Differential Diagnoses

Anorexia Nervosa
Congenital Hypertrichosis Lanuginosa
Hair growth (in sites of trauma and scarring)
Hurler syndrome
Hyperinsulinism
Malnutrition
Mucopolysaccharidoses Types I-VII
Trisomy 18

Workup

Mihailidis J, Dermesropian R, Taxel P, Luthra P, Grant-Kels JM. Endocrine evaluation of hirsutism. Int J Womens Dermatol. 2017 Mar. 3 (1 Suppl):S6-S10. [QxMD MEDLINE Link].
Mofid A, Seyyed Alinaghi SA, Zandieh S, Yazdani T. Hirsutism. Int J Clin Pract. 2008 Mar. 62(3):433-43. [QxMD MEDLINE Link].
Fanta M. [Hirsutism]. Ceska Gynekol. 2017 Summer. 82 (3):237-242. [QxMD MEDLINE Link].
Abdel Fattah NS, Darwish YW. Is there a role for insulin resistance in nonobese patients with idiopathic hirsutism?. Br J Dermatol. 2009 May. 160(5):1011-5. [QxMD MEDLINE Link].
Morgan J, Scholtz S, Lacey H, Conway G. The prevalence of eating disorders in women with facial hirsutism: an epidemiological cohort study. Int J Eat Disord. 2008 Jul. 41(5):427-31. [QxMD MEDLINE Link].
Escobar-Morreale HF. Diagnosis and management of hirsutism. Ann N Y Acad Sci. 2010 Sep. 1205:166-74. [QxMD MEDLINE Link].
Moghetti P, Toscano V. Treatment of hirsutism and acne in hyperandrogenism. Best Pract Res Clin Endocrinol Metab. 2006 Jun. 20(2):221-34. [QxMD MEDLINE Link].
Heidelbaugh JJ. Endocrinology Update: Hirsutism. FP Essent. 2016 Dec. 451:17-24. [QxMD MEDLINE Link].
Falsetti L, Gambera A, Legrenzi L, Iacobello C, Bugari G. Comparison of finasteride versus flutamide in the treatment of hirsutism. Eur J Endocrinol. 1999 Oct. 141(4):361-7. [QxMD MEDLINE Link].
Moghetti P, Tosi F, Tosti A, et al. Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial. J Clin Endocrinol Metab. 2000 Jan. 85(1):89-94. [QxMD MEDLINE Link].
Bergfeld WF. Hirsutism in women. Effective therapy that is safe for long-term use. Postgrad Med. 2000 Jun. 107(7):93-4, 99-104. [QxMD MEDLINE Link].
Hamzavi I, Tan E, Shapiro J, Lui H. A randomized bilateral vehicle-controlled study of eflornithine cream combined with laser treatment versus laser treatment alone for facial hirsutism in women. J Am Acad Dermatol. 2007 Jul. 57(1):54-9. [QxMD MEDLINE Link].
Unfer V, Zacche M, Serafini A, Redaelli A, Papaleo E. [Treatment of hyperandrogenism and hyperinsulinemia in PCOS patients with essential amino acids. A pilot clinical study]. Minerva Ginecol. 2008 Oct. 60(5):363-8. [QxMD MEDLINE Link].
Brown T. Updated Guidelines on Hirsutism in Premenopausal Women. Medscape News & Perspective. Available at https://www.medscape.com/viewarticle/893904. March 14, 2018; Accessed: April 13, 2018.
[Guideline] Martin KA, Anderson RR, Chang RJ, Ehrmann DA, Lobo RA, Murad MH, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 Mar 7. [QxMD MEDLINE Link].
Berek JS, Hillard PA, Adashi EY. Novak's Gynecology. 12th ed. Baltimore, Md: Williams & Wilkins; 1996. 799-801; 833-52.
Androgen excess. Scott JR, Disaia PJ, et al, eds. Danforth's Obstetrics and Gynecology. 7th ed. Philadelphia, Pa: Lippincott-Raven; 1994. 681-93.
Fauci AS, Braunwald E, Hauser SL, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998. 292-4.
Friedberg IM, Eisen AZ, Wolff K, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999. Vol 1: 746-9.

Media Gallery

Idiopathic hirsutism in an elderly woman.
The patient has late-onset congenital adrenal hyperplasia. She has clinical features similar to those found in polycystic ovarian syndrome, including hirsutism, acne, obesity, diabetes, and menstrual irregularities.
The photograph depicts hirsutism in a young woman with polycystic ovarian syndrome. Note the acne lesions and excessive hair on her face and neck.
The photograph depicts familial hirsutism in a Pakistani woman.

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Author

Basil M Hantash, MD, PhD, MBA Medical Director, Advanced Skin Institute

Basil M Hantash, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, Sigma Xi, The Scientific Research Honor Society, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Leonard Sperling, MD Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Herbert P Goodheart, MD Assistant Clinical Professor, Department of Dermatology, Mount Sinai Hospital

Disclosure: Nothing to disclose.

Bobby Y Reddy, MS University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Disclosure: Nothing to disclose.

Hendrik I Uyttendaele, MD, PhD Instructor, Department of Dermatology, Columbia Presbyterian Medical Center

Disclosure: Nothing to disclose.