Hirsutism medical therapy: Difference between revisions

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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 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>
===Disease Name===
**[[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
**Biological modifiers of hair follicular growth


* '''1 Stage 1 - Name of stage'''
===Hirsutism===
** 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 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)
****1.1.2.2 (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)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
*1. '''Adult'''
** 2.1 '''Specific Organ system involved 1 '''
**1.1 '''Systemic therapy'''
**: '''Note (1):'''  
*** Preferred regimen (1): [[Ethinyl estradiol]] 30 μg '''''PLUS''''' [[Norethindrone]] l mg PO daily over a 9-month period<ref name="pmid2136834">{{cite journal |vauthors=Murphy A, Cropp CS, Smith BS, Burkman RT, Zacur HA |title=Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women |journal=Fertil. Steril. |volume=53 |issue=1 |pages=35–9 |year=1990 |pmid=2136834 |doi= |url=}}</ref> 
**: '''Note (2)''':
*** Preferred regimen (2): [[Mestranol]] 100 μg '''''PLUS''''' [[Norethindrone]] 2 mg PO daily for about 2 weeks<ref name="GivensAndersen1974">{{cite journal|last1=Givens|first1=James R.|last2=Andersen|first2=Richard N.|last3=Wiser|first3=Winfred L.|last4=Fish|first4=Stewart A.|title=Dynamics of Suppression and Recovery of Plasma FSH, LH, Androstenedione and Testosterone in Polycystic Ovarian Disease Using an Oral Contraceptive|journal=The Journal of Clinical Endocrinology & Metabolism|volume=38|issue=5|year=1974|pages=727–735|issn=0021-972X|doi=10.1210/jcem-38-5-727}}</ref>
**: '''Note (3):'''  
*** Preferred regimen (3): [[Ethinyl estradiol]] 30 μg '''''PLUS''''' [[Desogesterol]] 150 mcg PO daily for 4-7 months<ref name="pmid3156694">{{cite journal |vauthors=Dewis P, Petsos P, Newman M, Anderson DC |title=The treatment of hirsutism with a combination of desogestrel and ethinyl oestradiol |journal=Clin. Endocrinol. (Oxf) |volume=22 |issue=1 |pages=29–36 |year=1985 |pmid=3156694 |doi= |url=}}</ref>
*** 2.1.1 '''Adult'''
*** Preferred regimen (4): [[Spironolactone]] starting dose of 50 mg PO q12h; may be increased to 200 mg PO daily.<ref name="pmid1826112">{{cite journal |vauthors=Shaw JC |title=Spironolactone in dermatologic therapy |journal=J. Am. Acad. Dermatol. |volume=24 |issue=2 Pt 1 |pages=236–43 |year=1991 |pmid=1826112 |doi= |url=}}</ref>
**** Parenteral regimen
*** Alternative regimen (1): [[Cyproterone|Cyproterone Acetate]] 50-100 mg PO daily<ref name="pmid12749435">{{cite journal |vauthors=Lumachi F, Rondinone R |title=Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism |journal=Fertil. Steril. |volume=79 |issue=4 |pages=942–6 |year=2003 |pmid=12749435 |doi= |url=}}</ref>
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*** Alternative regimen (2): [[Cyproterone|Cyproterone Acetate]] 2 mg '''''PLUS''''' [[Ethinyl estradiol]] 35 μg PO daily<ref name="pmid14583927">{{cite journal |vauthors=Van der Spuy ZM, le Roux PA |title=Cyproterone acetate for hirsutism |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD001125 |year=2003 |pmid=14583927 |doi=10.1002/14651858.CD001125 |url=}}</ref>
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*** Alternative regimen (3): [[Finasteride]] 1-5 mg PO daily<ref name="pmid9854686">{{cite journal |vauthors=Faloia E, Filipponi S, Mancini V, Di Marco S, Mantero F |title=Effect of finasteride in idiopathic hirsutism |journal=J. Endocrinol. Invest. |volume=21 |issue=10 |pages=694–8 |year=1998 |pmid=9854686 |doi=10.1007/BF03350800 |url=}}</ref>
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
