Beyond the Surface: A Closer Look at Hirsutism
DOI:
https://doi.org/10.66344/jpad.v34i4(Suppl).2810Keywords:
Hirsutism, Hyperandrogenism, Polycystic ovarian syndrome, PhotoelpilationAbstract
Hirsutism is characterized by excessive hair growth in females, resembling male-pattern hair growth. This condition often causes significant emotional distress and is a common concern among women seeking dermatological care. While hirsutism can stem from various causes, including androgen excess from the ovaries or adrenal glands, it is frequently associated with metabolic disorders like polycystic ovary syndrome (PCOS). Additionally, it can occur idiopathically, as a medication side effect, or rarely, due to an underlying medical condition. This article provides a succinct overview of hirsutism, covering its diagnosis and treatment options.
References
1. Cussen L, McDonnell T, Bennett G, Thompson CJ, Sherlock M, O’Reilly MW. Approach to androgen excess in women: Clinical and biochemical insights. Clin Endocrinol (Oxf). 2022 Aug;97(2):174–86.
2. Hafsi W, Kaur J. Hirsutism. 2023 May 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29262139.
3. Mahajan VK, Singh Chauhan P, Chandel M, Singh Mehta K, Karan Singh V, Sharma A, et al. Clinico-investigative attributes of 122 patients with hirsutism: A 5-year retrospective study from India. Int J Women’s Dermato. 2021;7(3):237–42.
4. Spritzer PM, Marchesan LB, Santos BR, Fighera TM. Hirsutism, Normal Androgens and Diagnosis of PCOS. Diagnostics (Basel). 2022 Aug 9;12(8):1922.
5. Amiri M, Fallahzadeh A, Sheidaei A, Mahboobifard F, Ramezani Tehrani F. Prevalence of idiopathic hirsutism: A systematic review and meta-analysis. J Cosmet Dermatol. 2022;21(4):1419–27.
6. Yilmaz B, Yildiz BO. Endocrinology of Hirsutism: From Androgens to Androgen Excess Disorders. Front Horm Res. 2019;53:108–19.
7. Gaber ME, El-Sayed S. Quality of life in patients having hirsutism. Menoufia Med J. 2021;34(2):477.
8. Hosseini MS, Ehsani AH, Fakour Y, Aryanian Z, Elhamfar M, Noormohammadpour P. Effect of Laser-Assisted Hair Removal (LAHR) on the Quality of Life and Depression in Hirsute Females: A Single-Arm Clinical Trial. J Lasers Med Sci. 2022;13:34172.
9. Saleh D, Yarrarapu SNS, Cook C. Hypertrichosis. 2023 Aug 16. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521275.
10. Cross AS, Moustafa M, Elder CJ. Fifteen-minute consultation: Approach to the adolescent presenting with hirsutism. Arch Dis Child Educ Pract Ed. 2023;109(2):66–72.
11. Lieman TS& HJ. Managing the PCOS - Related Symptoms of Hirsutism , Acne , and Female Pattern Hair Loss. In: Springer, editor. Polycystic Ovary Syndrome [Internet]. springer; 2022. p. 205–31. Available from: https://link.springer.com/chapter/10.1007/978-3-030-92589-5_11
12. Carmina E. Prevalence of idiopathic hirsutism. Eur J Endocrinol. 1998 Oct;139(4):421–3.
13. Alkheyr Z, Murad M, Das P, Aljenaee K, Kamel C, Hajji SA, et al. Self-esteem and body image satisfaction in women with PCOS in the Middle East: Cross-sectional social media study. PLoS One. 2024;19(4 April):e0301707.
14. Matheson E, Bain J. Hirsutism in Women. Am Fam Physician. 2019 Aug;100(3):168–75.
15. Rittmaster RS, Loriaux DL. Hirsutism. Ann Intern Med. 1987 Jan;106(1):95–107.
16. Azziz R, Carmina E, Sawaya ME. Idiopathic hirsutism. Endocr Rev. 2000 Aug;21(4):347–62.
17. Unluhizarci K, Hacioglu A, Taheri S, Karaca Z, Kelestimur F. Idiopathic hirsutism: Is it really idiopathic or is it misnomer? World J Clin cases. 2023 Jan;11(2):292–8.
