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Both hair and nails are derived from the epidermis, and both consist of the same dead tissue—the protein, keratin. Because of their derivation from the epidermis it is not surprising that diseases affecting the skin may affect the hair and nails as well. In addition, there are a number of disorders which are peculiar to the hair (including the scalp) and nails.
Hirsutism, or increased growth of facial and body hair, is a common complaint amongst women attending endocrinology, gynaecology and dermatology clinics. The presence of fine vellus fuzz on the upper lip and chin is very common in women of all races. After the menopause this vellus hair is frequently accentuated by darker terminal hairs, which may appear interspersed among the finer hairs. There is considerable racial variation as regards hirsutism, with women of southern or eastern European extraction being more prone to excess hair, and women of Asian extraction —particularly the Japanese-being rarely affected. Often there is also a familial tendency to hirsutism.
When women are affected in those areas of the body which normally only develop hair in males, and particularly if this is associated with menstrual abnormalities, deepening of the voice, and frontal scalp recession, then there is most likely to be a correctable hormonal cause for this. Hormonal factors causing excessive hair growth include excessive male hormone production from either the adrenal glands, the pituitary gland, or certain rare ovarian tumours. Occasionally some drugs may be implicated—for example dilantin, streptomycin, penicillamine, diazoxide, psoralens, and corticosteroids. Most women however show no clinical evidence of an endocrine disease or hormone abnormality, and this finding can of course by confirmed with appropriate blood and urine tests. If there is any doubt, these tests should be performed after medical assessment has been sought. In those cases of hirsutism where no abnormalities are suggested or found, the cause is probably excessive sensitivity of the hair follicles to the normal quantities of circulating male hormones, or the manufacture of excessive quantities of male hormones within the skin itself. Stress is also thought to be able to cause excess hair production by stimulating the overproduction of male hormones via the pituitary gland, which has a close relationship with the brain.
Excess hair, particularly facial, has always been thought of as an undesirable characteristic in women; although in men, for some reason, it is thought to denote virility! Witches are frequently illustrated with hair on the nose or chin. Grafitti often shows girls with moustaches, and so forth. Consequently many women become psychologically upset by being hirsute. This commonly results in such feelings as irritability, frigidity, masculine trends, and impaired sexuality. As a result, treatment is frequently sought. Here again, we have a situation likely to be exploited: these unfortunate women are very susceptible to the promises of complete and permanent hair removal. From the number of establishments advertising the myth of permanent hair removal, one can get some idea of how many women must be seeking the hairless face. The actual incidence of hirsutism is impossible to assess. However a survey of women students in Wales, in which the women were actually examined and questioned, showed that over one quarter had terminal hair on the face, and that in about 5 per cent of cases it was considered disfiguring.