Hair follicles cover the entire body and different types of hair are found in different sites. Androgens affect some areas of the human body and increase hair growth rate and also the thickness of terminal hairs. Androgens are also involved in sebum production and may cause this to be excessive. In some women excessive hair growth may occur on the arms, legs, abdomen, breasts and back such that it constitutes the problem of hirsutism. This may also be associated with acne, which may occur not only on the face but on the chest and back.
DIFFERENTIAL DIAGNOSIS
There are four major groups of disorders which may cause hirsutism in adolescence (Table 37.3). Those androgenic causes include congenital adrenal hyperplasia and its late
Table 37.3 Causes of hirsutism in adolescents
Androgenic causes
Congenital adrenal hyperplasia
• Late onset Androgen-secreting tumours
Polycystic ovarian syndrome Idiopathic
XY gonadal dysgenesis onset variant and also androgen-secreting tumours. The commonest groupare women with polycystic ovarian syndrome and, while this is sometimes a difficult diagnosis to make in adolescents, it by far constitutes the greatest problem group. The diagnosis of XY gonadal dysgenesis is something that should be borne in mind when considering a child with hirsutism but a large percentage of patients have idiopathic hirsutism. It is important to remember that some girls will have a constitutional basis for their hirsutism and familial body hair patterns should be borne in mind when considering whether or not a young patient does in fact have hirsutism. Treatments for hirsutism are as in the adult and are covered in Chapter 47. In adolescence the mainstay of androgen excess treatment has been the oral contraceptive pill and without doubt this remains the main form of treatment. As the majority of these girls have some ovarian dysfunction, be that polycystic ovarian syndrome or an undefined problem, suppression of ovarian activity is very effective at circulating androgen. If this is insufficient to gain control of hair growth, then the use of cyproterone acetate or spironolactone may be considered.
In those patients who are not considered to have hir-sutism due to a medical disorder, drug therapies may be ineffective and supportive measures may be necessary for cosmetic benefit. These include hair removal by shaving, waxing or electrolysis to those areas which are particularly cosmetically sensitive and also the use of bleaches to change hair colour thereby gaining cosmetic benefit.
Continue reading here: Absence of secondary sexual characteristics
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