Unwanted facial and body hair is a common problem that can be a source of distress for both men and women.
Hirsutism is the excessive hair on women in those parts of the body where terminal hair does not normally occur or is minimal – for example, a beard or chest hair. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a medical sign rather than a disease and may be a sign of a more serious medical condition, especially if it develops well after puberty.
Signs and symptoms
Hirsutism affects women and sometimes men, since the rising of androgens causes a male pattern of body hair, sometimes excessive, particularly in locations where women normally do not develop terminal hair during puberty (chest, abdomen, back and face). The medical term for excessive hair growth that affect both men and women is hypertrichosis.
Hirsutism can be caused by either an increased level of androgens, the male hormones, or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify the growth and pigmentation of hair. Other symptoms associated with a high level of male hormones include acne, deepening of the voice, and increased muscle mass.
Growing evidence implicates high circulating levels of insulin in women for the development of hirsutism. This theory is speculated to be consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemia) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism. It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate insulin-like growth factor 1 (IGF-1) receptor in those same cells. Again, the result is increased androgen production.
Signs that are suggestive of an androgen-secreting tumor in a patient with hirsutism is rapid onset, virilization and palpable abdominal mass.
The following may be some of the conditions that may increase a woman’s normally low level of male hormones:
· Polycystic ovary syndrome (PCOS), the most common cause
· Congenital adrenal hyperplasia, in turn mostly caused by 21-α hydroxylase deficiency
· Cushing’s disease
· Growth hormone excess (acromegaly)
· Tumors in the ovaries
· adrenal gland cancer, Von Hippel–Lindau disease
· Insulin resistance
· Stromal hyperthichotic (SH) – in postmenopausal women
· Obesity: As there is peripheral conversion of androgens to estrogen in these patients, this is the same mechanism as polycystic ovary syndrome, PCOS.
· Use of certain medications such as tetrahydrogestrinone, phenytoin, minoxidil
· Porphyria cutanea tarda
Diagnosis of patients with even mild hirsutism should include:
· Assessment of ovulation and ovarian ultrasound (because of the high prevalence of polycystic ovary syndrome),
· Assessment of 17-hydroxyprogesterone (because of the possibility of finding nonclassical 21-hydroxylase deficiency).
Other blood value that may be evaluated in the workup of hirsutism include:
· The androgens testosterone and dehydroepiandrosterone sulfate
· Thyroid-stimulating hormone
· If no underlying cause can be identified, the condition is considered idiopathic.
Many women with unwanted hair seek methods of hair removal. However, the causes of the hair growth should be evaluated by a physician, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the treatment.
Pharmacological treatments include:
· Spironolactone: Antialdosterone antiandrogenic compound.
· Cyproterone acetate: A progestin that also has strong antiandrogenic action. In addition to single form, it is also available in some formulations of combined oral contraceptives.
· Finasteride: 5 alpha reductase inhibitor that inhibits conversion of testosterone to more active 5 alpha hydroxy testosterone
· Metformin: Antihyperglycemic drug used for diabetes mellitus. However, it is also effective in treatment of hirsutism associated with insulin resistance (e.g. polycystic ovary syndrome)
· Eflornithine: Blocks putrescine that is necessary for the growth of hair follicles
· Flutamide: Androgen receptor antagonist. The most effective treatment that was tested is the oral flutamide for one year. Seventeen of eighteen women with hirsutism treated with combination therapy of flutamide 250 mg twice daily and an oral contraceptive pill had a rapid and marked reduction in their hirsutism score. Amongst these, one woman with pattern hair loss showed remarkable improvement.
· Combination oral contraceptives
· Laser Hair Reductions
Laser hair removal is a non-surgical procedure to remove unwanted hairs from specified regions of the body by using the intensified laser light which will attack the hair follicles. This process is very precise and effective since the laser intensity and direction can be well controlled.
Who needs it?
· People who need a permanent solution for hair growth in unwanted areas can opt for Laser Hair Reduction in order to completely remove the hair. Waxing, Shaving and trimming are only temporary results which cannot stop hair growth in time.
· In laser hair reduction procedure, the laser intensity is kept at a wavelength in order to kill only the hair follicles and not to damage the underlying skin tissues. The Laser light is concentrated upon the region and heat is produced which will result in hair removal.
Hair growth in body can be covered by wearing perfect clothes but facial hair cannot be concealed. Laser hair removal can help you remove the facial hair and give you a smooth face. This procedure is most common for women, but men also take up this if they are interested in a polished facial appearance.
v Sensitive areas
Laser light intensity can be adjusted in required level so that only the hair follicles are removed while the skin tissues which are fragile in the sensitive areas are not at all damaged. This procedure is completely safe and has no side effects also.
v Full body
Full body hair removal is also possible by laser hair removal. The patient’s full body is exposed to the laser light by moving it all along the body so that the cells are heated which weakens the root of the hairs which will eventually lead to hair removal.
Lifestyle change, including reducing excessive weight and addressing insulin resistance, may be beneficial. Insulin resistance can cause excessive testosterone levels in women, resulting in hirsutism. One study reported that women who stayed on a low-calorie diet for at least six months lost weight and reduced Insulin Resistance. Their levels of Sex hormone-binding globulin (SHBG) increased, which reduced the amount of free testosterone in their blood. As expected, the women reported a reduction in the severity of their hirsutism and acne symptoms.