18. de Kroon RWPM, den Heijer M, Heijboer AC. Is idiopathic hirsutism idiopathic? Clin Chim Acta. 2022 Jun;531:17–24.
19. Persson S, Ubhayasekera KA, Bergquist J, Turkmen S, Poromaa IS, Elenis E. Hyperandrogenic Symptoms Are a Persistent Suffering in Midlife Women with PCOS; a Prospective Cohort Study in Sweden. Biomedicines. 2022 Dec 30;11(1):96.
20. Abusailik MA, Muhanna AM, Almuhisen AA, Alhasanat AM, Alshamaseen AM, Bani Mustafa SM, Nawaiseh MB. Cutaneous manifestation of polycystic ovary syndrome. Dermatol Reports. 2021 Sep 15;13(2):8799.
21. Grymowicz M, Rudnicka E, Podfigurna A, Napierala P. Hormonal Effects on Hair Follicles. Int J Mol Sci. 2020;21(15):5342.
22. Qu X, Donnelly R. Sex Hormone-Binding Globulin (SHBG) as an Early Biomarker and Therapeutic Target in Polycystic Ovary Syndrome. Int J Mol Sci. 2020;21(21):8191.
23. Qu X, Donnelly R. Sex Hormone-Binding Globulin (SHBG) as an Early Biomarker and Therapeutic Target in Polycystic Ovary Syndrome. Int J Mol Sci. 2020 Nov 1;21(21):8191.
24. Zaman A, Rothman MS. Postmenopausal Hyperandrogenism: Evaluation and Treatment Strategies. Endocrinol Metab Clin North Am. 2021;50(1):97–111.
25. Lumezi BG, Berisha VL, Pupovci HL, Goçi A, Hajrushi AB. Grading of hirsutism based on the Ferriman-Gallwey scoring system in Kosovar women. Postepy Dermatol Alergol. 2018;35(6):631–5.
26. Kahraman FC, Erdoğan SS. Grading of hirsutism: a practical approach to the modified Ferriman-Gallwey scoring system. Postepy Dermatol Alergol. 2022 Aug;39(4):744-748.
27. Purwar A, Nagpure S. Insulin Resistance in Polycystic Ovarian Syndrome. Cureus. 2022;14(10):e30351.
28. Gruca-Stryjak K, Doda-Nowak E, Dzierla J, Wróbel K, Szymankiewicz-Bręborowicz M, Mazela J. Advancing the Clinical and Molecular Understanding of Cornelia de Lange Syndrome: A Multidisciplinary Pediatric Case Series and Review of the Literature. J Clin Med. 2024;13(8):2423.
29. Øzdemir CM, Nielsen MM, Liimatta J, Voegel CD, Elzenaty RN, Wasehuus VS, et al. Late diagnosis of partial 3β-hydroxysteroid dehydrogenase type 2 deficiency – characterization of a new genetic variant. Endocrinol Diabetes Metab Case Rep. 2024;2024(3):23-90.
30. Prasanthi A. Gynaecology clinical , biochemical and hormone profile in hirsute vs nonhirsute patients with polycystic ovary syndrome. Inadian J Applied Res. 2020;10–2.
31. Joham AE, Piltonen T, Lujan ME, Kiconco S, Tay CT. Challenges in diagnosis and understanding of natural history of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2022;97(2):165–73.
32. Taieb A, Farid H, Zarrouk O, Ben Abdessalem F, Layouni S. Identifying the First Val281L Mutation Causing Nonclassic Congenital Adrenal Hyperplasia in the Central-East Region of Tunisia. Cureus. 2024;1–5.
33. Sagvekar P, Dadachanji R, Patil K, Mukherjee S. Pathomechanisms of polycystic ovary syndrome: Multidimensional approaches. Front Biosci - Elit. 2018;10(3):384–422.
