A Clinical Approach to Hirsutism
Journal name: Ayushdhara
Original article title: A Clinical Approach to Hirsutism
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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S. Jaya Lekshmi
PG Scholar, Department of Kayachikitsa, Pankajakasthuri Ayurveda Medical College and PG centre , Killy, Kattakada, India
Arun Pratap
Professor and HOD, Department of Kayachikitsa, Pankajakasthuri Ayurveda Medical College and PG centre , Killy, Kattakada, India
Arjun Chand C P
Associate professor, Department of Kayachikitsa, Pankajakasthuri Ayurveda Medical College and PG centre , Killy, Kattakada, India
Lekshmi R
Assistant Professor, Department of Kayachikitsa, Pankajakasthuri Ayurveda Medical College and PG centre , Killy, Kattakada, India
Kasthuri Nair A
Assistant Professor, Department of Kayachikitsa, Pankajakasthuri Ayurveda Medical College and PG centre , Killy, Kattakada, India
Ayushdhara:
(A peer-reviewed, bi-monthly open-access journal)
Full text available for: A Clinical Approach to Hirsutism
Year: 2022 | Doi: 10.47070/ayushdhara.v9i5.1064
Copyright (license): CC BY-NC-SA 4.0
Download the PDF file of the original publication
Summary of article contents:
Introduction
Hirsutism is a condition characterized by excessive male-pattern hair growth in females, affecting around 10% of women. It stems from hyperandrogenism, a situation marked by elevated levels of androgens, primarily testosterone. The condition can be physiological if it runs in families or can indicate underlying metabolic or genetic issues, including androgen-secreting tumors. In Ayurvedic texts, while the term hirsutism does not explicitly exist, related concepts regarding hair growth can be found, suggesting that the condition involves a disturbance of the Kapha dosha, particularly Kapha Pradhana Tridosha Kopa.
Understanding Hirsutism through Ayurveda
From an Ayurvedic perspective, hirsutism is understood through its underlying causes, including metabolic dysfunctions and genetic factors. Metabolic issues can arise from dietary and lifestyle errors, such as consuming incompatible foods and not exercising enough, potentially leading to conditions like polycystic ovarian syndrome (PCOS) and hypothyroidism. Genetic causes involve inherited traits or conditions like Congenital Adrenal Hyperplasia (CAH). The Ayurvedic interpretation emphasizes the role of Dooshita Rasa and Dooshita Sukra, suggesting that disturbed bodily humors (doshas) contribute to increased hair growth, particularly in androgen-sensitive areas.
Causes and Evaluation of Hirsutism
Hirsutism's causes can be broadly classified as metabolic, genetic, and tumor-related. Metabolic issues trigger hormonal imbalances that can lead to symptoms like hirsutism, particularly in cases of PCOS, thyroid dysfunction, or Cushing syndrome. Genetic factors might manifest as familial hirsutism or congenital conditions. To evaluate hirsutism, a comprehensive assessment is vital, involving thorough medical history taking, physical examination, and appropriate laboratory investigations to identify hormonal levels and potential underlying conditions. The Modified Ferriman-Gallwey score, which quantifies hirsutism based on hair distribution, is also employed in clinical practice to assess the severity of the condition.
Conclusion
Hirsutism is a complex manifestation of hyperandrogenism with various underlying etiologies. A thorough evaluation encompassing medical history, physical assessments, and laboratory tests is crucial in diagnosing the root cause of hirsutism. Once the cause is identified, a tailored treatment approach can be developed, merging modern medical practices with Ayurvedic principles. This comprehensive strategy may include both internal and external therapies, addressing the imbalance within the body while also considering cosmetic concerns related to excessive hair growth.
FAQ section (important questions/answers):
What is hirsutism and what causes it in women?
Hirsutism is the condition of excessive male-pattern hair growth in women, generally caused by hyperandrogenism. It can be idiopathic or a result of underlying conditions like PCOS, adrenal tumors, or hormonal imbalances, which increase circulating male hormones like testosterone.
How is hirsutism evaluated and diagnosed?
Evaluation involves thorough history taking and physical examination to identify underlying causes. Tools like Casey’s classification and the Modified Ferriman–Gallwey score help assess severity. Laboratory tests, including hormonal assays and imaging techniques, confirm diagnoses of metabolic or genetic causes.
