dermatologic disorders
Hirsutism and Hypertrichosis
Evaluation of Hirsutism and Hypertrichosis
History of present illnessshould cover the extent, location, and acuity of hair growth as well as the age of onset. Review of systemsshould seek symptoms of virilization and review menstrual and fertility history. Symptoms of causative disorders should be sought, including polyuria (diabetes), bingeing and purging (eating disorders), and weight loss and fevers (cancer). Past medical historyshould specifically seek known causative disorders such as endocrine disorders, adrenal or ovarian pathology, and cancer. Family historyshould inquire about excess hair growth in family members. should review all prescribed drugs and specifically query for the surreptitious use of Anabolic Steroids . The presence of excess coarse and dark hair growth should be assessed at multiple sites, including the face, chest, lower abdomen, back, buttocks, and inner thigh. Signs of virilization should be sought, including Female-pattern baldness (ie, Androgenetic alopecia in women) Acne Increased muscle mass Breast atrophy Clitoromegaly General physical examination should note signs of potentially causative disorders: The general habitus should be examined for fat distribution (particularly a round face and accumulation of fat at the base of the neck posteriorly). The skin should be examined for velvety, black pigmentation on the axillae and neck and under the breasts (acanthosis nigricans), and striae. The eyes should be examined for extraocular movements and the visual fields should be assessed. The breasts should be examined for galactorrhea. The abdomen (including pelvic examination) should be examined for masses. The following findings are of particular concern: Virilization Abrupt appearance and rapid growth of excess hair Pelvic or abdominal mass Excess hair growth beginning after use of an anabolic steroid or other causative drug (see table Causes of Hypertrichosis ) in an otherwise healthy female is likely due to that drug. Symptoms and signs sometimes point to other underlying diagnoses (see table Interpreting Findings in Hirsutism ). Abrupt onset of hirsutism or hypertrichosis may portend cancer. The abrupt onset of hirsutism may be due to adrenal, ovarian, or pituitary tumors or from ectopic hormone production from other types of tumors. Hypertrichosis lanuginosa (malignant down) is fine hair growth that appears over the entire body over a short period of time, although it can be localized to the face. It can be present in patients with several types of cancers including lymphoma and lung, breast, uterine, colorectal, and bladder cancer. Less commonly, it can be present in those with systemic diseases such as hyperthyroidism, AIDS, or undernutrition or with certain drugs. 