This document discusses the clinical approach and management of hirsutism and virilism. It defines hirsutism as excessive hair growth in androgen-dependent areas, while virilism is a more severe form involving additional masculine features. The clinical approach involves assessing a patient's history and examination findings to determine the severity and underlying cause. Management aims to remove excess hair, suppress androgens, and remove their source. Treatment options depend on the site of androgen overproduction and may include oral contraceptives, antiandrogens, cosmetic treatments like bleaching or laser, and surgery to remove tumors.

1. DR SALINI MANDAL B.G.
ASST PROFESSOR
DEPT OF OBG
FMHMC

2.  Hirsutism is the
excessive growth of
androgen dependent
sexual hair (terminal
hair) in facial and central
part of the body that
worries the patient

3.  Virilism is defined as the presence
of any one or more of the following
features—deepening of the voice,
temporal balding, amenorrhea,
enlargement of clitoris
(clitoromegaly) and breast atrophy.
 It is a more severe form of androgen
excess.
 Virilism may be due to adrenal
hyperplasia or tumors of adrenal or
ovary.

4. Sebaceous glands and hair follicles.
 Both are sensitive to androgens.
 The sebaceous glands are more sensitive to androgens
than the hair follicles.
 Hyperstimulation of the sebaceous glands leads first to
oily skin and subsequent infection results in acne.

7.  History- Onset and progression
 Physical examination
 Assess the severity of hirsutism (+/- virilisation)
 Acertain the underlying cause
 Investigations
 Treatment
CLINICAL APPROACH TO A PATIENT
WITH HIRSUTISM

8.  Onset and progression
Most of the causes begins in early adolescence
Presentation may be late depending upon the cause
Rapid progression – androgen secreting tumors
THE GUIDELINES TO PINPOINT
DIAGNOSIS

9. Principles of management
 To remove excess hair
 To suppress or neutralise the action of androgen
 To remove the source of excess androgen
MANAGEMENT

10. PRINCIPLES OF TREATMENT OF
HIRSUTISM
 Best results are achieved by combination treatment
including antiandrogens, suppression.
 Goal should be to reduce the time spent mechanically
removing unwanted hair.
 The choice of drug depends mainly on its tolerability by
each individual patient.

11. Drugs- ( depending upon the site of production of
excess androgens)
 OCPS
 Progestrogens
 Antiandrogens
 Spironolactone
 Dexamethasone
 GnRH Analogues
 Combined approach
TO SUPPRESS THE EXCESS
ANDROGEN ACTION

12. COSMETIC TREATMENT
 Bleaching - can cause irritation, purities, skin discoloration
 Shaving - Shaving does not lead to worsening of hirsutism and
is a good short-term solution for facial hair.
- Does not affect the rate or duration of anagen phase,
or diameter of hair
- But yields a blunt tip – illusion of thicker hair
 Plucking, Waxing - scarring, folliculitis, hyperpigmentation
 Depilatory creams - Irritant dermatitis
 Electrolysis - painful, erythema, inflammation, scarring
 Laser

13. Removal of the source
Adrenal or ovarian tumour – surgically treated
Cushing disease – Adrenalectomy
Radiation to pituitary
Removal of ACTH producing tumor
Iatrogenic cases – Offending drug to be stopped