What are the treatment options for managing hirsutism?
Treatment depends on the underlying pathology and may include internal (Abhyantara) therapies and external (Bahya) treatments. These can involve lifestyle changes, hormonal therapy, and various depilation techniques like waxing or laser therapy to manage hair growth effectively.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “A Clinical Approach to Hirsutism�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Hair:
Hair is a natural ornament that everyone is fond of. It begins to grow from the root, in the bottom of the follicle, and is affected by hormones like estrogen and androgens. Hirsutism is a condition marked by excessive male-pattern hair growth.[see source text or glossary: Hair]
2) Kapha:
Kapha is one of the three doshas in Ayurveda, characterized by properties such as stability and lubrication. In the context of hirsutism, Kapha Pradhana Tridosha Kopa signifies an increase in Kapha alongside other doshas, leading to metabolic disruptions.[see source text or glossary: Kapha]
3) Drug:
The treatment for hirsutism in Ayurveda includes both internal and external therapies. Drugs such as Dipana, Pachana, and Artava Pravartaka are used to balance deranged doshas and manage the condition effectively.[see source text or glossary: Drug]
4) Loma (Lomaka):
Loma refers to body hair. In Ayurveda, excessive growth of body hair (Atiloma) is discussed and linked with certain classical conditions such as hypertrichosis, which differs from hirsutism in pathology.[see source text or glossary: Loma]
5) Dravya:
Dravya means substance or drug in Ayurveda. Specific Dravyas with Tikshna and Ushna Gunas are used externally in the form of yogas to manage conditions like hirsutism by reducing Kapha Dosha, thus promoting hair fall.[see source text or glossary: Dravya]
6) Bahya:
Bahya refers to external therapies in Ayurveda. For hirsutism, Bahya Chikitsa includes depilation techniques and the use of topical medicaments like Lepas and oils to manage and reduce excessive hair growth.[see source text or glossary: Bahya]
7) Shukra (Sukra):
Sukra (semen) or reproductive tissue is considered in Ayurveda to be connected to hair growth. Dooshita Sukra or deranged sexual tissue is believed to contribute to conditions like hirsutism by stimulating hair follicles in androgen-sensitive areas.[see source text or glossary: Sukra]
8) Agni:
Agni refers to digestive fire. Agni Mandhya, or weak digestive fire, is considered a root cause in the pathology of many diseases in Ayurveda, including hirsutism. Correcting Agni is part of the approach to treating hirsutism.[see source text or glossary: Agni]
9) Yoga:
Yoga in this context refers to medicinal formulations or combinations used to treat conditions. For hirsutism, specific Loma Shatana Yogas are recommended to reduce excessive hair growth.[see source text or glossary: Yoga]
10) Dosha (Dosa):
Dosha refers to the three fundamental bio-energies (Vata, Pitta, Kapha) in Ayurveda. Imbalance among these doshas leads to diseases. Hirsutism is primarily associated with Kapha Pradhana Tridosha Kopa.[see source text or glossary: Dosha]
11) Vayu:
Vayu refers to the air element and one of the five types of Vata Dosha in Ayurveda. Its Pratiloma gati (abnormal movement against the natural flow) is implicated in the spread of excessive hair growth in hirsutism.[see source text or glossary: Vayu]
12) Samprapti:
Samprapti refers to the pathogenesis or the process of disease formation. For hirsutism, it includes causes such as metabolic disturbances, genetic factors, and androgen-secreting tumors leading to hyperandrogenism.[see source text or glossary: Samprapti]
13) Pradhana:
[see source text or glossary: Pradhana]
14) Shatana (Satana):
Shatana in the context of Ayurveda means destruction. Loma Shatana is a term that refers to therapies and formulations aiming at reducing or removing hair growth.[see source text or glossary: Shatana]
15) Vriddhi (Vrddhi):
Vriddhi means increase or growth. In the context of hirsutism, we discuss the Vriddhi of Malaroopa Kapha leading to symptoms such as excessive hair growth.[see source text or glossary: Vriddhi]
16) Disease:
