0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13
Hirsutism (Endocrinology) 717
Absolute: pregnancy; breast, ovarian or uterine cancer; clotting
disorders; previous thrombophlebitis
Relative: migraine headaches
■Spironolactone:
➣Side effects: common: irregular menses; infrequent: polyuria, dry
skin, hypotension, fatigue, hyperkalemia, hepatotoxicity, dys-
pepsia, breast tenderness
➣Contraindications:
➣Absolute: pregnancy, renal insufficiency, hyperkalemia, abnor-
mal uterine bleeding
➣Relative: drugs that elevate potassium; family history of breast
cancer
■Flutamide:
➣Side effects: amenorrhea, increased appetite, dry skin, green-
hued urine, hepatotoxicity
➣Contraindications: pregnancy (absolute)
■Finasteride:
➣Side effects: none
➣Contraindications: pregnancy (absolute)
■Eflornithine:
➣Side effects: dysesthesias at application sites
➣Contraindications: pregnancy (absolute)follow-up
During Treatment
■At 3–6 mo intervals: related acne usually responds in 1–3 mo
■Slow response, mechanical means needed for existing hair
■Establish 1 or more objective measures to follow:
➣Time spent on hair removal
➣Frequency of mechanical interventions
➣Photographs after using no cosmetic measures for arbitrary time
q3mo
➣Weigh shaven hair q 3 mo
➣Periodically repeat Ferriman-Gallwey scoreRoutine
■Quarterly to annual office visit for 1 or 2 y, periodically thereafter,
depending on severity and associated problems
■Add medicine if no improvement in 6 mo
■Reduce dose of antiandrogen if benefit stable