Hirsutism medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hirsutism}} | {{Hirsutism}} | ||
{{CMG}}; {{AE}}{{ | {{CMG}}; {{AE}}{{EG}} | ||
==Overview== | ==Overview== | ||
Pharmacologic medical therapies for hirsituism include [[oral contraceptives]], [[antiandrogen therapy|androgen receptor blockers]], [[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]], [[GnRH|gonadotrophin-releasing hormone]] ([[GnRH agonist]]), [[adrenal]] suppressive [[glucocorticoids]], [[insulin]]-sensitising agents, and biological modifiers of hair follicular growth. Treatment options are [[systemic therapy]] and [[topical|topical therapy]]. | Pharmacologic medical therapies for hirsituism include [[oral contraceptives]], [[antiandrogen therapy|androgen receptor blockers]], [[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]], [[GnRH|gonadotrophin-releasing hormone]] ([[GnRH agonist]]), [[adrenal]] suppressive [[glucocorticoids]], [[insulin]]-sensitising agents, and biological modifiers of hair follicular growth. Treatment options are [[systemic therapy]] and [[topical|topical therapy]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacologic medical therapies for hirsituism include:<ref name="pmid20418968">{{cite journal| author=Sachdeva S| title=Hirsutism: evaluation and treatment. | journal=Indian J Dermatol | year= 2010 | volume= 55 | issue= 1 | pages= 3-7 | pmid=20418968 | doi=10.4103/0019-5154.60342 | pmc=2856356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20418968 }} </ref> | *Pharmacologic medical therapies for hirsituism include:<ref name="pmid20418968">{{cite journal| author=Sachdeva S| title=Hirsutism: evaluation and treatment. | journal=Indian J Dermatol | year= 2010 | volume= 55 | issue= 1 | pages= 3-7 | pmid=20418968 | doi=10.4103/0019-5154.60342 | pmc=2856356 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20418968 }} </ref> | ||
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*** Preferred regimen (1): [[Eflornithine|Eflornithine hydrochloride]] 13.9% cream topical q12h<ref name="pmid18252793">{{cite journal |vauthors=Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA |title=Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline |journal=J. Clin. Endocrinol. Metab. |volume=93 |issue=4 |pages=1105–20 |year=2008 |pmid=18252793 |doi=10.1210/jc.2007-2437 |url=}}</ref> | *** Preferred regimen (1): [[Eflornithine|Eflornithine hydrochloride]] 13.9% cream topical q12h<ref name="pmid18252793">{{cite journal |vauthors=Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA |title=Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline |journal=J. Clin. Endocrinol. Metab. |volume=93 |issue=4 |pages=1105–20 |year=2008 |pmid=18252793 |doi=10.1210/jc.2007-2437 |url=}}</ref> | ||
*** Preferred regimen (2): [[Finasteride]] 0.25% or 0.5% cream topical daily<ref name="pmid22658123">{{cite journal |vauthors=Farshi S, Mansouri P, Rafie F |title=A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism |journal=J Cosmet Laser Ther |volume=14 |issue=4 |pages=193–9 |year=2012 |pmid=22658123 |doi=10.3109/14764172.2012.699680 |url=}}</ref> | *** Preferred regimen (2): [[Finasteride]] 0.25% or 0.5% cream topical daily<ref name="pmid22658123">{{cite journal |vauthors=Farshi S, Mansouri P, Rafie F |title=A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism |journal=J Cosmet Laser Ther |volume=14 |issue=4 |pages=193–9 |year=2012 |pmid=22658123 |doi=10.3109/14764172.2012.699680 |url=}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
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|25 mg | |25 mg | ||
|- | |- | ||
|rowspan="2" |[[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]] | | rowspan="2" |[[5-alpha-reductase inhibitor|5-alpha reductase inhibitors]] | ||
|[[Finasteride]] | |[[Finasteride]] | ||
|1-5 mg | |1-5 mg | ||
|rowspan="2" | | | rowspan="2" | | ||
*Type II inhibitor of the [[5-alpha-reductase|5α-reductase enzyme]] | *Type II inhibitor of the [[5-alpha-reductase|5α-reductase enzyme]] | ||
*Reduces the conversion of [[testosterone]] into [[dihydrotestosterone]] | *Reduces the conversion of [[testosterone]] into [[dihydrotestosterone]] | ||
