Women are far more likely to present with this symptom than men, often for cosmetic reasons. The likeliest queries relate to normal nails that break easily or are not smooth. Other abnormalities may be detected during physical examination rather than being volunteered by the patient, and may indicate significant pathology.
This is defined as excess growth of terminal hair in women in male distribution sites (i.e. chin, cheeks, upper lip, lower abdomen and thighs). It presents as a cosmetic problem. Ethnic origin must be taken into account: Mediterraneans and Indians grow more than Nordics. Japanese, Chinese and American Indians grow the least. In the UK, according to surveys, up to 15% of women believe they have excess body hair, although only a minority present to the primary care.
A distressing symptom for both genders: young men may fret about self-image, and women are horrified at the cosmetic disaster unfolding. The psychological significance of increased hairfall is all too easy to overlook in a typical busy surgery should be recognized and reassurance given that the problem is being taken seriously.
This might appear a mundane symptom, but it can cause the patient significant distress. It’s usually a presentation, in which a brief examination can be performed at the same time as an equally brief history. But the clinician should be mindful that the problem can sometimes be more complicated than it might at first appear.