Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hirsutism (Dermatology) 713

■Hair bleach

■Laser hair removal

■Electrolysis

■Oral contraception: helps 75% of cases with ovarian or adrenal

etiology

■Glucocorticoids as needed for CAH

■Eflornithine cream (Vaniqa) – 13.9% applied BID

➣Not a hair remover – slows growth and lengthens normal hair

cycle

■Antiandrogens

➣Cimetidine – weak

➣Cyproterone acetate – FDA orphan drug

Generic Name: Cyproterone acetate; Trade Name: Androcur

Orphan Indication: Treatment of severe hirsutism

Sponsor: Berlex Laboratories, Inc. Contact: Dr. Suzanne Hamp-

ton, Wayne, NJ; (973) 694–4100

➣Spironolactone: 75–200 mg/day, start at 50 mg BID

➣Finasteride: 5-alpha-reductase inhibitor, 5 mg/day

➣GnRH (gonadatropin releasing hormone)

■Surgical treatment of any neoplasm

Side Effects & Complication

■Systemic Rx: all require strict contraception – possible feminization

of male fetus

■Spironolactone: contraindicated in renal insufficiency

■Laser: post-inflammatory pigmentation changes, hypertrophic scar-

ring

follow-up

■Depends on treatment modality

■Rule out any serious underlying disorder.

■OB/GYN or Endocrine consults for severe or rapid-onset cases, or

where underlying disease diagnosis warrants

complications and prognosis

Complications

■Feminization of male fetus

■Side effects of individual treatments

Prognosis

■Treatable underlying disorder (e.g., neoplasm): varies with etiology

➣Hirsutism may resolve.