الفهرس 
ANATOMY AND TYPES OF HAIROnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
H
irsutism is the presence of terminal (coarse) hairs in females in a male-like pattern, affecting between 5-10% of women, however normal or acceptable hair growth depends on a woman’s ethnicity and her perception of familial, cultural, and societal norms for the quantity and distribution of hair.
Hirsutism is caused by increased androgenicity in the pilosebaceous system resulting in increased growth of terminal hairs. Hirsute patients have increased dermal activity of the enzyme 5α-reductase, which is responsible for conversion of testosterone to the more powerful androgen; dihydrotestosterone (DHT). High DHT levels increase terminal hair growth and therefore, 5α-reductase inhibitors can be used for the treatment of hirsutism. Individual variations in dermal 5α-reductase activity may explain the often near normal testosterone levels and the lack of correlation between circulation testosterone levels and clinical hirsute manifstations.
The etiology of hirsutism can be attributed to ovarian causes like Polycystic ovary syndrome (the most common cause), Hyperthecosis and Virilizing ovarian tumors, adrenal causes like Congenital adrenal hyperplasia, Adrenal tumors and Cushing syndrome, Pituitary causes like Hyperprolactinemia, drugs like Oral contraceptives pills, Danazol, L-Thyroxin therapy, Diazoxide and Carbamazepine and idiopathic hirsutism in which there is excessive growth and distribution of androgenic hair in conjunction with normal circulating serum androgen levels and normal ovulatory function and is caused by over activity of 5α-reductase enzyme in hair follicles. Other causes include the syndrome of hyperandrogenism, insulin resistance, and acanthosis nigricans, abbreviated as HAIR-AN and The syndrome of seborrhea, acne, hirsutism, and acanthosis nigricans, abbreviated as SAHA.
Hirsutism is diagnosed by history of symptoms like menstrual irregularity, galactorrhea, symptoms of virilization (eg, deepened voice, clitoromegaly, increased muscle mass), family history of hirsutism, polycystic ovary syndrome, HAIR-AN syndrome and history of symptoms of any condition known to produce hirsutism, such as Cushing disease, acromegaly, or a thyroid disorder. Also important is a drug history to determine if the patient has taken drugs such as androgens and anabolic steroids. The physical examination involves use of the Ferriman-Gallwey hirsutism scoring system which helps categorize the severity and distribution of excess hair growth. A Ferriman-Gallwey score of 8 to 15 (out of a possible 36) indicates moderate hirsutism, whereas a score above 15 indicates severe hirsutism. Laboratory investigations include measurement of serum testosterone, DHEAS, 17-hydroxyprogesterone, FSH: LH ratio, prolactin, urine free cortisol level, dexamethasone suppression test and midnight cortisol level. Imaging studies like ovarian ultrasonography and adrenal computed tomography scanning or magnetic resonance imaging can be performed to evaluate for either ovarian or adrenal sources of androgen production.
The treatment of hirsutism is directed to ameliorate the hirsutism and reproductive complaints, to prevent and/or treat the possible associated metabolic derangements and, if possible, to treat the underlying cause.
The treatment includes non mechanical and mechanical treatment, non mechanical treatments include life modification and medical treatment such as Oral contraceptive pills, Glucocorticoids, Gonadotropin-releasing hormone analogs, Spironolactone, Flutamide, Finasteride, Cyproterone acetate, Ketoconazole, Insulin sensitizers (eg. Metformin), and Eflornithine topical cream.
Mechanical treatments include two main categories which are depilation and epilation. Methods if depilation include Shaving and Chemical depilatories. Methods of epilation include Plucking/tweezing, Waxing/sugaring, Threading, Electrolysis, Intense pulsed light and Laser hair removal.