Hirsutism refers to abnormal hair growth in the androgen-dependent area of women. Compared with people of the same age and gender, the hair grows excessively, becomes thicker, and becomes darker. It is caused by various reasons that increase the level of androgens in the body or increase the sensitivity of target organs to androgens.
Congenital hirsutism is often related to race and family inheritance.
1. Systemic hirsutism, a rare atavism phenomenon in human genetics, is a gene mutation. Most of them are autosomal dominant inheritance. Only about 50 cases have been reported worldwide so far.
2. Congenital local hirsutism, such as pigmented nevus hirsutism.
Endocrine disorders refer to tumors or glandular hyperplasia of endocrine glands, or local manifestations of certain syndromes (such as acromegaly). Common in the following diseases:
1. Adrenal hirsutism, ① Adrenal tumors. ② Cushing's disease, due to long-term excessive secretion of cortisol, causes serious disorders in protein, fat, sugar, and electrolyte metabolism, interfering with the secretion of many other hormones. ③ Congenital adrenal hyperplasia, seen in 21-hydroxylase deficiency and 11B-hydroxylase deficiency.
2. Ovarian hirsutism, ① Polycystic ovary syndrome, mostly occurs on the face, breasts and abdomen, but without masculinization. ② Ovarian tumors, common ones include theca cell tumor, granulosa cell tumor, hilar cell tumor, testicular blastoma and residual adrenal cell tumor.
3. Patients with pure gonadal dysgenesis, develop normally before puberty, and 5% to 10% of cases develop hirsutism
Other types of hirsutism are often related to systemic diseases and are a manifestation of physical diseases.
For patients with drug-induced hirsutism who have been taking large amounts of corticosteroids for a long time, the hair is more likely to be on the face, but may also be distributed on the back and upper limbs, but it will subside after stopping the drug for a few months. For example, taking minoxidil orally every day for several months may cause hirsutism; most kidney transplant patients may develop hirsutism with cyclosporine; long-term use of certain drugs such as phenytoin sodium can also cause hirsutism.
Idiopathic hirsutism refers to familial or constitutional hirsutism, that is, hirsutism with a clear family tendency, no endocrine disorder, and no iatrogenic causes. It is currently believed that this disease is mainly caused by increased sensitivity of hair follicles and sebaceous glands to androgens or increased local 5α reductase activity, which increases dihydrotestosterone (DHT).
Temporary hypertrichosis such as menopausal hypertrichosis and pregnancy hypertrichosis
1. Patients with systemic hypertrichosis generally have black and hard hair all over their body after birth. The hair on the face, trunk and limbs is dense and long, and the hair can be up to 10 cm long. Other physical conditions are the same as those of ordinary people, and intellectual development is usually normal. It is commonly known as "werewolf syndrome" or "hairy child"
2. Localized hypertrichosis
(1) Black hair grows on the basis of melanin nevus, also known as hairy nevus or nevus-like hypertrichosis
(2) Patients often suffer from congenital spina bifida and grow a tuft of long, black hair in the lumbar sacral region.
The hirsutism of idiopathic hirsutism begins in adolescence and continues to develop for decades. There are no other endocrine abnormalities, normal menstruation and normal circulating androgen levels.
Increases in endogenous and exogenous androgens can cause hirsutism. Hirsutism caused by increased circulating androgens accounts for 75% to 85% of this disease. It mainly originates from various lesions of the adrenal glands and ovaries, which release excessive endogenous androgens. It is also accompanied by manifestations of other organs such as hair loss, obesity, and acanthosis nigricans.
Patients with other endocrine diseases such as acromegaly and all diseases that can cause hyperprolactinemia may develop hirsutism; patients with hyperthyroidism and pretibial myxedema may develop hirsutism in the pretibial edema area.
(I) Excessive hair and hirsutism
Excessive hair refers to the increase of hair on the body surface, which has no gender difference and can occur in any part of the body. Most people have a family history of excessive hair. Hirsutism refers to the excessive growth of hair in the androgen-dependent parts of women, with a male-like distribution pattern. It can appear on the mandible, above the lips, in front of the ears, forehead, back of the neck, around the nipples, and the midline below the umbilicus. The face is the most common part, and it is accompanied by masculinization phenomena, such as the appearance of knots, low voice and clitoral hypertrophy.
Hirsutism should be differentiated from polycystic ovary syndrome, adrenal hyperplasia, adrenal cortical adenoma, adrenal cortical carcinoma, (II) other diseases, ovarian tumors and ectopic ACTH syndrome. For example, polycystic ovary syndrome may also have symptoms and signs such as obesity, amenorrhea, infertility, clitoral hypertrophy, acne, breast hypoplasia and hirsutism; adrenal hypertrichosis may have central obesity, hypertension, acne, amenorrhea, polysanguineous, skin purple lines, full moon face and osteoporosis, and its elevated cortisol level, elevated urine 17-KS and 17-0HCS, and elevated urine cortisol can be used for differential diagnosis; congenital adrenal hyperplasia, accompanied by hermaphroditism, is easier to identify, while late-onset and latent patients often develop the disease after puberty, and clinically only show hirsutism and mild clitoral hypertrophy, which is not easy to differentiate from idiopathic hirsutism.
Medical indications for hair removal include pseudofolliculitis barbae (PFB), keloid acne on the neck (AKN1) and cellulitis dissecans. However, social standards put great psychological pressure on people with excessive facial and body hair. Most patients who require hair removal have normal hair distribution and quantity. Laser hair removal is to remove unwanted hair, not excessive hair. Hair removal is a cosmetic need. Clinically, most women feel that excessive hair in the armpits, bikini area, legs, and face is indecent, while men mainly have excessive hair on the chest, abdomen, and facial beard. In short, excessive body hair is a very painful thing for some patients, especially in certain ethnic groups such as South Asians.
Society or individual views on the distribution and density of hair will affect patient preferences. Therefore, it is necessary to first clearly understand the patient's expectations and the actual effect of hair removal. There are many methods for removing excess hair, which can be divided into four categories.
1. Temporary hair removal Such as plucking, shaving, tweezers plucking, waxing and sugaring, twisting wire, grinding
Hair removal.
2. Temporary hair suppression DC electrolysis, pyrolysis, and comprehensive methods.
3. Permanent hair suppression--laser There are many methods, each with its own advantages and disadvantages. Temporary hair removal or hair suppression can only temporarily remove the hair shaft on the surface of the skin, and the deep hair follicles are not damaged, and the hair regenerates quickly. Among them, the electrolysis method in permanent hair removal is to use low direct current between two electrodes to act on the tissue, and the chemical reaction at the top of the electrode causes tissue damage and hair follicle destruction.
4. The hot melt method uses high-frequency current to heat the tissue and destroy the hair follicles, also known as "electrical hair removal". Although the latter two methods can remove hair for a long time, they are cumbersome, time-consuming, inefficient, and may leave scars, and are rarely used now. Laser hair removal is convenient, permanent, efficient, has little discomfort in treatment, and has a low incidence of scars and other complications. It has been widely used.
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