Unwanted Hair/Excess Hair/Hirsutism

What types of hair are there?

  • Lanugo hair – long, colorless hairs seen in babies in the uterus that are shed at the end of pregnancy and in the first months of life
  • Vellus hair– also known as “peach fuzz,” are short, light-colored and barely noticeable hair over most of the body surface
  • Terminal hair – thick, long, dark hair mostly seen on the scalp in everyone, and in the beard area in men
    • During puberty an increase in male-like (androgenic) hormones causes vellus hairs in certain areas to become terminal hairs.
    • The underarms and pubic areas are particularly sensitive to androgenic hormones.
    • Males develop terminal hair in more areas than females, such as the face, chest, abdomen, back, legs and arms.
    • Females retain more of the vellus hair.

What are the types of excess hair growth?

  • Hirsutism – excessive growth of terminal hair in a male-like pattern in a woman or child
  • Hypertrichosis – hair growth that is abnormal in amount for the age and gender of an individual or for a particular area of the body.  Hypertrichosis can occur in areas that are not androgen-dependent.
  • Both of these can be caused by medications

What is hirsutism?

Hirsutism is growth of unwanted, excess terminal hair in a male-like pattern in women. As a result, dark, coarse hair grows in areas typically seen in men: upper lip, beard, chest, abdomen, back, arms and legs.  These areas are particularly sensitive to androgen hormones.  Hirsutism occurs in 5-15% of women.

What causes hirsutism?

The amount of hair on the body is largely determined by genetics and ethnicity. The average amount of hair on the body varies by ethnic groups and geographic locations. In addition, the amount of body hair is a family trait, that is, if women in your family tend to have more hair, you will be more likely to have it as well.

There are a number of conditions that can cause hirsutism.  Most of them are associated with increased levels of androgen hormones, particularly testosterone. However, hirsutism can occur in women with normal levels of hormones and normal ovulatory function (idiopathic hirsutism).

Most of the time hirsutism is primarily of cosmetic concern, however, when it is associated with other signs and symptoms, such as a deepening voice, hair loss on the scalp, acne, increased muscle mass, and decreased breast size, an underlying cause must be looked for.  Usually these signs occur in very high levels of androgen hormones.

The most common diagnosis associated with hirsutism is polycystic ovary syndrome (PCOS), a common disorder of imbalance of androgen hormones that includes the following:

  • Menstrual irregularities
  • Glucose  intolerance and insulin resistance
    • Women with PCOS are 10 times more likely to develop diabetes.
    • Women with PCOS are 2-3 times more likely to develop metabolic syndrome
    • Women with PCOS are also twice as likely to die of a heart attack (myocardial infarction)
  • Obesity
  • Infertility
  • Cysts in ovaries

Other causes of high androgen levels include Cushing’s syndrome, congenital adrenal hyperplasia, ovarian or adrenal tumors and medications. 

What does hirsutism look like?

Unwanted Hair/Excess Hair/Hirsutism  Unwanted Hair/Excess Hair/Hirsutism  Unwanted Hair/Excess Hair/Hirsutism
*Photos courtesy of Dermquest and Global Skin Atlas

How is hirsutism diagnosed?

Hirsutism is diagnosed by a detailed personal and family history and physical examination.  It is determined by history and examination whether a laboratory work-up and ultrasound of the ovaries are needed.

Treatment of hirsutism

  • Removal of unwanted hair
  • Permanent hair reduction - At Summit Medical Group we use Broad Band Light therapy (a form of IPL) to remove unwanted hair.
  • Because the growth of terminal hairs is hormonally-driven in many cases of hirsutism, more laser treatment sessions may be necessary to improve the condition.
  • Eflornithine (Vaniqa) – a cream that slows down hair growth around the lips and chin by blocking a natural substance needed for hair to grow.  Vaniqa must be applied twice a day to maintain results.
  • Treating the underlying hormonal dysfunction
  • A consultation with an endocrinologist and a gynecologist is usually requested.
  • Oral spironolactone
  • Oral contraceptives
  • Finasteride
  • Insulin-sensitizing medications, like metformin, may be helpful in controlling PCOS-related hirsutism

Summit Medical Group is proud to provide medical, surgical and cosmetic dermatology services to women and men in the Tri-State Area, New York and New Jersey, including the following counties and cities: Essex County, Morris County, Bergen County, Union County, Passaic County, Somerset County and Sussex County, NJ - Livingston, Millburn, Short Hills, West Orange, Berkley Heights, Caldwell, Cedar Grove, Cedar Knolls, Chatham, East Hanover, Englewood Cliffs, Essex Fells, Fair Lawn, Florham Park, Fort Lee, Glen Ridge, Jersey City, Kinnelon, Madison, Maplewood, Mendham, Montclair, Montvale, Morristown, New Providence, North Caldwell, Parsippany, Randolph, Roseland, South Orange, Springfield, Summit, Union, Verona, West Caldwell, Whippany and Westfield, NJ.

Unwanted Hair/Excess Hair/Hirsutism
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