Hirsutism is defined as a disease involving hyperandrogenism, where an excess of male hormones leads to excessive growth of male-pattern body hair in women. It's associated with various underlying conditions like PCOS.[see source text or glossary: Disease]
17) Sthula:
Sthula is a term for obesity in Ayurveda. In the treatment of hirsutism, both Sthula (obese) and Krisha (lean) individuals are considered, with specific therapies recommended for each body type.[see source text or glossary: Sthula]
18) Sthana:
Sthana refers to a site or location in Ayurveda. Kaphasthana denotes places in the body where Kapha dosha accumulates, which can influence hirsutism by affecting hair follicle activities.[see source text or glossary: Sthana]
19) Nidana:
Nidana means cause or etiology. For hirsutism, including consumption of Viruddhahara and other lifestyle factors, the Nidana leads to metabolic disturbances contributing to the disease.[see source text or glossary: Nidana]
20) Medas (Meda, Medash):
[see source text or glossary: Meda]
21) Sadyas (Sadya, Sadyash):
Sadya refers to the curability status of a disease in Ayurveda. Conditions like hirsutism have different prognoses based on the underlying cause, such as genetic factors or tumors, which may be Asadhya or surgical (Sastra Sadya).[see source text or glossary: Sadya]
22) Blood:
Blood is essential for providing nutrients to hair follicles. Hormones that influence hair growth are transported through blood, which can be analyzed to diagnose conditions like PCOS or Cushing syndrome contributing to hirsutism.[see source text or glossary: Blood]
23) Mala:
Mala refers to waste products of the body. In Ayurveda, Mala for Asthi (bone) is hair (Kesha). Mala's role, including the waste product of Shukra Dhathu affecting hair growth, relates to the condition of hirsutism.[see source text or glossary: Mala]
24) Vata:
Vata is one of the three doshas and is responsible for movement and physiological processes. Its Pratiloma gati leading to tissue vitiation is crucial in the pathogenesis of hirsutism.[see source text or glossary: Vata]
25) Abhyantara (Abhyamtara):
Abhyantara means internal therapies. Treating hirsutism involves the use of internal medications (Abhyantara Chikitsa) to balance doshas and rectify metabolic disturbances.[see source text or glossary: Abhyantara]
26) Tridosha (Tridosa, Tri-dosha):
Tridosha refers to the three fundamental bio-energies in Ayurveda: Vata, Pitta, and Kapha. A Kapha Pradhana Tridosha Kopa is implicated in the pathogenesis of hirsutism, leading to metabolic disorders.[see source text or glossary: Tridosha]
27) Kasturi:
Kasthuri refers to the author named in the article, Kasthuri Nair A, a contributor to the study on hirsutism's clinical approach.[see source text or glossary: Kasthuri]
28) Atiloma:
Atiloma in Ayurveda describes a condition with excessive body hair growth, seen as undesirable and comparable to hypertrichosis, which includes genetic aspects as discussed in the text about disease conditions.[see source text or glossary: Atiloma]
29) Avastha:
Avastha means state or condition. In Ayurveda, Avastha like Atiloma avastha indicates a state of excessive hair growth which is comparable to hypertrichosis.[see source text or glossary: Avastha]
30) Dipana:
Dipana refers to substances that stimulate the digestive fire (Agni). Drugs with Dipana properties are used in treatment to enhance Agni and manage conditions like hirsutism by balancing doshas.[see source text or glossary: Dipana]
31) Krisha (Krsa):
Krisha means lean or thin. In the context of treating hirsutism, different treatment strategies are adopted for Krisha Dehi (lean individuals), including mild purgative therapies and nourishing (Brimhana) treatments.[see source text or glossary: Krisha]
32) Asthi (Ashthi):
Asthi refers to bone tissue. Classical texts mention that vitiation of Asthi Dhatu could lead to excess hair growth, although in hirsutism, Dooshita Sukra possibly plays a more significant role.[see source text or glossary: Asthi]
33) Taila (Thaila):
Taila means oil and is used in external treatments (Bahya Chikitsa). Oils such as those in Loma Shatana Yogas are applied to manage hyperandrogenism-induced hair growth in hirsutism.[see source text or glossary: Taila]
34) Dhatu:
