Hirsuitsm can be induced by various drugs

Hirsutism is a human hair growth and development disorder that affects approximately 5 percent to 15 percent women. Its main signs are dense, coarse and excess hair growth in a male-like pattern in various body parts of women, like in the face, neck, chest, lower abdomen etc. At least 5 percent of women of reproductive age suffer from this ailment. Hirsutism is the cause of substantial social and psychological agony, apart from the associated ailments and risks.

Drug induced hirsutism is a rare cause and other causes of this disease must be ruled out before it is confirmed. First let us check out the three sets of causes of hirsutism to understand the drug induced type better:

1. Androgenic causes.
2. Idiopathic hirsutism.
3. Nonandrogenic factors are the one’s that are not related to disproportionate androgen activity. Under this category comes the drug induced type of hirsutism.

Androgenic causes: They are mainly a result of androgen excess disorder, since this hormone plays a vital role in the production and development of human hair. Among the androgenic causes, the Polycystic Ovarian Syndrome (PCOS) is the most common and accounts for 70–80% of hirsute cases. The rarer syndromes and their percentage of prevalence are as below:

• Hyperandrogenism - 6.8%
• Hypothyroidism - 0.7%
• The hyperandrogenic insulin-resistant acanthosis nigricans syndrome (HAIR-AN) - 3 %
• 21-hydroxylase non-classic I adrenal hyperplasia (late-onset CAH) - 1.6%
• 21-hydroxylase-deficient congenital adrenal hyperplasia - 0.7%
• Hyperprolactinemia - 0.3%
• Androgenic tumors - 0.2%
• Cushing’s syndrome - 0-1%

Idiopathic hirsutism: The idiopathic cause is traced in 4.7 percent patients and its associated symptoms are hirsutism and probable overactive 5a-reductase action in skin and hair follicle. However, menses are regular.

Non-androgenic causes: They are less prevalent and can be divided in the following forms:

1. Unnecessary hair growth of acromegalics.
2. Coarsening of the hairs associated with chronic skin problems, since a major function of the hair is to protect the skin
3. Non-androgenic anabolic drugs often cause a general increase of many tissues, particularly hair. This can also result in vellus hypertrichosis and not hirsutism. To evaluate this cause a detailed drug history must be conducted. The process must include clinical investigations about the use of the following drugs (exogenous pharmacologic agents) that cause hirsutism as a probable side effect:

• Danazol (Danocrine)
• Norplant
• Metoclopramide (Reglan)
• Anabolic steroids
• Methyldopa (Aldomet)
• Phenothiazines
• Progestins
• Reserpine (Serpasil)
• Testosterone
• Oral contraceptives (OCs) that contain levonorgestrel, norethindrone and norgestrel induce more powerful androgen activity, while those that include ethynodiol diacetate, norgestimate and desogestrel have lesser androgenic activity.
• Some drugs that also result in hyperprolactinemia can also cause hirsutism.

However, one must exclude the possibility of vellus hypertrichosis, that is also often medication related, before confirming a case of drug induced hirsutism.