Normal hair growth:
There are two major types of hair
1.vellous hairs which is fine &lightly pigmented& are present over most of the body &produced by smaller hair follicle.
2.terminal hair are larger &pigmented &are found mostly on the scalp,eyebrow&eyelashes prior to puberty &found in the axilla,pubic area& male after puberty.
Human hair growth occur in three phases:
1.anagen:is the growing phase &last for 2-5 years.
2.catagen :the hair stop growth& last for 2 weeks.
3.telogen : a resting phase &last for 3 months.
Transformation of vellous hair to terminal hair at puberty is driven by systemic androgen.
Hirsutism is the result of the change in the quality,size,degree of pigmentation& length of the hair produced by individual follicle.
Incidance:
It varies with cultural&social factor.
It affect about 9% of female.
Pathogenesis: the active form of testosterone,dihydrotestosterone interact with dermal papilla s androgen recepters result in increase the size of hair follicle& the type of hair produced by this follicle.
Hirsutism occur in about 60%-70% of patient with PCOS.
Clinical feature :Ferriman&Gallwey grading system is widely used .
Treatment:
1.physical methods:
a. bleaching
b.shaving
c.electrolysis
d. weight loss in obese one with polycystic ovaries.
2.pharmacological method:
oral contraceptive pills
cyproterone acetate
spironolactone
flutamide
finasteride
the last two drugs are rarely used.
Virilism:
Is invariably due to excessive androgenic stimulation& the source of androgen is either the adrenal cortex or the ovary.
The clinical feature of virilism are defeminizing secondary amenorrhea, loss of subcutaneous fat, breast atrophy, positive masculine feature(deepening of the voice, temporal recession of hair growth, clitoral enlargement& abnormal hair growth).
Causes:
congenital adrenal hyperplasia
iatrogenic virilism
adrenal tumor
musculinizing ovarian tumor
Cushing syndrome
acromegaly
rarely PCOS.
In order to reach the diagnosis ,the following investigation should be performed
1.17-hydroxy progesterone
2.serum cortisol
3. dexamethasone suppression test
4. MRI of adrenal gland
5. free testosterone
6. androstenedion&DHEA
7.chromosomal study.
Treatment:
It depend upon the diagnosis& natural history of the condition
Related articles:
Further reading:
1.Dewhurst s text book.
2.essential in obstetrics and gynecology.