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Hirsutism

Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Updated in February 2016.


Hirsutism — codes and concepts
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What is hirsutism?

Hirsutismis a male pattern of secondary or post-pubertal头发growth occurring in women. It arises in the moustache and beard areas atpuberty当头发也出现在腋下和耻骨区域的非骑兵妇女中时。妇女也可能开发thicker, longer hair than is usual on their limbs and trunk.

毛毛主义也被称为痛苦。

Hirsutism

谁得到了毛毛主义?

哪些妇女被认为是因培训而变化的culture和种族,随着次生头发生长的正常范围随种族而变化。还应该指出的是,妇女花费大量时间和精力去除多余的头发,,,,resulting in an unnaturally hair-free norm in today’s society.

  • 通常在遗传上确定头发生长的毛发模式,由男性和女性家庭成员证实,头发的头发也比平均水平更多。
  • Late-onset hirsutism may be due to hyperandrogenism, ie an increase in circulating雄激素including睾丸激素
  • Mild hirsutism can develop in pregnancy.

超雄激素通常与polycystic ovaries,,,,胰岛素resistance and obesity. Rare causes include:

  • 雄激素药物
  • 库欣syndrome
  • 先天性adrenalhyperplasia
  • 肾上腺gland或卵巢

What causes hirsutism?

Different基因expressed in individual hair卵泡svary in their response to androgens.

  • Hair follicles in secondary hair growth sites are more sensitive to androgens than those in other areas.
  • Androgens alter mesenchyme-上皮细胞相互作用,改变头发生长的持续时间,dermal乳头大小和皮肤乳头细胞,角质形成细胞melanocyteactivity.
  • Small vellus follicles producing tiny, virtually invisible hairs become larger intermediate and terminal follicles making bigger色素头发。

What are the clinical features of hirsutism?

Hirsutism通常在十几岁末期首先注意到,随着女性年龄的增长,往往会逐渐变得更加严重。

毛毛主义可能涉及一个单位或多个站点。

  • 面部头发:胡子,胡须,眉毛
  • 腹部:阴毛的钻石形状延伸到umbilicus
  • 胸部:乳头周围或更广泛的生长
  • 背部上方
  • Inner thighs

使用Ferriman-Gallwey Visual评估了多毛的严重性scale或修改版本,评估身体的9个区域。分数在每个区域的0(无头发)到4(广泛的头发生长)不等。

  • Total score < 8: normal hair growth
  • 总分8–14:温和的赫尔斯特斯
  • 总分≥15:中度至重度

Ferriman-Gallwey的视觉量表评估多毛症。Open access file.

一般检查

A general examination may reveal clues as to the cause of hirsutism.

  • Acanthosisnigricans建议胰岛素抵抗。
  • 半乳乳菌提示高酸性血症。
  • Purple striae, thin skin, bruising and facial plethora suggest库欣syndrome
  • Virilisationsuggests hyperandrogenism. Signs include:
    • Deepening voice
    • Balding
    • Acne
    • 乳房大小的减小
    • 阴蒂的扩大
    • 增加肌肉的体积。

Diagnostic features for polycystic ovary syndrome are:

  1. Oligo/anovulation
  2. 高雄激素的临床/生化体征
  3. Presence of ≥12 follicles in each ovary, measuring 2–9 mm in diameter and/or increased ovarian volume (> 10 mL) on pelvic/transvaginal超声((optional).

痛觉的并发症

People affected by excessive hair may suffer from great embarrassment with consequent社会心理effects。他们可能会付出相当大的长度和费用来删除头发。

如果有的话,其他并发症可能来自潜在的疾病。

如何被诊断出痛觉主义?

Hirsutism is diagnosed clinically. Investigations are not usually necessary unless the patient has a Ferriman-Gallwey score of > 15 when blood tests are done to evaluate male hormone levels and underlying diseases.

