According to statistics, hirsutism occurs in 5% of women of reproductive age. Ethnic hirsutism, which is commonly observed and considered a normal variant in southern Europe and Asia, begins at puberty. Other variants of hirsutism (including those associated with androgen-secreting tumors) can be observed in people of different ages. Hirsutism may occur in postmenopausal women as a result of a relative increase in androgen levels against a background of a decrease in estrogen.
Find out in the article on estet-portal.com what are the leading causes of hirsutism.
- mechanism of development of hirsutism
- Hirsutism Severity Assessment
- hirsutism and androgenetic alopecia
Mechanism of development of hirsutism
The trigger factors for the development of hirsutism, as manifestations of hyperandrogenism, do not differ from the factors for the formation of seborrhea and acne.
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The mechanism of development of hirsutism consists in hyperproduction of androgenic hormones, their accelerated transformation into more active forms due to increased activity of the 5α-reductase enzyme, increased sensitivity of androgen receptors, reduced androgen metabolism.
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The above factors lead to an increase in the size of hair follicles, an increase in hair diameter, increased pigmentation, lengthening of the anagen phase (growth phase) of hair follicles; there is no correlation between the severity of hirsutism and the level of androgens in the blood.
This is due to the fact that hirsutism occurs not only as a result of hyperproduction of androgenic hormones, but also as a result of the sensitivity of specific receptors to them and the activity of the 5α-reductase enzyme.
Therefore, when choosing the most optimal treatment for hyperandrogenism associated with hirsutism, preference should be given to combined oral contraceptives, which would affect not only the synthesis of androgenic hormones, but also the activity of their receptors and enzyme systems, which convert inactive testosterone to active dihydrotestosterone, and also had a positive effect on the synthesis of globulins that bind sex hormones.
Hirsutism Severity Assessment
The Ferriman-Gallwey scoring is used to establish the severity of hirsutism and assess the effectiveness of its correction. On this scale, a scoring of the degree of hirsutism is carried out in 9 zones:
- on the face (primarily in the area of the mustache, beard, temporal region);
- breasts;
- areola;
- linea alba;
- upper back;
- lower back;
- buttocks;
- inner thighs;
- external genitalia.
Evaluation in each zone is carried out on a 5-point scale, where 0 is the absence of hirsutism, and 4 is its maximum severity.
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If the total score in all zones is 8 or more points, then this is a sign of hirsutism, which requires a thorough examination of the patient with subsequent appointment of combined oral contraceptives in prolonged mode. In the case when the total score on the Ferriman-Gallwey scale is less than 8, but the patient has a significant thickness of hair in the above areas, this is also an indication for prescribing drugs.
Hirsutism and androgenetic alopecia
In hyperandrogenism, against the background of the transformation of vellus hair into thicker and more pigmented ones in the corresponding androgen-sensitive zones, the opposite process occurs on the scalp: under the influence of androgenic hormones, the terminal hair follicles begin to produce shorter and thinner hair , similar to guns.
Over time, these hair follicles atrophy, the anagen phase of hair growth is reduced against the background of a constant duration of the telogen phase. As a result, more hair follicles are in the telogen phase, which is clinically manifested by increased hair loss and the formation of androgenetic alopecia.
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So, androgenetic alopecia is a progressive baldness caused by the action of androgens on the hair follicles, which occurs in individuals with a genetic predisposition. It can begin in individuals of any age after the completion of puberty. Most often occurs in women over 40 years of age (noted in 50% of women of this age). However, in young women, androgenetic alopecia is also not a rare finding ─ it occurs in 13%.
Unlike other types of alopecia, androgenetic alopecia never covers the temporal and occipital zones (even in old age). In women with androgenetic alopecia, unlike men, the frontal hairline is always preserved and there is no formation of a clear focus of alopecia.
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