Dhatu means tissue or fundamental bodily components in Ayurveda. The imbalance of Dhatus like Sukra and involvement of Asthi and Medas is significant in the pathology of hirsutism.[see source text or glossary: Dhatu]
35) Chand:
Chand refers to the author named in the article, Arjun Chand C P, who is highlighted as a key contributor to the research on a clinical approach to hirsutism.[see source text or glossary: Chand]
36) Kesa (Kesha):
Kesha means hair, including that on the scalp. The imbalance involving Kapha and other doshas affect Kesha and can result in conditions like hirsutism where hair pattern and growth are significantly altered.[see source text or glossary: Kesha]
37) Jaya:
[see source text or glossary: Jaya]
38) Lepa:
Lepa refers to topical applications or pastes used externally. In hirsutism, specific Lepas made from Ayurvedic formulations are used to manage excess hair growth by balancing doshas externally.[see source text or glossary: Lepa]
39) Rasa (Rasha):
Rasa refers to plasma and primary body fluids in Ayurveda. Dooshita Rasa due to Agnimandya (weak digestive fire) is part of the pathology in hirsutism, necessitating treatments to correct these imbalances.[see source text or glossary: Rasa]
40) Guna:
Guna means quality or attribute. The Tikshna (sharp) and Ushna (hot) Gunas of various drugs are used to reduce Kapha, which is responsible for the steadiness of hair, hence managing hirsutism.[see source text or glossary: Guna]
41) Food:
Certain types of food like Viruddhahara (incompatible foods) can disrupt metabolic functions and are mentioned as Nidana (causative factors) for hirsutism in Ayurveda. Addressing dietary causes is part of treatment.[see source text or glossary: Food]
42) Agnimandya (Agni-mandya, Agnimamdya):
Agnimandya refers to weak digestive fire. It is a key factor in the pathogenesis of hirsutism, leading to the formation of Dooshita Rasa and further downstream effects such as metabolic disruptions.[see source text or glossary: Agnimandya]
43) Pratiloma (Prati-loma):
Pratiloma means abnormal or reverse movement, typically against the natural flow. Pratiloma gati of Vayu (air element) is discussed as a factor in the pathogenesis of hirsutism, contributing to excess hair growth.[see source text or glossary: Pratiloma]
44) Ayurveda (Ayus-veda):
Ayurveda is the traditional system of medicine from India, providing holistic and customized therapeutic approaches. The article discusses Ayurvedic concepts and therapies in the management of hirsutism.[see source text or glossary: Ayurveda]
45) Langhana (Lamghana):
Langhana refers to emaciation therapy. In the treatment of hirsutism, Langhana is used to correct Agnimandya and Srotorodha (obstruction in body channels) by fasting or lightening therapies.[see source text or glossary: Langhana]
46) Mandata:
Mandata means decreased action or slow function. In the context of hirsutism, Mandata of Kapha in Kapha Sthana and improper Vata movements lead to the metabolic disruptions causing the condition.[see source text or glossary: Mandata]
47) Asadhya:
Asadhya means incurable. Certain forms of hirsutism due to genetic causes or Beeja Dosha (congenital aspects) are considered Asadhya, requiring specific management strategies as mentioned in the text.[see source text or glossary: Asadhya]
48) Tikshna (Tiksna):
Tikshna refers to sharp or intense qualities. Therapies with Tikshna Gunas (qualities) are used for their effectiveness in reducing excess Kapha and managing hair growth in hirsutism.[see source text or glossary: Tikshna]
49) Samana (Shamana):
Samana means similar or related. The Samanya Gunas (similar qualities) of Kapha and Sukra contribute to the spread of Dooshita Kapha, influencing conditions like hirsutism.[see source text or glossary: Samana]
50) Lavana:
[see source text or glossary: Lavana]
51) Mamsa (Mamsha):
Mamsa means muscle tissue. Vitiation of Mamsa along with Medas can lead to the development of tumors in androgen-secreting organs causing hirsutism as discussed in the Samprapti.[see source text or glossary: Mamsa]
52) Sanga (Samga, Shanga, Shamga):
Sanga means obstruction or blockage in Ayurvedic terminology. In the pathology of hirsutism, Sanga of Kapha and resultant obstructions are crucial factors leading to abnormal hair growth.[see source text or glossary: Sanga]
