Professional Documents
Culture Documents
and Hirsutism
Unwanted Hair and Hirsutism
What is hirsutism? 4
Why should you treat unwanted hair? 5
What is ‘normal’ hair growth? 5
What can cause hirsutism? 6
What tests might be done? 8
How does the patient feel about her hair growth? 9
What treatments are available? 10
Facial and Body hair growth scoring 16
4 5
Symptoms associated with excessive hair growth may include: What is ‘normal’ hair growth?
• greasy skin The body is completely covered with hair, except the lips, the palms of
the hands and the soles of the feet. But on most of the body, the hair
• acne
is so fine and soft that you cannot see it easily. Normally, a human
• menstrual cycle changes being has two types of hairs:
• decreased breast size 1. Terminal hairs (coloured and thicker hair on the scalp, but also found on
• masculine signs (such as deepening of the voice) eyebrows, eyelashes, groin, and under the arms)
• increased muscle size 2 Vellus hairs (fine and light, normally not coloured. These hairs can become
• hair loss on the scalp terminal hairs in the presence of male-type hormones)
• change in libido (sex drive) Women have the same number of hair follicles (places where hair is produ-
ced) on their body and face as men do. In women, most of the hair follicles
on the face and the body produce fine and light (vellus type) hair. The male
If a patient has any of these symptoms, or if they think that a medicine they
hormone, testosterone, makes hairs on men grow thicker, darker and longer,
are taking might be making the unwanted hair growth worse, they should
so that they appear more noticeable. All women produce small amounts of
contact a doctor.
testosterone and this allows terminal hairs to appear in the groin and armpit
areas, and around the brown circles of the nipple. This is normal and happens
from around puberty. However, when there are higher levels of male hormo-
nes in women, terminal hairs can develop over the shoulders, over parts of
6 7
2. Ethnic/Racial
Women from some ethnic groups (e.g. from Mediterranean countries) are
more likely to have darker, more dense hair. There is no underlying medical
condition causing the excess hair, and this is termed ‘ethnic hypertrichosis’.
the back, upper legs and abdomen. The amount of terminal hair increases
4. Medication
with age in women, and some races naturally grow longer and darker hair
(even on the body) although they do not produce any extra hormones. Some drugs are able to induce hair growth in general, and some drugs can
contribute to hirsutism, e.g.
are being over-produced. Obesity can cause changes in how the hormones The levels of male and female hormones in the blood may be tested.
are regulated, and so lead to hirsutism. Increased weight may increase the Occasionally, other hormone tests are needed and these may be done by an
amount of the male hormone produced by the body and so in addition endocrinologist or gynaecologist. Sometimes, a scan of the ovaries or other
weight loss may enhance the result of any treatment. glands may be helpful.
6. Congenital Adrenal Hyperplasia How does the patient feel about her hair growth?
In rare cases, hirsutism may be caused by an increase in hormone production Some people find it easy to discuss their worries with their doctor. For others,
by the adrenal glands. This condition is called Congenital Adrenal Hyperplasia this can be more difficult; especially with an embarrassing or upsetting
and is hereditary. Often it is not diagnosed until teenage years or later. The condition such as hirsutism. A patient may find the answers to the following
condition is usually treated with small amounts of steroids. questions useful, to help her explain how she feels to her doctor.
What tests might be done? If the patient answered ‘yes’ to at least three of these questions, she worries.
A physical examination will probably carried out and also following questions It is also common for women to remove their unwanted hair before they visit
should be answered. their doctor, or go outside the house (especially if the unwanted hair is on the
face). This can make it difficult for the doctor to assess how severe the hair
• Do other members of your family also have excessive
growth is. In this case, it might be useful for the patient to use the scoring
amounts of hair?
scale at page 16 to show her doctor, or to document treatment changes
• What medications are you taking?
where the unwanted hair is, giving an idea of how severe the growth is.
• Have your periods been regular?
• Are you pregnant?
• Have you noticed other signs of excess male hormones such
as increased muscle mass, deepening voice, acne, or
decreased breast size?
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1. Cosmetic Treatment
• Bleaching is an option for dark hair and makes the excessive hair less ob-
vious. Bleaching works well on the arms, thighs, and just below the nose. • Electrolysis may cause permanent hair loss, but takes time as a small area
The results are immediate, but bleaching needs to be done frequently, de- is treated every few weeks, and unskilled treatment may cause scarring.
pending on how quickly the hair grows. Bleaching may also leave skin red, Electrolysis uses electrical current to damage individual hair follicles so they
cause rash/skin irritation, can be painful, is time-consuming, and can make do not grow back. This is expensive and requires multiple treatments.
hair more obvious • Tweezing is good for removing a few hairs, such as around the eyebrows.
• Depilatory creams dissolve the hair, and the results are immediate, but The results are immediate, but tweezing needs to be done frequently.
the treatment needs to be done frequently, which can be uncomfortable. Tweezing may also leave skin red, cause rash/skin irritation, can be painful,
Depilatory creams may also cause irritation to the skin. and is time-consuming.
• Shaving: electric shavers are probably better than the wet type, as there is
less tendency to irritate or damage the skin. The results are immediate, but 2. Medical Treatment
shaving needs to be done frequently, and can also cause a rash/skin irrita- In most cases, hirsutism will return once the medical treatment is stopped.
tion, and is time-consuming. Shaving can also leave stubble, and although
shaving does not influence the hair thickness the newly grown hair appe-
Examples of drugs* that may be prescribed are:
ars thicker.
• Eflornithine cream: a prescription cream applied twice per day to slow
• Waxing pulls hairs out from the roots. The results are immediate, but wa-
the growth of unwanted facial hair. First effects can usually be seen after
xing needs to be done frequently and the hair must be allowed to grow
8 weeks of treatment. Therefore, in the beginning it should ideally be
long enough to be able to repeat the procedure. Waxing may also leave
combined with another form of therapy such as laser, waxing etc.
skin red, cause rash/skin irritation, can lead to pimples full of pus, can be
painful, and is time-consuming.
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Name:
Date of birth:
Dates 0 1 2 3 4
1st visit
2nd visit
3rd visit
A few hairs at Small mousta- Moustache Moustache
outer margin che at outer extending halfway extending to
margin from outer margin mid-line
1st visit
2nd visit
3rd visit
A few Scattered hairs Complete cover, light and heavy
scattered hairs with small
concentrations
1st visit
2nd visit
3rd visit
Circumareola With mid-line Fusion of these Complete cover
hairs hair in addition areas, with three-
quarter cover
1st visit
2nd visit
3rd visit
A few scattered Rather more, Complete cover, light and heavy
hairs still scattered
1st visit
2nd visit
3rd visit
A sacral tuft With some lateral Three quarter Complete
of hair extension cover cover
1st visit
2nd visit
3rd visit
E-mail: experts@skinacademy.eu A few mid-line
hairs
Rather more,
still mid-line
Half and full cover
1st visit
2nd visit
3rd visit
A few mid-line Mid-line streak A mid-line band An inverted V
hairs of hair of hair shape grow
E-mail: experts@skinacademy.eu
This document is a consensus of opinion from the Experts of the Skin Academy.
Sponsored by an unrestricted educational grant from Almirall Laboratoires, Spain.
E-mail: experts@skinacademy.eu