A detailed history is taken by a provider in search of possible causes for hyperandrogenism or other non-endocrine-related causes. If the distribution of hair growth occurs throughout the body, this is referred to as hypertrichosis, not hirsutism. Endocrine causes
Ovarian cysts such as in polycystic ovary syndrome (PCOS), the most common cause in women. Adrenal gland tumors, adrenocortical adenomas, and adrenocortical carcinoma, as well as adrenal hyperplasia due to pituitary adenomas (as in Cushings disease). Inborn errors of steroid metabolism such as in congenital adrenal hyperplasia, most commonly caused by 21-hydroxylase deficiency. Acromegaly and gigantism (growth hormone and IGF-1 excess), usually due to pituitary tumors. Causes of hirsutism not related to hyperandrogenism include
Familial: Family history of hirsutism with normal androgen levels. Drug-induced: medications were used before the onset of hirsutism. The recommendation is to stop the medication and replace it with another.Minoxidil
Testosterone, danazol, progestins, anabolic steroids, valproic acid, methyldopa
Pregnancy or post-menopause: moderate hirsutism due to prolactin secretion and hyperandrogenism due to decrease estrogen production, respectively. Idiopathic: When no other cause can be attributed to an individuals hirsutism, the cause is considered idiopathic by exclusion. In these cases, mensuration cycles and androgen levels are normal. Diagnosis
Hirsutism is a clinical diagnosis of excessive androgenic, terminal hair growth. A complete physical evaluation should be done prior to initiating more extensive studies, the examiner should differentiate between widespread body hair increase and male pattern virilization. One method of evaluating hirsutism is the Ferriman-Gallwey Score which gives a score based on the amount and location of hair growth.
Associated conditions
Many people with severe ichthyosis have problems sweating due to the buildup of scales on the skin. This may lead to problems such as "prickly itch", which results from the afflicted skin being unable to sweat due to the buildup of scales, or problems associated with overheating. The majority of people with vulgaris can sweat at least a little. Paradoxically this means most would be more comfortable living in a hot and humid climate. Sweating helps to shed scales, which improves the appearance of the skin and prevents "prickly itch".The dry skin will crack on digits or extremities and create bloody cuts. Skin is painful when inflamed and/or tight. For children and adolescents, psychological concerns may include inconsistent self-image, mood fluctuating due to cyclical outbreaks, tendency to addiction, possibility of social withdrawal when skin is noticeably infected, and preoccupation with appearance.Strong air conditioning and excessive consumption of alcohol can also increase the buildup of scales. Over 50% of people with ichthyosis vulgaris have some type of atopic disease such as allergies, eczema, or asthma. Another common condition associated with ichthyosis vulgaris is keratosis pilaris (small bumps mainly appearing on the back of the upper arms). Genetics
Ichthyosis vulgaris is one of the most common genetic disorders caused by a single gene. The disorder is believed to be caused by mutations to the gene encoding profilaggrin (a protein which is converted to filaggrin, which plays a vital role in the structure of the skin).