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Hypertrichosis

Hirsutism

Mecanismo
  • Development of androgen-dependent terminal body hair in a women where this hair is not normally found
    • Upper lip, chin, suprapubic triangle, chest, back, buttocks and thighs
  • Ethnic variation is an important consideration
 
Other dermatologic signs of elevated androgens
  • Androgenic alopecia
  • Acne
  • Seborrhea
 
Other systemic signs of elevated androgens
  • Hearseness
  • Accentuated musculature
  • Clitoromegaly
  • Menstrual disorder
 
Causes of hirsutism
  • Familial
  • Drugs: phenytoin, minoxidil, diazoxide, cyclosporine, hexachlorobenzene
  • Tumor (adrenal, pituitary, ovary)
  • Polycystic ovarian syndrome
  • Cushing’s syndrome
  • Congenital adrenal hyperplasia
  • Idiopathic
      • notion image
 
 
Clues to diagnosis
  • Hirsutism in breasts/areola and lateral face and neck - excess testosterone with ovarian source
  • Hirsutism in bikini area (central, pubic triangle to upper abdomen) and central chest to chin - excess adrenal androgens (DHEA-S)
  • Hirsutism in lateral face and back: iatrogenic/exogenous (suplements)
 
Treatment
  • Antiandrogenic treatment: flutamide, spironolactone, cyproterone acetate, finasteride
  • Adrenal hyperandrogenism: low dose corticosteroids
  • Insulin resistance: metformin

Hypertrichosis

Excessive hair on areas of the body which typically have hair
Lanugo, vellus or terminal
 
Generalized or localized
Congenital or acquired
 
  • Generalized Hypertrichosis
    • Acquired
      • Acquired hypertrichosis lanuginosa paraneoplastic
        • Most common
        • Most common: GI, breast or lung malignancy
      • Acquired generalized hypertrichosis
        • Most commonly drug induced
        • Most common: minoxidil, phenytoin, cyclosporine
        • Others: streptomycin, glucocorticosteroids, dazoxide, prostaglandin E1, acetazolamide, mycophenolate mofetil, psoralens, penicillamine, IFN alpha, EGFR inhibitors
    • Congenital
      • Congenital hypertrichosis lanuginosa (AD)
      • Congenital generalized hypertrichosis
  • Localized
    • Nevoid hypertrichosis
    • Congenital hypetrichosis of the ears
    • Localized inflammatory hypertrichosis - following chemical, thermal or physical irritation (repeated friction, plaster)