53) Gati:
Gati means movement or path. Pratiloma Gati of Vata (reverse movement) is a vital concept in Ayurveda related to the aberrant movement causing metabolic disruptions in hirsutism.[see source text or glossary: Gati]
54) Butea monosperma:
[see source text or glossary: Butea monosperma]
55) Musa paradisiaca:
[see source text or glossary: Musa paradisiaca]
56) Ashtangahridaya (Astangahrdaya, Ashtanga-hridaya):
[see source text or glossary: Ashtanga-hridaya]
57) Saindhavalavana (Saindhava-lavana, Saimdhavalavana):
[see source text or glossary: Saindhava-lavana]
58) Oroxylum indicum:
[see source text or glossary: Oroxylum indicum]
59) Sthanasamshraya (Sthanasamsraya, Sthana-samshraya):
Sthanasamsraya refers to the stage of disease localization. In hirsutism, deranged doshas and wastes accumulate at specific sites (Kaphasthana), contributing to the clinical presentation of excess hair growth.[see source text or glossary: Sthanasamsraya]
60) Samanyaguna (Samanya-guna):
Samanya-guna refers to similar attributes. In hirsutism, Samanya Gunas of Kapha and Sukra contribute to the spread of Kapha, leading to excess hair growth in androgen-sensitive areas.[see source text or glossary: Samanya-guna]
61) Viruddhahara (Viruddha-ahara):
[see source text or glossary: Viruddhahara]
62) Ksharataila (Ksarataila, Kshara-taila):
[see source text or glossary: Kshara-taila]
63) Asthidhatu (Asthi-dhatu):
Asthi-dhatu refers to bone tissue. Although excessive hair growth traditionally associates with Asthi Mala (waste product), for hirsutism, Dooshita Sukra is considered more relevant.[see source text or glossary: Asthi-dhatu]
64) Kaphadosha (Kaphadosa, Kapha-dosha):
Kapha-dosha refers to one of the three fundamental bio-energies in Ayurveda. It plays a significant role in the pathology of hirsutism through Kapha Pradhana Tridosha Kopa, causing disturbances in metabolic functions.[see source text or glossary: Kapha-dosha]
65) Adhyashana (Adhyasana):
[see source text or glossary: Adhyashana]
66) Bhallataka:
[see source text or glossary: Bhallataka]
67) Saindhava (Saimdhava):
[see source text or glossary: Saindhava]
68) Anulomana:
Anulomana refers to mild purgation. It is a part of managing hirsutism in lean individuals (Krisha Dehi), targeting to balance vitiated Vata alongside other therapies like Dipana and Pachana.[see source text or glossary: Anulomana]
69) Vitiation (Vitiated):
Vitiation refers to the derangement of doshas. In hirsutism, Vitiated Sukra and Kapha lead to excess hair growth by influencing the hair follicles in androgen-sensitive areas.[see source text or glossary: Vitiation]
70) Brimhana (Brmhana):
Brimhana means nourishing therapy. For lean individuals (Krisha Dehi) with hirsutism, Brimhana therapies are used alongside internal and external treatments to restore balance to the body.[see source text or glossary: Brimhana]
71) Kashyapa (Kasyapa, Kashya-pa, Kashyapanamdana):
Kashyapa refers to Kashyapa Samhitha, an Ayurvedic text. It mentions conditions like Pushpagni where increased facial hair (Lomasha Ganda) is observed, indicating hormonal imbalances related to hirsutism.[see source text or glossary: Kashyapa]
72) Haritala (Hari-tala):
[see source text or glossary: Haritala]
73) Sthirata:
Sthirata means steadiness or stability. In the treatment of hirsutism, reducing the Kapha Dosha, which provides Sthirata to hair (Loma) in follicles, is aimed to cause hair fall and manage growth.[see source text or glossary: Sthirata]
74) Rasayana (Rasa-ayana):
Rasayana refers to rejuvenation therapy. In the context of hirsutism, Rasayana Chikitsa is employed to maintain dosha equilibrium after addressing initial causes and symptoms.[see source text or glossary: Rasayana]
75) Sthaulya:
[see source text or glossary: Sthaulya]
[Note: The above list is limited to 75. Total glossary definitions available: 123]
Other Science Concepts:
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Atiloma, Laboratory investigation, Langhana therapy, Dushya involvement, Proper diagnosis, Bahya Chikitsa, Abhyantara Chikitsa, Metabolic Causes, Hyper Androgenism, Genetic cause, Excessive hair growth, Virilization, Diagnostic Technique, Depilation techniques, Hypertrichosis.