Hirsutism: Maleness in Ladies!

 DR.  K S Prasanna, Dermatologist, Institute of Applied Dermatology, Kasaragod, Kerala

Snigdha is a 16-year-old beautiful fair girl admired by all because of her beautiful facial skin texture. But slowly she started growing moustache, like teenage boys, and also dark hairs on the chin, and hands. Everyone started asking her why is she developing hairs on her face? Boys in her class started making fun of her. She also wondered about this. Being a bold girl, she asked her parents to take her to a doctor. But parents said, "let us wait for some more time. Your grandmother also had it. But she was obese and she had menstrual problems. After this corona pandemic is over, we will consult a dermatologist". In the meantime, she googled and found out that it is Hirsutism and Laser treatment gives a permanent cure for this. She asked for teleconsultation with us. I asked her history in detail, like when she noticed hair growth? is it growing slow or rapid? and associated symptoms or signs (menstrual irregularities, acne, hair loss, weight gain, blackening of the neck, family history of similar complaints and infertility, etc). After taking a detailed history, I advised her to get abdominal scanning and blood hormonal, sugar and cholesterol tests done. So, she was satisfied and she was ready to wait for the consultation.

What is Hirsutism

Hirsutism is the growth of excessive male pattern hair in women after puberty. It affects facial and body hair depending on hormonal abnormality, namely moustache, beard, chest, abdomen, back, thigh, and pubic hair. It affects nearly 10% of ladies. There are multiple causes for it. But irrespective of the cause, hirsutism can cause significant emotional stress and mental anguish. The key is to find out the cause for it and address the cosmetic issue behind it.

There are four main sex hormone-producing glands in ladies. They are ovaries, adrenals, pituitary, and hypothalamus. Excessive hormone production by any of these glands for any reason causes excessive hair growth. It is most often Idiopathic (where the cause is not known) or could be due to excessive hormones associated with polycystic ovarian disease (PCOS), certain drugs, adrenal gland hyperplasia, or rarely due to ovarian or adrenal tumours. Idiopathic hirsutism and PCOS usually begin at puberty and hairs grow very slow. Hirsutism that occurs in middle-aged or older women, where a history of sudden, severe hirsutism with deepening of the voice, breast atrophy, increased muscle bulk, should suggest an adrenal or ovarian tumour.

Hirsutism Diagnosis and Treatment

It is important to examine a patient with hirsutism before making a clinical diagnosis. Measuring the height and weight and then calculating the body mass index (BMI) is very essential. A BMI of >25kg/m2 is indicative of excessive weight for height, and values >30kg/m2 are often seen in association with hirsutism, probably the result of excessive sex hormone secretion. Blood pressure should be noted, as adrenal gland abnormality may be associated with hypertension. We have to look for any abdominal growth. Skin examination for excessive hair growth should include, whether it is central or peripheral and its distribution score, and also should look for, acne, thinning of scalp hair, skin tag, and blackening of the neck.

After taking a proper detailed history and clinical examination, we arrive at a clinical diagnosis of hirsutism and its cause. But for the management of hirsutism investigation is very important. Unless we find out the cause for it, it is difficult to treat the patient satisfactorily. These blood tests include hormonal tests like thyroid function tests, serum testosterone, Dehydroepiandrosterone sulphate (DHEAS), LH/FSH,17hydroxy progesterone, prolactin, and sugar &lipid levels, abdominal scanning, and in some cases CT and MRI of the abdomen.

After detecting the cause, we can plan the treatment depending upon the cause and the patient’s priority. Can be treated with oral medications or with nonpharmacological methods. This includes

·         Bleaching -makes the hair look less prominent

·        Depilatory-Removes the hair from skin surfaces such as shaving and chemical treatment (hair removal   creams such as Fem)

o   Despite perceptions to the contrary, shaving does not increase the rate or density of hair growth

o   Chemical depilatory creams may be useful for mild hirsutism that affects only limited skin areas, though they can cause skin irritation. A thick layer is applied for 10-15 minutes to the hairy areas, then wiped off and the hair comes off with the cream.

·     Epilation-Removal of the hair including the root such as plucking, waxing, electrolysis, LASER, and Intense pulsed light (IPL).

o   Waxing needs to be repeated every six weeks. The warm wax hardens on the skin and as it is stripped off, hairs are pulled out with it from the root. Waxing removes the hair temporarily but is uncomfortable.

o   Electric hair remover- This removes the hair by combined cut and pull

o   Electrolysis- It may result in permanent hair loss, but it is time-consuming. A small probe is inserted along with each hair and a small electrical or heat discharge destroys the hair root. A small area is treated at a time. It is expensive if the area affected is extensive. Treatment by an unskilled person may cause scarring.

o   Laser and IPL are used to treat large areas of pigmented terminal hair in Idiopathic and PCOS for cosmetic purposes. We need multiple treatments from months to a year and is expensive. Light of specific wavelength, duration, and energy is absorbed by the melanin in the hair shaft and follicle leading to photo thermolysis. Side effects of laser hair removal include swelling, redness, blistering, infection, hypo/hyperpigmentation, and occasionally scaring.  If properly delivered, this treatment is safe, effective, delays hair regrowth, and causes permanent hair removal in many patients.

 

Summarily, I wish to advise all teenaged girls and young ladies, not to make a hasty decision on removing your unwanted facial hair. Find out the nature of hair growth in your lady family members. If they have don`t blame them or get depressed. Meet your, doctor, discuss in detail and find out the cause. If there is no underlying disease, use temporary hair removal methods, before consulting cosmetologists for Lasers.