*** Alternative regimen (4): [[Flutamide]] 125-250 mg PO q12h
**** Oral regimen
*** Alternative regimen (5): [[Bicalutamide ]] 25 mg PO daily<ref name="pmid20218823">{{cite journal |vauthors=Castelo-Branco C, Cancelo MJ |title=Comprehensive clinical management of hirsutism |journal=Gynecol. Endocrinol. |volume=26 |issue=7 |pages=484–93 |year=2010 |pmid=20218823 |doi=10.3109/09513591003686353 |url=}}</ref>
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*** Alternative regimen (6): [[Metformin]] 500-1000 mg PO q12h<ref name="pmid21856600">{{cite journal |vauthors=Paparodis R, Dunaif A |title=The Hirsute woman: challenges in evaluation and management |journal=Endocr Pract |volume=17 |issue=5 |pages=807–18 |year=2011 |pmid=21856600 |doi=10.4158/EP11117.RA |url=}}</ref>
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*** Alternative regimen (7): [[Rosiglitazone]] 4-8 mg PO daily
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*** Alternative regimen (8): [[Pioglitazone]] 10-30 mg PO daily<ref name="pmid23159176">{{cite journal |vauthors=Blume-Peytavi U |title=How to diagnose and treat medically women with excessive hair |journal=Dermatol Clin |volume=31 |issue=1 |pages=57–65 |year=2013 |pmid=23159176 |doi=10.1016/j.det.2012.08.009 |url=}}</ref>
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
*** Alternative regimen (9): [[Leuprolide]] 7.5 mg IM '''''PLUS''''' [[Estradiol]] 25-50 µg [[transdermal]] monthly<ref name="pmid22335316">{{cite journal |vauthors=Bode D, Seehusen DA, Baird D |title=Hirsutism in women |journal=Am Fam Physician |volume=85 |issue=4 |pages=373–80 |year=2012 |pmid=22335316 |doi= |url=}}</ref>
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*** Alternative regimen (10): [[Prednisone]] 5-10 mg PO daily<ref name="pmid22064667">{{cite journal |vauthors=Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, Pugeat M, Qiao J, Wijeyaratne CN, Witchel SF, Norman RJ |title=Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society |journal=Hum. Reprod. Update |volume=18 |issue=2 |pages=146–70 |year=2012 |pmid=22064667 |doi=10.1093/humupd/dmr042 |url=}}</ref>
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
**1.2 '''Topical Therapy'''
*** 2.1.2 '''Pediatric'''
*** 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>
**** Parenteral regimen
*** 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 (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)
** 2.2 '''Other Organ system involved 2'''
**: '''Note (1):'''
**: '''Note (2):'''
**: '''Note (3):'''  
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** 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)


==Overview==
==Overview==

Revision as of 19:15, 9 October 2017

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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

Hirsutism

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

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 [17] 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.[18]

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.[19]

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

[20]

References

  1. ↑ Sachdeva S (2010). "Hirsutism: evaluation and treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Shaw JC (1991). "Spironolactone in dermatologic therapy". J. Am. Acad. Dermatol. 24 (2 Pt 1): 236–43. PMID 1826112.
  6. ↑ Lumachi F, Rondinone R (2003). "Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism". Fertil. Steril. 79 (4): 942–6. PMID 12749435.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ Castelo-Branco C, Cancelo MJ (2010). "Comprehensive clinical management of hirsutism". Gynecol. Endocrinol. 26 (7): 484–93. doi:10.3109/09513591003686353. PMID 20218823.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ Bode D, Seehusen DA, Baird D (2012). "Hirsutism in women". Am Fam Physician. 85 (4): 373–80. PMID 22335316.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ Rosenfield, Robert L. (2005). "Hirsutism". New England Journal of Medicine. 353 (24): 2578–2588. doi:10.1056/NEJMcp033496. ISSN 0028-4793.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.

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