hirsutism Hirsutism refers to a condition in which a patient's hair is coarser, longer, and more abundant compared to individuals of the same age and gender. This condition can be classified as congenital or acquired based on whether it is present at birth, and as generalized or localized based on the areas of excessive hair growth. One common type of hirsutism affects women, manifesting as the clinical phenomenon in which women develop male-pattern hair characteristics.

Hirsutism refers to a condition in which a person develops coarse, long, and excessive hair compared to their same-age and same-sex counterparts. This condition can be categorized as congenital or acquired, depending on whether it is present at birth, and as generalized or localized based on the areas of excessive hair growth. One of the most prevalent forms of hirsutism occurs in women, where they develop male-pattern hair growth, representing a clinical manifestation of excessive hair growth.

Hirsutism in women: Caused by androgens, the severity and extent of hirsutism depend on the levels of androgens and the sensitivity of hair follicles to androgens. Specific causes include:

Adrenal disorders: Conditions such as congenital adrenal hyperplasia, virilizing adrenal tumors, Cushing's syndrome, and adrenal insufficiency can lead to hirsutism.

Ovarian disorders: Virilizing ovarian tumors, polycystic ovary syndrome, and gonadal dysgenesis can also cause hirsutism.

Pituitary gigantism.

Achard-Thiers syndrome: Also known as diabetes mellitus with virilization, where patients may have adrenal tumors or hyperplasia.

Pseudohermaphroditism.

Turner syndrome with androgenic manifestations: These patients have underdeveloped ovaries, lack female hormones, and may exhibit increased androgen levels, leading to hirsutism.

Iatrogenic causes: Hirsutism can be induced by the use of androgens and related medications in some patients.

Genetic factors.

Additionally, there are cases of hirsutism in women where the cause is unknown, known as idiopathic hirsutism. Other types of excessive hair growth

The causes of these types of hirsutism are often unclear, but current research has identified associations with the following:

Malignant tumors: Various cancers such as lung cancer, breast cancer, bladder cancer, and bronchogenic carcinoma can lead to sudden generalized excessive hair growth, which may be a cutaneous manifestation of malignancy.

Endocrine disorders: Hypothyroidism in children can cause excessive hair growth on the back and extensor surfaces of the limbs. Additionally, individuals with hypothyroidism may develop coarse hair at the site of pretibial myxedema.

Primary malnutrition in children, intestinal diseases, or severe malabsorption leading to malnutrition can result in excessive systemic hair growth.

Neurogenic anorexia nervosa: Patients may develop new vellus-like hair on the face, trunk, and upper limbs, and symptoms can be quite pronounced.

Iatrogenic factors leading to hirsutism: Common drugs leading to iatrogenic hirsutism include phenytoin, streptomycin, corticosteroids, chloramphenicol, lipotropin, procarbazine, phenobarbital, and cyclosporine.

Use of certain topical medications, such as minoxidil, or prolonged topical application of glucocorticoids.

Hirsutism in Women

Hair changes: Excessive and dense hair growth on the upper lip, preauricular area, cheeks, back, chest, and proximal limbs, exhibiting partial or complete male-pattern hair distribution. The distribution and severity of hirsutism depend on the levels of androgens and the sensitivity of hair follicles to androgens, as well as age and genetics.

Other physical changes: Acne, seborrhea, androgenic alopecia, obesity, seborrheic dermatitis, muscular hypertrophy, and other manifestations may occur.

Female reproductive system: Menstrual irregularities, short menstrual cycles, amenorrhea, uterine bleeding, anovulation, and infertility may be present.

Masculinization in women: Deepening of voice, male voice tone, clitoromegaly, excessive hair on the breasts and face, muscular development, loss of feminine curves, prominent Adam's apple, and flattening of buttock muscles may occur.

Breast-related changes: Underdevelopment of breasts, nipple discharge, and other manifestations.

Children may exhibit signs of precocious puberty, such as early development of pubic and axillary hair.

Decreased or absent libido.

Other manifestations of adrenal cortex hypersecretion: Overproduction of adrenal cortex hormones can lead to skin striae, centripetal obesity, and elevated blood pressure.

Congenital Hirsutism

Excessive body hair is present at birth, with thick and long eyebrows that often connect at the sides.

Acquired Hirsutism

It often has a sudden onset, with the appearance of tissue resembling infantile hair growth on the face. The growth rate is much faster than that of normal hair growth, and it can occur on all parts of the body except the palms and soles. Even a bald scalp can develop hair.

Congenital Localized Hirsutism

Onset occurs at birth or in early childhood, and patients may have moles. Excessive hair growth may also occur in isolation. The diameter, color, and length of the hair may not match the patient's age.

There are several specific types of this condition, including:

Spina bifida with hirsutism: A cluster of dark hair is present at the lowest part of the back, specifically the sacral region.

Auricular hirsutism: Common in males, with excessive hair on the ears and no other abnormalities.

Elbow hirsutism: Excessive hair on both elbows at birth, which gradually decreases before the age of 5.

Hirsutism at the proximal phalanges of the middle fingers: Excessive hair growth at the proximal phalanges of the index, middle, ring, and little fingers.

Acquired Localized Hirsutism

Manifests as localized excessive hair growth, often accompanied by pigmentation.

Individuals should take care to avoid scratching, especially during treatments such as hair removal, to prevent secondary bacterial infections.

If using topical medications for treatment, family members should assist the patient in the correct application and observe the growth of hair in the treated areas.

Patients should maintain a positive outlook, actively seek treatment, and adjust their mindset. Family members should provide psychological support, alleviate the patient's mental stress, and encourage them to actively participate in treatment.

Lifestyle: Personal hygiene and skin cleanliness should be maintained.

Diet: During treatment, it is advisable to consume a light and nutritious diet, avoiding spicy and irritating foods.

Patients should refrain from incorrect or excessively frequent hair plucking or removal, especially while actively undergoing treatment.

Family members should pay attention to the patient's mental state, provide timely guidance, and prevent the patient from experiencing prolonged anger, depression, anxiety, or other negative emotions.