自由的雄激素指数是总睾丸激素浓度除以性别激素结合球蛋白浓度并乘以100。如果升高,请检查:

  • 二羟基甲状不是硫酸盐硫酸盐(如果雄激素为肾上腺起源,则升高)
  • 雄激素(如果雄激素为卵巢起源,则升高)。

如果早期的痛觉,过早adrenarche,和/或先天性肾上腺增生的家族史:

  • 17-羟基酸酯。

If Cushingoid features:

  • Urinary and血清皮质醇或过夜地塞米松测试。

如果月经障碍:

  • Luteinising hormone (LH) and卵泡刺激激素(FSH)
  • 催乳素。

总体健康:

  • 甲状腺功能
  • Glucose
  • Lipids((胆固醇甘油三酸酯
  • 成像,根据任何症状。

可以对卵巢进行骨盆检查和腹部/经阴道超声检查,如polycystic ovaries是多毛主义的普遍原因。

Physical methods of hair removal

漂makes excessive hair less obvious.

脱敏性creams

脱尿霜通常基于硫甘氨酸酯(也用于perming解决方案)。将厚的层施加到毛茸茸的区域15-30分钟,然后擦掉,头发脱落cream。脱敏性creams can irritate and cause皮炎

Shaving

Shaving,如有必要,每天两次,将防止难看的茬。剃须不会使头发变得更厚。

打蜡

打蜡needs to be repeated every six weeks. The warm wax hardens on the skin and as it is stripped off, the hairs are pulled out with it from the roots.

Electric hair removers

这些通过合并的切割和拉动去除头发。

Electrolysis/thermolysis

Electrolysisor thermolysis may result in permanent hair loss but it takes time. A small probe is inserted along each hair, and a small electrical or heat释放破坏头发。每隔几周就会处理一个小区域。如果受影响的地区广泛,可能会很昂贵。非熟练治疗可能会导致疤痕。

Laser治疗

Long wavelengthlasers强烈的脉冲光是脱毛最有效的设备。这主要用于黑发在白色皮肤中生长,但棕色皮肤中的深色头发也可以由某些中心处理。预计在几个月到几年中进行多种治疗。

Complications of physical methods of hair removal

卵泡炎的风险是一个不幸的采摘、剃须和waxing. The treated hair follicles become inflamed, and painfulpustulesmay develop.

卵泡炎may take weeks to settle. Hair removal has to be stopped, at least temporarily.

由于脱毛引起的卵泡炎

Medical treatment of hirsutism

女人polycystic ovarian syndrome,,,,particularly if they are overweight or have代谢综合征,,,,may be prescribed metformin or rosiglitazone (more commonly used in type 2 diabetes).

激素治疗使用抗雄激素药物(抵消雄性激素)可用于中度或重度毛肌症的女性。在许多情况下,头发的生长会减慢,头发变得更薄且不明显。注意到差异很大,需要六到十二个月,然后应该继续使用几年。

螺内酯

螺内酯每天50-200毫克可以缓慢降低头发的过度生长。有时与口服避孕药结合使用。副作用包括嫩乳房和不规则的月经出血。

口服避孕药

虽然几个低剂量合并birth控制药丸may be helpful, it is best to select one that has been specifically formulated to treat hirsutism. These contain雌激素和antiandrogenicprogesterone:cyproterone(Co-Pyrindiol,带有商标名称Diane™-35,Estelle™35,Gien™84),drospirenone(Yasmin™,Yaz™)或Dienogest(Valette™)。副作用包括斑点(时期出血),嫩乳房,恶心和头痛,尤其是在最初的几个月中。口服避孕药并不适合所有人。请参考新西兰卫生部(Medsafe)有关使用混合口服避孕药的建议。

cyproterone

Larger doses ofcyproterone((50–200 mg for 10 days each cycle), are combined with the oral contraceptive pill and are very effective for most women with hirsutism. Side effects include weight gain, depression, and loss of libido. Specialist approval is required for prescription in New Zealand.

脱毛霜elflornithineare available in some countries.

How can hirsutism be prevented?

尚无法防止遗传预测的过度头发生长。与肥胖相关的胰岛素抵抗可以通过减肥和饮食控制来降低。

多毛主义的前景是什么?

Prognosis取决于原因。头发生长的最常见类型坚持终身。多毛主义的趋势随着年龄的增长而变得更加明显。

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