34. Tan K, Coster T, Mousa A, Mar A, Piltonen T, Boyle JA, et al. Laser and Light-Based Therapies for Hirsutism Management in Women with Polycystic Ovarian Syndrome: A Systematic Review. JAMA Dermatology. 2024;160(7):746–57.
35. Hussain A, Uy E, Marlowe S, Piercy J, Akbar A. A Rare Case of Hyperandrogenism Due to Fibrothecoma and Leydig Cell Tumor in a Postmenopausal Woman With Adrenal Adenoma: A Case Report and Literature Review. Cureus. 2023;15(8):e43180.
36. Mimoto MS, Oyler JL, Davis AM. Evaluation and Treatment of Hirsutism in Premenopausal Women. JAMA. 2018;319(15):1613–4.
37. Thiede RM, Rastogi S, Nardone B, Sadowsky LM, Rangel SM, West DP, et al. Hyperkalemia in women with acne exposed to oral spironolactone: A retrospective study from the RADAR (Research on Adverse Drug Events and Reports) program. Int J Women’s Dermatol. 2019;5(3):155–7.
38. Duman M, Durgun Ozan Y. A comparison of physical anxiety levels in adolescent and young women with polycystic ovary syndrome and in other healthy adolescent and young women in a university hospital, Turkey. J Heal Res. 2020;34(6):515–22.
39. Pathania YS, Budania A, Rafi S, Kumar A. Psychosocial and financial impact of facial hair among female patients of hirsutism: A cross-sectional study. J Cosmet Dermatol. 2023;22(6):1906–10.
40. Nasiri-Amiri F, Tehrani FR, Simbar M, Montazeri A, Mohammadpour RA. The polycystic ovary syndrome health-related quality-of-life questionnaire: Confirmatory factor analysis. Int J Endocrinol Metab. 2018;16(2):0–1.
41. Vadan RL, Varela N, Zhuravko N, Ogidan NO, Adedara VO, Keku E. Comparative Management Methods for Adolescents With Polycystic Ovarian Syndrome: A Systemic Review. Cureus. 2024;16(3):e55876.
42. Forslund M, Landin-Wilhelmsen K, Krantz E, Trimpou P, Schmidt J, Brännström M, et al. Health-Related Quality of Life in perimenopausal women with PCOS. Clin Exp Obstet Gynecol. 2022;49(2):52.
43. Naheed A, Hayat AA, Ain QU, Razzaque B, Fatima S, Dar N. Psychological Morbidity in patients with Idiopathic Hirsutism presenting for Laser Treatment at a Tertiary Care Hospital. J Rawalpindi Med Coll. 2021;25(3):345–50.
44. Zappia E, Federico S, Volpe C, Scali E, Nisticò SP, Bennardo L. Alexandrite and Nd:YAG Laser vs. IPL in the Management of Facial Hirsutism: A Retrospective Study. Photonics. 2023;10(5): 572.
45. Ekobena FM, Etoga MCE, Yon LCN, Dehayem M, Nengom SO, Ngassam E, et al. Clinical, Psycho-Social and Metabolic Profile of Women with Hirsutism in Yaounde. Open J Endocr Metab Dis. 2022;12(11):225–37.
46. Eil C. Ketoconazole binds to the human androgen receptor. Horm Metab Res. 1992;24(8):367–70.
47. Lolou V. The role of probiotics and synbiotics on hirsutism. Fermentation. 2021;7(1):1–20.
48. Tahmasbi B, Eshraghi R, Amini-Tehrani M, Zamanian H, Ilami A. Polycystic ovarian syndrome elevates the distress of sexual pain in Iranian women with infertility. BMC Womens Health. 2024;24(1):1–9.
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Copyright (c) 2024 Yasaan Saaqib, Shazia Saaqib, Divyanshu Srivastava; Nabeela Shahzadi; Atif Shahzad, Nadia Ali Azfar

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