Hirsutism medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of treatment for [disease name] is [therapy]. | The mainstay of treatment for [disease name] is [therapy]. | ||
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==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacologic medical therapies for hirsituism include (either) [[oral contraceptives]], [[androgen receptor blockers]], [[5-alpha reductase inhibitors]], [[gonadotrophin-releasing hormone]] ([[GnRH agonists]]), [[adrenal]] suppressive [[glucocorticoids]], and biological modifiers of hair follicular growth. | |||
*Pharmacologic medical therapies for | |||
===Disease Name=== | ===Disease Name=== | ||
Revision as of 17:30, 9 October 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: ; Ogheneochuko Ajari, MB.BS, MS [2] Rasam Hajiannasab M.D.[3]
Overview
The mainstay of treatment for [disease name] is [therapy].
OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Medical Therapy
- Pharmacologic medical therapies for hirsituism include (either) oral contraceptives, androgen receptor blockers, 5-alpha reductase inhibitors, gonadotrophin-releasing hormone (GnRH agonists), adrenal suppressive glucocorticoids, and biological modifiers of hair follicular growth.
Disease Name
- 1 Stage 1 - Name of stage
- 1.1 Specific Organ system involved 1
- 1.1.1 Adult
- Preferred regimen (1): drug name 100 mg PO q12h for 10-21 days (Contraindications/specific instructions)
- Preferred regimen (2): drug name 500 mg PO q8h for 14-21 days
- Preferred regimen (3): drug name 500 mg q12h for 14-21 days
- Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
- Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
- Alternative regimen (3): drug name 500 mg PO q6h for 14–21 days
- 1.1.2 Pediatric
- 1.1.2.1 (Specific population e.g. children < 8 years of age)
- Preferred regimen (1): drug name 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
- Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
- Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
- 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
- Preferred regimen (1): drug name 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
- Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
- 1.1.2.1 (Specific population e.g. children < 8 years of age)
- 1.1.1 Adult
- 1.2 Specific Organ system involved 2
- 1.1 Specific Organ system involved 1
- 2 Stage 2 - Name of stage
- 2.1 Specific Organ system involved 1
- Note (1):
- Note (2):
- Note (3):
- 2.1.1 Adult
- Parenteral regimen
- Oral regimen
- Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
- Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
- Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
- Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
- Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
- Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
- 2.1.2 Pediatric
- Parenteral regimen
- Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
- Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
- Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
- Oral regimen
- Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
- Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
- Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
- Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
- Parenteral regimen
- 2.2 Other Organ system involved 2
- Note (1):
- Note (2):
- Note (3):
- 2.2.1 Adult
- Parenteral regimen
- Oral regimen
- Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
- Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
- Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
- Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
- Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
- Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
- 2.2.2 Pediatric
- Parenteral regimen
- Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
- Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
- Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
- Oral regimen
- Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
- Preferred regimen (2): drug name 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
- Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
- Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
- Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
- Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
- Parenteral regimen
- 2.1 Specific Organ system involved 1
Overview
Many women with unwanted hair seek methods of hair removal to control the appearance of hirsutism. But the actual causes should be evaluated by physicians, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the best course of treatment.
Medical Therapy
Pharmacologic Treatment
Hormonal Therapy
- Oral contraceptives : Suppresses free testosterone level eg Yasmin which contains 30 microgram of estradiol and 3mg of drospirenone or Yaz (20microgram of estradiol and 3mg of drospirenone).
- Gonadotropin-releasing hormone agonists :An alternative to oral contraceptives[1]
If a tumor of ovaries or adrenal glands is the underlying cause of hirsutism, surgery may be the treatment option.
- Parenteral long acting gonadotropin-releasing hormone analogues [2] combined with OCPs containing estrogen and progestin for severe hirsutism not respinding to OCPs and antiandrogen e.g Leuprolide.
Adrenal Suppression
- Oral glucocorticoids : In patients with CAH eg Prednisone or Dexamethasone.
- Metformin for infertile women with PCOS.
Antiandrogens
- Finasteride: A 5α-reductase inhibitor, 2.5mg daily. (this is rarely used because it causes fatal hepatitis with a high risk of being teratogenic.
- Eflornithine hydrochloride cream (Vaniqa): Applied twice daily to the face.
Non-Pharmacologic Treatment
- Cosmetic therapy : Bleaching, shaving, depilating agents, plucking, waxing treatments.
- Electrosurgical methods include electrosurgical epilation and Laser therapy which can remove unwanted hair for some women specially for women with dark hair and light skin.[3]
Light-source-assisted hair reduction (photoepilation) is a common method in the treatment of unwanted hair and is more effective than shaving, waxing and electrolysis.[4]
| Skin/hair color | Choice of photoepilation device |
|---|---|
| Light skin/dark hair | Relatively short wavelength |
| Dark skin/dark hair | Relatively long wavelength or IPL(intense pulsed light) |
| Light/white hair | IPL + radiofrequency |
References
- ↑ Rosenfield, Robert L. (2005). "Hirsutism". New England Journal of Medicine. 353 (24): 2578–2588. doi:10.1056/NEJMcp033496. ISSN 0028-4793.
- ↑ Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B; et al. (2010). "Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature". Exp Clin Endocrinol Diabetes. 118 (5): 291–7. doi:10.1055/s-0029-1225351. PMID 20198556.
- ↑ Franks, Stephen (2012). "The investigation and management of hirsutism". Journal of Family Planning and Reproductive Health Care. 38 (3): 182–186. doi:10.1136/jfprhc-2011-100175. ISSN 1471-1893.
- ↑ Dierickx CC, Grossman MC, Farinelli WA, Anderson RR (1998). "Permanent hair removal by normal-mode ruby laser". Arch Dermatol. 134 (7): 837–42. PMID 9681347.
- ↑ Goh CL (2003). "Comparative study on a single treatment response to long pulse Nd:YAG lasers and intense pulse light therapy for hair removal on skin type IV to VI--is longer wavelengths lasers preferred over shorter wavelengths lights for assisted hair removal". J Dermatolog Treat. 14 (4): 243–7. doi:10.1080/09546630310004171. PMID 14660273.