LS1 A PRACTICAL APPROACH TO HIRSUTISM

Francisco Camacho. Department of Medical-Surgical Dermatology. Hospital Universitario Virgen Macarena. School of Medicine. Seville. Spain.

To understand, diagnose and treat hirsutism it is necessary to know the hormonal metabolism in women. For this reason, first of all I will develop the androgenic metabolism in the woman.

Once a woman comes to our Trichology Unit because of overproduction of hair, it is necessary to know whether this excess is hypertrichosis or hirsutism, and in the last case what type of hirsutism: peripheral (constitutional) or organic. In the last case, we must classificate the hirsutism in relation with the origin of the androgens: ovarian, adrenal, hypophyseal, hepatic, due to ectopic hormones, iatrogenic or due to peripheral failure in converting androgens to estrogens.

When the hirsutism has already been diagnosed, it is necessary to know the degree of organic participation and the  score of hirsutism. The score will be made using Ferriman & Gallwey’s score with nine areas to investigate. The degree of organic affectation will be assessed by clinical and biochemical evaluation. Clinically, we must search for defeminization and virilization signs, including menstrual irregularities.

The biochemical evaluation will investigate circulating androgens and other hormones with influence over androgens: free testosterone, DHEA-S, androstenedione, FSH, LH, prolactin, 17-b-hydroxyprogesterone, 17-b-estradiol and androstanediol glucuronide.

The treatment of hirsutism will be the last part. Corticosteroids, drug contraceptives or antagonists of the gonadotropin releasing hormones and bromocriptine may be used according to the diagnosis. Topical and dermato-cosmetic therapy could also be used.