|rowspan="2" | | | rowspan="2" | | ||
*[[Feminisation]] of the male fetus | *[[Feminisation]] of the male fetus | ||
*[[Liver dysfunction]] | *[[Liver dysfunction]] | ||
|rowspan="2" | | | rowspan="2" | | ||
- | - | ||
|- | |- | ||
| Line 197: | Line 194: | ||
|10-30 mg | |10-30 mg | ||
|} | |} | ||
==References== | ==References== | ||
Latest revision as of 22:59, 7 November 2017
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Hirsutism Microchapters |
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Diagnosis |
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Treatment |
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Medical Therapy |
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Case Studies |
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Hirsutism medical therapy On the Web |
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Risk calculators and risk factors for Hirsutism medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Pharmacologic medical therapies for hirsituism include oral contraceptives, androgen receptor blockers, 5-alpha reductase inhibitors, gonadotrophin-releasing hormone (GnRH agonist), adrenal suppressive glucocorticoids, insulin-sensitising agents, and biological modifiers of hair follicular growth. Treatment options are systemic therapy and topical therapy.
Medical Therapy
- Pharmacologic medical therapies for hirsituism include:[1]
- Oral contraceptives
- Androgen receptor blockers
- 5-alpha reductase inhibitors
- Gonadotrophin-releasing hormone (GnRH agonist)
- Adrenal suppressive glucocorticoids
- Insulin-sensitising agents
- Biological modifiers of hair follicular growth
Hirsutism
- 1. Adult
- 1.1 Systemic therapy
- Preferred regimen (1): Ethinyl estradiol 30 μg PLUS norethindrone 1 mg PO daily over a 9-month period[2]
- Preferred regimen (2): Mestranol 100 μg PLUS norethindrone 2 mg PO daily for about 2 weeks[3]
- Preferred regimen (3): Ethinyl estradiol 30 μg PLUS desogestrel 150 mcg PO daily for 4-7 months[4]
- Preferred regimen (4): Spironolactone starting dose of 50 mg PO q12h; may be increased to 200 mg PO daily.[5]
- Alternative regimen (1): Cyproterone Acetate 50-100 mg PO daily[6]
- Alternative regimen (2): Cyproterone Acetate 2 mg PLUS ethinyl estradiol 35 μg PO daily[7]
- Alternative regimen (3): Finasteride 1-5 mg PO daily[8]
- Alternative regimen (4): Flutamide 125-250 mg PO q12h
- Alternative regimen (5): Bicalutamide 25 mg PO daily[9]
- Alternative regimen (6): Metformin 500-1000 mg PO q12h[10]
- Alternative regimen (7): Rosiglitazone 4-8 mg PO daily
- Alternative regimen (8): Pioglitazone 10-30 mg PO daily[11]
- Alternative regimen (9): Leuprolide 7.5 mg IM PLUS estradiol 25-50 µg transdermal monthly[12]
- Alternative regimen (10): Prednisone 5-10 mg PO daily[13]
- 1.2 Topical Therapy
- Preferred regimen (1): Eflornithine hydrochloride 13.9% cream topical q12h[14]
- Preferred regimen (2): Finasteride 0.25% or 0.5% cream topical daily[15]
- 1.1 Systemic therapy
| Group | Medicine | Dosage | Mechanism of action | Side effect | Notes |
|---|---|---|---|---|---|
| Oral Contraceptive Pills (OCPs) | Ethinyl estradiol/ Norethindrone |
30 μg / 1.0 mg |
|
|
|
| Mestranol/norethindrone | 100 μg / 2mg | ||||
| Ethinyl estradiol/ desogestrel |
30 μg / 150 mcg | ||||
| Antiandrogens | Spironolactone | 100-200 mg |
|
| |
| Cyproterone Acetate | 50-100 mg |
|
|
- | |
| Cyproterone Acetate/ ethinyl estradiol |
2 mg / 35 μg | ||||
| Flutamide | 125-250 mg |
|
| ||
| Bicalutamide | 25 mg | ||||
| 5-alpha reductase inhibitors | Finasteride | 1-5 mg |
|
|
- |
| Dutasteride | 0.5 mg | ||||
| Gonadotrophin-releasing hormone (GnRH agonist) | Leuprolide | 7.5 mg |
|
|
|
| Adrenal suppressive glucocorticoids | Prednisone | 5-10 mg |
|
- | |
| Insulin-sensitising agents | Metformin | 500-1000 mg |
|
|
|
| Rosiglitazone | 4-8 mg | ||||
| Pioglitazone | 10-30 mg |
References
- ↑ Sachdeva S (2010). "Hirsutism: evaluation and treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.
