treatment of hirsutism

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The underlying cause should always be treated if possible.

Physical methods of hair removal - waxing removes a large part of the hair shaft underlying the skin surface; other methods include shaving, bleaching, plucking, depilation, and electrolysis. There is evidence for the effectiveness of treatment with the ruby laser in hirsutism (1).

Women who are overweight or obese should be advised on losing weight (2)

Medical treatments include:

  • anti-androgens e.g. cyproterone acetate - competitively inhibits androgens at peripheral receptors and may also reduce androgen synthesis. Often cyproterone acetate is used in a combined preparation (2mg cyproterone and 35 mcg ethinyloestradiol) Dianette (R) which is useful in women who also wish to receive oral contraception (4)

  • oestrogen such as ethinlyoestradiol, or a combined oral contraceptive pill (without an androgenic progesterone) - these suppress ovarian androgen production in patients in whom the androgen is of ovarian origin (3,4)

  • spironolactone occupies androgen binding sites on target tissues and has direct anti-androgenic properties. Some women develop polymenorrhoea and should receive oral contraceptives. It is not considered as a first line treatment in UK (4)

  • flutamide and finasteride are occasionally used in hospital practice
  • GnRH analogs: two to three months of treatment may be required to achieve maximum effect, usually combined with estrogen-progestin replacement or an OC, and an androgen blocker (5)
  • Glucocorticoids – used for the treatment of both classic and non classic forms of congenital adrenal hyperplasia (5).

  • metformin can be used in women with polycystic ovarian disease (4)

  • topical eflornithine cream
    • used in UK to treat facial hirsutism (4)
    • 11.5% eflornithine cream used in treatment of hirsutism; irreversibly inhibits ornithine decarboxylase
    • marketed as a treatment modality to reduce the frequency of the woman's usual method of hair removal. It is not being marketed as a replacement
    • . ".overall response may be modest, with marked improvement being seen in 32% of women (4)". See linked item for more details.

Reference:

Last reviewed 08/2021

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