Hirsutism cuta ce da ke shafar mata kaɗai, wanda ke nuna karuwar gashin gemu, gangar jikin… tushen da ke yawan haifar da wahalar tunani ga matan da abin ya shafa.

Ma'anar hirsutism

Wannan shine ci gaban karin girma na girma gashi a cikin maza (gemu, gangar jiki, baya, da dai sauransu) daga ƙuruciya ko kwatsam a cikin mace babba.

Hirsutism ko yawan gashi?

Muna rarrabe hirsutism daga haɓaka haɓakar gashi na al'ada (makamai, kafafu, da sauransu) da ake kira hypertrichosis. Gashi daga hypertrichosis saboda haka kawai yana shafar wuraren al'ada a cikin mata, amma gashin yana da tsayi, kauri da kauri fiye da yadda aka saba. 

Ba kamar hirsutism ba, wannan kusanci ya fi kasancewa a ƙuruciya kuma yana shafar jinsi biyu. Hypertrichosis galibi dangi ne kuma yana yawan faruwa a kusa da Bahar Rum da kuma launin ruwan kasa. Magungunan Hormonal ba su da tasiri kuma galibi ana ba da cire gashin laser.

Hirsutism shine tsinkayar tasirin hormones na maza akan jikin mace. Akwai manyan nau'ikan hormones guda uku waɗanda zasu iya shafar haɓaka gashi a yankunan maza a cikin mata:

Hormone na maza daga ovary (testosterone da Delta 4 Androstenedione):

Su karuwa iya zama tunani na wani ovarian ƙari secreting wadannan namiji hormones ko fiye akai-akai na microcysts a kan ovaries secreting wadannan hormones (micropolycystic kwai ciwo). Idan aka sami hauhawa a cikin kwayar testosterone ko matakin Delta 4-androstenedione, likita ya ba da umarnin duban dan tayi don neman waɗannan cututtukan guda biyu (micropolycystic ovaries ko ovarian tumor).

Hormone na maza daga glandan adrenal

Wannan shine SDHA don De Hydroepi Androsterone Sulfate wanda ƙwayar ƙwayar ƙwayar cuta ta ɓoye kuma mafi yawan lokuta shine aikin adrenal hyperandrogenism ta haɓaka matsakaici a cikin ɓarkewar 17 hydroxyprogesterone (17-OHP) sannan yana buƙatar gwajin motsawa tare da Synacthène® don tabbatar da ganewar asali. Ƙari da yawa, saboda ana tsara shi ta tsari ta hanyar haihuwa ta hanyar samfurin jini daga diddige a ranar 3 na rayuwa ta hanyar auna matakin 17 hydroxyprogesterone (17-OHP) a cikin jini, anomaly na iya zama na haihuwa: ayyukan haihuwa ne. adrenal hyperplasia ta rashi 21-hydroxylase wanda ke da alaƙa da maye gurbi na halittar sa akan chromosome 6.

Cortisol

Haɓaka cortisol a cikin jini (Ciwon Cushing) na iya kasancewa saboda tsawaita amfani da corticosteroids, ƙwayar adrenal da ke ɓoye cortisol, ko ƙari mai ɓoye ACTH (hormone wanda ke ɓoye cortisol daga gland na adrenal).

Abubuwan da ke haifar da ƙwayar cuta galibi suna farawa ne a cikin mace babba, yayin da hirsutism da ke cikin ƙuruciya galibi yana faruwa ne saboda ƙwayayen ovarian ko adrenal hyperandrogenism.

Tare da allurai na hormonal na al'ada da duban dan tayi na ovarian, ana kiranta hirsutism idiopathic.

A aikace, sabili da haka, a gaban hirsutism, likitan ya nemi a samar da jini na testosterone, Delta 4-androstenedione, SDHA da 17-hydroxyprogesterone (tare da gwajin Synacthène® idan yana da matsakaicin matsayi), cortisoluria a yayin da ake zargin Cushing da duban dan tayi na ovarian.

Ya kamata a nemi allurai ba tare da shan cortisone ba, ba tare da maganin hana haihuwa na hormonal na watanni uku ba. Yakamata a yi su da safe da misalin ƙarfe 8 na safe kuma a ɗaya daga cikin kwanaki shida na farkon sake zagayowar (bai kamata a nemi su ba a cikin shekaru ukun farko na lokacin ƙuruciya saboda ba su da mahimmanci).

Gashin gashi mai ƙarfi a fuska, kirji, baya… a cikin mata.

