Derm Cases · Dermatology / Endocrinology
OSCE — excess hair: hirsutism vs hypertrichosis, PCOS vs androgen-secreting tumour
An 8-minute OSCE distinguishing hirsutism from hypertrichosis, Ferriman–Gallwey scoring, red-flag virilisation work-up, and stepwise cosmetic plus anti-androgen therapy.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE distinguishing hirsutism from hypertrichosis, Ferriman–Gallwey scoring, red-flag virilisation work-up, and stepwise cosmetic plus anti-androgen therapy.
Brief (to candidate)
A 24-year-old woman has increasing facial terminal hair and irregular periods. Another patient has diffuse lanugo-type hair after starting a drug. You have 8 minutes to distinguish hirsutism from hypertrichosis, identify red-flag tumours, diagnose PCOS pathway, and plan treatment.
[8]Candidate instructions
- Define hirsutism (androgen-dependent male-pattern terminal hair) vs hypertrichosis.
- Score severity (modified Ferriman–Gallwey) and list differentials.
- Screen for PCOS vs non-classic CAH, Cushing, androgen-secreting tumour red flags.
- List classic drug-induced hypertrichosis agents.
- Outline cosmetic methods, eflornithine, COC/anti-androgens, laser principles.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Definitions | Hirsutism: terminal hair in female in male distribution (face, chest, abdomen); hypertrichosis: excess hair any site, androgen-independent pattern often diffuse[1] |
| Scoring / causes | Modified Ferriman–Gallwey; commonest cause PCOS; idiopathic hirsutism; endocrine rarities[2][3] |
| Red flags | Rapid progression, virilisation (voice, clitoromegaly, balding); very high testosterone/DHEAS → ovarian/adrenal tumour pathway; Cushing features; adult acquired lanugo → paraneoplastic work-up |
| Labs | Total/free testosterone, DHEAS, 17-OHP (non-classic CAH), TSH; pregnancy test before therapy; imaging if tumour thresholds/clinical red flags[1] |
| Drug hypertrichosis | Minoxidil, ciclosporin, phenytoin, diazoxide, systemic corticosteroids — stop/modify culprit when possible[7] |
| Treatment ladder | Local hair removal + eflornithine 15% cream for facial; combined oral contraceptive ± spironolactone / cyproterone pathways; laser/IPL long-term reduction; treat metabolic PCOS risks[1][4] |
| Safety | Anti-androgens teratogenic — contraception mandatory; counsel slow response (3–6 months) |
Model key actions
- Separate hirsutism (androgen-driven) from hypertrichosis (often drugs).[1][7]
- Screen PCOS as default, escalate labs/imaging for rapid virilisation.[3]
- Combine cosmetic control with COC ± spironolactone and eflornithine for face.[1][4]
Common errors
- Missing tumour red flags in rapid virilisation.
- Prescribing anti-androgens without contraception.
- Calling drug hypertrichosis “PCOS” without androgen excess pattern.
- Expecting immediate laser cure without hormonal control.
References6ShowHide
- [1]Martin KA, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2018.PMID 29522147
- [2]Spritzer PM, Marchesan LB, Santos BR, et al. Hirsutism, Normal Androgens and Diagnosis of PCOS. J Clin Endocrinol Metab, 2022.PMID 36010272
- [3]Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril, 2004.PMID 14688154
- [4]Wolf JE Jr, et al. Randomized, double-blind clinical evaluation of the efficacy and safety of eflornithine 15% cream. Int J Dermatol, 2007.PMID 17214730
- [7]Miwa LJ, et al. Drug-induced excess hair growth. Prescriber / review, 2017.PMID 30730670
- [8]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.PMID 17270315