Question

Discuss the treatment of Hirsutism.

Hint:

A combination of pharmacologic treatments (OCPs, spironolactone) and cosmetic procedures (laser hair removal) is often the most effective approach to treating hirsutism.

Answer 1

Step 1: Treatment Goals for Hirsutism.
The primary goals in treating hirsutism are to reduce or eliminate unwanted hair growth, treat any underlying causes (if present), and improve the patient's quality of life and psychological well-being.
Step 2: Treatment Options for Hirsutism.
(1) Pharmacologic Treatments:
- Oral Contraceptives (OCPs):
- Combined oral contraceptives (COCs) are the first-line treatment for women with hirsutism, particularly if they have an underlying condition like PCOS. OCPs suppress ovarian androgen production and reduce hirsutism.
- Drospirenone-containing OCPs (e.g., Yasmin) are particularly effective as they have anti-androgenic properties.
- Anti-androgens:
- Spironolactone is a commonly used anti-androgen that blocks androgen receptors and reduces hair growth. It is often used in combination with oral contraceptives.
- Finasteride and flutamide are other anti-androgens that can be used in more severe cases.
- Topical Treatments:
- Eflornithine (Vaniq: A topical cream that inhibits hair growth by blocking the enzyme ornithine decarboxylase. It is effective for reducing facial hair growth.
(2) Cosmetic Treatments:
- Laser Hair Removal:
- Laser treatments are effective in permanently reducing hair growth by targeting the hair follicles with light. It works best on individuals with fair skin and dark hair.
- Electrolysis:
- A more invasive treatment option that involves using an electric current to destroy hair follicles.
(3) Lifestyle Modifications:
- In cases where hirsutism is associated with obesity or insulin resistance (as in PCOS), weight loss, and exercise can help improve symptoms.
(4) Management of Underlying Conditions:
- If the hirsutism is caused by an underlying condition such as Cushing's syndrome, treatment of the underlying disorder is crucial to managing the symptoms.