dermatologic disorders
Hirsutism and Hypertrichosis
Treatment of Hirsutism and Hypertrichosis
Treatment of underlying disorder Topical treatments Hormonal treatment The underlying disorder should be treated, including stopping or changing causative drugs. Treatment for hirsutism itself is necessary only if the patient finds the excess hair cosmetically objectionable. Patients with androgen-dependent hirsutism require a combination of hair removal and antiandrogen therapy. Nonandrogen–dependent excess hair growth, such as hypertrichosis, is treated primarily with physical hair removal methods. There are several techniques. Depilatory techniques remove hair from the surface of the skin and include shaving and over-the-counter depilatory creams, such as those containingbarium sulfateand calcium thioglycolate. Epilation involves removing intact hairs with their roots and can be achieved via mechanical means (eg, tweezing, plucking, waxing) or home epilating devices. Permanent epilation techniques, including electrolysis, thermolysis, and laser epilation, can result in more long-term hair removal but often require multiple treatments. As an alternative to hair removal, hair bleaching is inexpensive and works well when hirsutism is not excessive. Bleaches lighten the color of the hair, rendering it less noticeable. There are several types of commercial hair-bleaching products, most of which usehydrogen peroxideas the active ingredient. Topicaleflornithine, applied twice daily, slows the rate of hair growth and, with long-term use, may increase the amount of time between hair removal treatments. Hirsutism resulting from androgen excess usually requires long-term therapy because the source of excess androgen rarely can be eliminated permanently. Hormonal treatments include Oral contraceptives Antiandrogenic drugs Sometimes other drugs Oral contraceptives in standard doses often are the initial treatment for hirsutism caused by ovarian hyperandrogenism. Oral contraceptives reduce ovarian androgen secretion and increase sex hormone–binding globulin, thereby decreasing freetestosteronelevels. Antiandrogenic therapy is also used and can includefinasteride(1 to 5 mg orally once/day) orspironolactone(25 to 100 mg orally 2 times a day). These drugs are contraindicated in women of childbearing age unless contraception is used because they may feminize a male fetus. Corticosteroids are used when necessary to suppress adrenal androgen production. Gonadotropin-releasing hormone agonists (eg,leuprolideacetate,nafarelin,triptorelin) can be used for severe forms of ovarian hyperandrogenism under the direction of a gynecologist or endocrinologist. 