- ↑ Murphy A, Cropp CS, Smith BS, Burkman RT, Zacur HA (1990). "Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women". Fertil. Steril. 53 (1): 35–9. PMID 2136834.
- ↑ Givens, James R.; Andersen, Richard N.; Wiser, Winfred L.; Fish, Stewart A. (1974). "Dynamics of Suppression and Recovery of Plasma FSH, LH, Androstenedione and Testosterone in Polycystic Ovarian Disease Using an Oral Contraceptive". The Journal of Clinical Endocrinology & Metabolism. 38 (5): 727–735. doi:10.1210/jcem-38-5-727. ISSN 0021-972X.
- ↑ Dewis P, Petsos P, Newman M, Anderson DC (1985). "The treatment of hirsutism with a combination of desogestrel and ethinyl oestradiol". Clin. Endocrinol. (Oxf). 22 (1): 29–36. PMID 3156694.
- ↑ Shaw JC (1991). "Spironolactone in dermatologic therapy". J. Am. Acad. Dermatol. 24 (2 Pt 1): 236–43. PMID 1826112.
- ↑ Lumachi F, Rondinone R (2003). "Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism". Fertil. Steril. 79 (4): 942–6. PMID 12749435.
- ↑ Van der Spuy ZM, le Roux PA (2003). "Cyproterone acetate for hirsutism". Cochrane Database Syst Rev (4): CD001125. doi:10.1002/14651858.CD001125. PMID 14583927.
- ↑ Faloia E, Filipponi S, Mancini V, Di Marco S, Mantero F (1998). "Effect of finasteride in idiopathic hirsutism". J. Endocrinol. Invest. 21 (10): 694–8. doi:10.1007/BF03350800. PMID 9854686.
- ↑ Castelo-Branco C, Cancelo MJ (2010). "Comprehensive clinical management of hirsutism". Gynecol. Endocrinol. 26 (7): 484–93. doi:10.3109/09513591003686353. PMID 20218823.
- ↑ Paparodis R, Dunaif A (2011). "The Hirsute woman: challenges in evaluation and management". Endocr Pract. 17 (5): 807–18. doi:10.4158/EP11117.RA. PMID 21856600.
- ↑ Blume-Peytavi U (2013). "How to diagnose and treat medically women with excessive hair". Dermatol Clin. 31 (1): 57–65. doi:10.1016/j.det.2012.08.009. PMID 23159176.
- ↑ Bode D, Seehusen DA, Baird D (2012). "Hirsutism in women". Am Fam Physician. 85 (4): 373–80. PMID 22335316.
- ↑ Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, Pugeat M, Qiao J, Wijeyaratne CN, Witchel SF, Norman RJ (2012). "Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society". Hum. Reprod. Update. 18 (2): 146–70. doi:10.1093/humupd/dmr042. PMID 22064667.
- ↑ Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA (2008). "Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline". J. Clin. Endocrinol. Metab. 93 (4): 1105–20. doi:10.1210/jc.2007-2437. PMID 18252793.
- ↑ Farshi S, Mansouri P, Rafie F (2012). "A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism". J Cosmet Laser Ther. 14 (4): 193–9. doi:10.3109/14764172.2012.699680. PMID 22658123.