Management of Hirsutism

Journal Watch:


Management of hirsutism

Alsantali and Shapiro

Skin Therapy Letter

2009 Sep;14(7):1-3.
Highlights:

•  More than 70% of hirsutism is caused by PCOS
• Early morning plasma total testosterone level and free testosterone level need to be evaluated in cases of mild to moderate hirsutism OR any severity of hirsutism with certain listed key clinical features.
•  Topical Eflornithine 13.9% is FDA approved for reduction of unwanted facial hair in women but takes six to eight weeks to start showing any results. It may cause itching and dryness in some women.
• Oral Contraceptive Pills are the mainstay of treatment. Commonly used brand names are Diane (Ethinyl Estradiol + 2 mg Cyproterone Acetate) and Yasmin (Ethinyl Estradiol + 3 mg Drospirenone).
• Flutamide and Finasteride have some effect but are not first line treatments for hirsutism.
• Insulin Sensitizers like Metformin give limited or no improvement in hirsutism and are not indicated.
• GnRH agonists give good reduction of ovarian androgens. But they are expensive, require injections, therapy with estrogen and show no significant benefit over OCPs or anti andogens. 
• GnRH agonists and Glucocorticoids are not widely used in the management of hirsutism and their use is limited to certain special casesor those not responding to therapy with the other classes of drugs.