An evaluation of the available pharmacotherapy for the treatment of hirsutism.

INTRODUCTION: Hirsutism is the presence of excessive body hair in a male pattern distribution in a woman, and can affect up to 20% of women. It can be associated with high levels of psychosocial and psychosexual morbidity. It is a common cause for presentation to medical staff, particularly endocrinologists, gynecologists, and dermatologists. AREAS COVERED: The authors discuss the definition, causes, and diagnosis of hirsutism. Current and evolving pharmacotherapy is available for hirsutism with an evaluation of the available evidence, consensus opinions, and guidelines to date. Physical therapies that can be recommended in combination with medical pharmacotherapies are also outlined. EXPERT OPINION: Combined oral contraceptive pills (OCP) are recommended as first-line therapy. The addition of oral antiandrogens can be combined for severe cases. Antiandrogens and OCPs have been demonstrated to be the most effective pharmacotherapy available in improving hirsutism. Greater insight is being achieved in the use of antiandrogens and their role in managing hyperandrogenism states such as hirsutism. Insulin sensitizers such as metformin are found to be the least effective. Medical treatments for hirsutism often need to be combined with physical therapies for optimal management. Psychological support should be considered in patients with associated psychosocial morbidity.

Risk Factors for Nonattendance in Delusional Infestation: A Multicenter Observational Study.

BACKGROUND: Nonattendance is common among patients suffering from delusional infestation (DI) with a risk factor for poorer patient outcomes. OBJECTIVE: The aim of this study was to determine the incidence rate and predictors of nonattendance among patients presenting to a psychodermatology department with DI and the subsequent effect on the success of prescribing new antipsychotics. METHODS: Data of 265 patients were reviewed of the Amsterdam UMC, the Erasmus University Medical Center, the Royal London Hospital, and the Liverpool School of Tropical Medicine between January 2008 and October 2019. RESULTS: We observed that among the patients who attended the first consultation, 57% (n = 144) did not attend their second visit. Recreational drug use was significantly higher in the nonattendance group compared to the attendance group (25% against 18%). Patients who had a history of previously prescribed antipsychotics at the time of the first consultation were less likely to get prescribed antipsychotics from the psychodermatology departments for DI; however, prescribing antipsychotic drugs by the psychodermatology department did not influence nonattendance significantly. CONCLUSIONS: People suffering from DI are at high risk of nonattendance, even in specialist settings. Patients with current illicit drug use and younger patients are particularly at risk of this.

Tuberous xanthoma secondary to homozygous familial hypercholesterolaemia: a life-threatening diagnosis.

We report the case of a 9-year-old girl who presented with asymptomatic lesions on the extensor surfaces of the elbows and knees, in keeping with tuberous xanthoma. She was investigated and diagnosed with homozygous familial hypercholesterolaemia, and commenced on lipid-lowering treatment. We highlight the importance of identification of this condition early, such that life-saving treatment can be initiated and premature death avoided. Click here for the corresponding questions to this CME article.