Hypertrichosis or hirsutism: what is the difference?
The difference is fundamental because the examination depends on it. With hypertrichosis, hair grows excessively in any area in men, women, and children; their distribution does not depend on gender. With hirsutism, we are talking only about women whose vellus hair turns into hard and dark hair in androgen-dependent areas: above the upper lip, on the chin, around the nipples, along the midline of the abdomen, on the back. Hirsutism almost always requires hormonal testing, and hypertrichosis requires a search for a drug or systemic cause.
- Hypertrichosis: any part of the body, both sexes, hormones are usually normal
- Hirsutism: women only, male-patterned growth plates
- Hirsutism is often combined with menstrual irregularities and acne
- A combination of both conditions is possible
- Treatment tactics in these cases vary
Causes of excess hair growth
The most common preventable cause is medications. Hair begins to grow stronger a few months after starting treatment and gradually returns to normal after discontinuation, which must be agreed upon with the attending physician. The second group of reasons are diseases and conditions affecting metabolism. Local hypertrichosis stands out separately: hair grows thicker over a long-term irritated area, under a cast, in the area of a birthmark or scar. Congenital forms are extremely rare and are noticeable from birth.
- Medicines: some immunosuppressants, anticonvulsants, hair growth and blood pressure medications
- Systemic glucocorticoids with long-term use
- Anorexia nervosa and severe malnutrition
- Diseases of the thyroid gland and adrenal glands
- Porphyria and some metabolic disorders
- Local irritation, trauma, long-term wearing of a cast
- Rare congenital syndromes
When it's only a cosmetic problem
For many people, excessive hairiness is a family trait associated with the origin and type of skin. Hair grows evenly, appears gradually in adolescence, the menstrual cycle is not disrupted, and there are no other complaints. This situation does not require tests or treatment: it is enough to choose a convenient method of hair removal. It is not the amount of hair in itself that should be alarming, but the rapid change over several months, especially together with other symptoms.
- Hair growth is gradual, starting in adolescence
- Relatives have a similar picture
- Regular cycle, skin without severe acne
- No weight gain, stretch marks, pressure surges
- In this case, examination is usually not necessary.
What examinations are needed
The doctor begins with a conversation: when did the hair appear, how quickly, what medications were taken in the last year, are there any complaints about the cycle, weight, blood pressure, mood. Then it evaluates hair distribution and skin condition. If the picture indicates hirsutism or a systemic disease, hormonal testing is prescribed. If an adrenal or ovarian tumor is suspected, imaging is added. For a purely cosmetic option, tests are not needed.
- Detailed drug history
- TSH and thyroid function assessment
- Total testosterone, DHEA sulfate for suspected hirsutism
- Cortisol and tests for suspected hypercortisolism
- Ultrasound of the pelvic organs or adrenal glands according to indications
- Consultation with an endocrinologist and gynecologist for cycle disorders
Treatment and hair removal
If the cause is found, it is treated: the drug is discontinued or replaced, the functioning of the thyroid gland or adrenal glands is corrected, and nutrition is restored. Hair does not thin out immediately, it takes months. At the same time, a removal method is selected. Laser and photoepilation give long-lasting results on dark hair and light skin; electrolysis is suitable for light and gray hair. Shaving, depilatory creams and waxing do not increase hair growth, contrary to popular belief, but do require regularity. Any medications to reduce hair growth are prescribed only by a doctor.
- Cancellation or replacement of the drug in consultation with the attending physician
- Treatment of the underlying disease
- Laser and photoepilation
- Electrolysis for blonde hair
- Shaving, waxing, depilatory creams as temporary methods
- Lightening hair with a slight excess