Abstract
Hirsutism refers to an excess of terminal hair on body sites where terminal hair is normally minimal or absent. Women are more likely to experience stress, anxiety or low self-esteem as a result of hirsutism than men. A number of grading systems are available that define normal and excess body hair; however, they should be interpreted in the context of ethnic and cultural norms. Hirsutism may be idiopathic or secondary to virilization, in which case it may be a sign of a serious medical condition. Androgen activation of hair follicle androgen receptors leads to hair follicle enlargement and increased anagen duration. This in turn produces increased hair diameter and hair fiber elongation. Hirsutism can result from either a high level of tissue androgens or a low activation threshold for the androgen receptor. High tissue androgens can result from elevated levels of circulating androgens (ovarian or adrenal) or local production within skin from chemical precursors. The need for biochemical investigation to identify systemic virilization and any possibly associated medical condition is guided by the severity of the hirsutism, the rate of development and any associated symptoms such as menstrual irregularity, acne, hoarse voice and alopecia. Many pharmaceutical and physical therapies are available to remove excess hair, including shaving, waxing, plucking, depilatory creams, electrolysis, pulsed light and laser therapy. Pharmacotherapy includes topical ornithine decarboxylase inhibition, oral antiandrogens, ovarian and adrenal suppression.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.