Dermatologic Manifestations of Hirsutism Medication
- Author: Basil M Hantash, MD, PhD; Chief Editor: William D James, MD more...
Medication Summary
Usually, pharmacologic treatments for hirsutism are selected based on the underlying cause. Medications (antiandrogens) often are administered simultaneously while cosmetic hair removal techniques are performed. All of these drugs must be administered continuously, because when they are discontinued, androgens revert to their former levels. These medications are absolutely contraindicated for use during pregnancy, because a risk exists of feminization of a male fetus.
Oral contraceptives are often the initial treatment for hirsutism caused by ovarian hyperandrogenism and idiopathic hirsutism. Oral contraceptives also help enhance antihirsutism effects and prevent adverse effects of menstrual irregularity caused by spironolactone and other antiandrogen therapy. Finasteride, a 5-alpha reductase inhibitor approved for use in benign prostatic hypertrophy and in male-pattern alopecia, blocks conversion of testosterone to its more active metabolite, dihydrotestosterone. Currently, finasteride is being evaluated for use in hormonal treatment of acne accompanied by hirsutism. For androgen-excess syndromes, such as PCOS, the following medications are used, often in combination with oral contraceptives.
Antihypertensives
Class Summary
May have properties that improve symptoms of hirsutism.
Spironolactone (Aldactone)
Effective for hormonal acne and hirsutism. May cause menstrual irregularities (usually metrorrhagia). Normal menses may resume with a reduction of dosage. Do not administer in patients already receiving antihypertensive medications, cardiac drugs, or diuretics. Not recommended in patients with renal insufficiency.
Antiandrogens
Class Summary
Block active androgen production.
Flutamide (Eulexin)
Nonsteroidal antiandrogen that inhibits androgen uptake or binding of androgen to target tissues. Approved for treatment of prostate cancer.
Cyproterone (Diane-35)
Steroidal androgen-receptor blocker and potent progestin available in the United States only for compassionate use. Acts as competitive inhibitor of testosterone and DHEA-S at level of androgen receptors.
Powerful antiandrogen usually administered with estrogens to maintain regular menstruation and to prevent conception. Contains a combination of cyproterone acetate and ethinyl estradiol.
Dermatologic agents
Class Summary
May inhibit cell growth and proliferation.
Eflornithine cream (Vaniqa)
Recently approved by the FDA. Prescription topical cream that acts as a growth inhibitor, not a depilatory. Inhibits ornithine decarboxylase, an enzyme required for hair growth. Reportedly takes up to 2 mo to work in approximately 30% of patients.
Glucocorticoids
Class Summary
For classic CAH, systemic corticosteroids are used. Corticosteroids are effective in reducing serum androgen levels, but contradictory reports exist regarding their therapeutic effect on hair growth.
For late-onset CAH and PCOS, oral contraceptives and spironolactone are used. In addition, small doses of dexamethasone may be helpful in reducing androgen production in late-onset CAH; however, changes suggesting Cushing disease may develop in patients receiving long-term corticosteroids.
Dexamethasone (Decadron, Dexasone)
Decreases immune reactions by suppressing migration of PMN leukocytes and reducing capillary permeability.
Prednisone (Deltasone, Sterapred, Orasone)
May decrease immune reactions by reversing increased capillary permeability and suppressing PMN activity.
Antidiabetic agents
Class Summary
Insulin-sensitizing agents appear to improve symptoms of hirsutism.
Metformin (Glucophage)
Patients with a clinical diagnosis of persistent anovulation who wish to become pregnant may benefit from use. Effective in treating hirsutism in women with PCOS. Women with PCOS also often receive oral contraceptives and/or spironolactone. If PCOS primarily is considered to be a metabolic syndrome of insulin resistance, perhaps first-line treatment should be with an insulin-sensitizing agent such as metformin.
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