Likitan yana neman wasu alamomin da ke da alaƙa da hyperandrogenism (ƙaruwa a cikin hormones na maza): hyperseborrhea, kuraje, androgenetic alopecia ko baldness, rikicewar haila… Waɗannan alamun suna ba da shawarar ƙara matakan hormone a cikin jini sabili da haka kada ku yi jayayya don son hirsutism na idiopathic.

Farawar waɗannan alamun ba zato ba tsammani yana nuna ciwace -ciwace yayin da shigowar su sannu -sannu daga ƙuruciya ya fi dacewa da aikin ovarian ko adrenal hyperandrogenism, ko ma hirsutism na idiopathic idan gwajin na al'ada ne.

hadarin dalilai

Abubuwan haɗari ga hirsutism a cikin mata sun haɗa da:

• shan cortisone na watanni da yawa (Ciwon Cushing)
• kiba: yana iya yin nuni da matsalar cortisol ko kuma ya kasance wani ɓangare na ciwon ƙwayar mahaifa na polycystic. Amma kuma mun san cewa kitse yana da halin haɓaka haɓaka metabolization na hormones na maza.
• tarihin iyali na hirsutism

Juyin halitta et rikitarwa mai yiwuwa ne

Hirsutism da ke da alaƙa da ƙwayar cuta yana fallasa mutane ga haɗarin da ke da alaƙa da ƙwayar kanta, musamman idan m (haɗarin metastases, da sauransu)

Hirsutism, ko kumburi ko aiki, ban da rashin kyawun sa, galibi yana rikitarwa ta kuraje, folliculitis, santsi a cikin mata…

Maganin hirsutism ya dogara ne akan maganin sanadin da haɗewar shan anti-androgens da cire gashi ko dabaru

Maganin sanadin

Kau da wani ovarian ko adrenal ƙari, ACTH-secreting ƙari (sau da yawa dake cikin huhu) ... idan ya cancanta.

Haɗuwa da dabarar ɓarna ko ɓarna da anti-androgen

Dole ne a haɗa dabarun cire gashi ko ɓarnawa tare da maganin hormonal na anti-androgen don iyakance haɗarin muguwar gashi

Cire gashi da depilation

Za'a iya amfani da dabaru da yawa kamar bleaching gashi, aski, kirim mai ƙyalƙyali, kakin zuma ko ma cire gashin gashi a ofishin likitan fata wanda yake da zafi da gajiya.

Akwai cream wanda ya dogara da eflornithine, wani ƙwayar antiparasitic wanda, ana amfani da shi a cikin gida, yana hana ornithine decarboxylase, wani enzyme da ke da hannu wajen samar da gashi ta wurin gashin gashi. Wannan shine Vaniqa® wanda, ana amfani dashi sau biyu a rana, yana rage girma gashi.

Ana nuna cire gashin Laser a lokuta masu yawa na hirsutism. An haɗa shi da maganin anti-androgen don hana sake dawowa.

Anti androgens

Kalmar anti-androgen tana nufin cewa kwayar tana hana ɗaurin testosterone (don zama madaidaicin 5-dihydrotestosterone) ga mai karɓar ta. Kamar yadda testosterone baya samun dama ga masu karɓa a cikin gashi, ba zai iya samun sakamako mai ƙarfafawa ba.

Akwai hanyoyi guda biyu da ake amfani da su a halin yanzu:

• cyproterone acetate (Androcur®) an sake biya a Faransa don alamar hirsutism. Bugu da ƙari ga ayyukan hana mai karɓar maganin anti-androgen, yana kuma da tasirin antigonadotropic (yana rage samar da androgens ta hanyar rage motsawar pituitary) da kuma hana hadaddun 5-dihydrotestosterone / receptor a matakin furotin dauri. .

Yana da progestogen wanda dole ne galibi a haɗa shi da isrogen don yin kwaikwayon yanayin halittar hormonal na mata: likita galibi yana rubuta kwamfutar Androcur® 50 mg / rana haɗe da isrogen na halitta a cikin kwamfutar hannu, gel ko faci, kwana ashirin daga cikin ashirin da takwas.

Ingantawa a cikin hirsutism ana ganin shi ne bayan kusan watanni 6 na jiyya.

• spironolactone (Aldactone®), mai diuretic, ana iya ba da alamar-alama. Bayan tasirin toshewar anti-androgenic, yana hana haɓakar testosterone. Likitan ya rubuta allunan biyu a kowace rana na 50 ko 75 MG don cimma adadin yau da kullun na 100 zuwa 150 MG / rana, a haɗe, kwanaki goma sha biyar a wata, tare da progestogen wanda ba androgenic ba don gujewa rikice-rikice na sake zagayowar. Kamar yadda cyproterone acetate, ana fara lura da tasirin ne bayan watanni 6 na magani, wani lokacin a shekara.