-feeding