Assessment of Health-Related Quality of Life in Patients with Idiopathic Hirsutism Compared to Patients with Polycystic Ovary Syndrome

Objective

Hirsutism affects 5-15% of women of reproductive age. Health-related quality of life (HQOL) is a multidimensional assessment of well-being that considers the physical, social, and emotional aspects associated with a specific disease. The aim of this study is to evaluate HQOL in patients diagnosed with idiopathic hirsutism (IH) and compare it with patients diagnosed with polycystic ovary syndrome (PCOS).

Methods

This cross-sectional observational study was performed on 183 female individuals, consisting of 51 patients diagnosed with idiopathic hirsutism, 76 patients diagnosed with PCOS, and 56 healthy volunteers. Participants with a history of neuropsychiatric disorders, under 18 and over 45 years of age, during pregnancy and lactation, with any chronic disease that could interfere with diagnostic laboratory tests, and who had previously been treated for IH or PCOS were excluded from the study. Demographic, anthropometric, laboratory, and clinical data on the cases were recorded. The Short Form-36 (SF-36) questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were administered in a face-to-face interview by related authors involved in the study.

Results

The mean age, level of education, lifestyle, and marital status of all three groups were similar. There were no significant differences in body mass index (BMI) or waist circumference between the groups. Mean modified Ferriman-Gallwey (mFG) scores were similar in the IH and PCOS groups. In the IH patients, the general health and mental health domains of the SF-36 questionnaire scores were significantly lower than in the control group (p<0.001 and p=0.026, respectively). When the SF-36 questionnaire scores were compared between the IH and PCOS groups, the general health and role emotional domains were significantly lower in the PCOS group (p=0.013 and p<0.001, respectively), and the other domains were similar. All SF-36 questionnaire domains were significantly and negatively correlated with BMI and waist circumference measurements in IH patients. Both BDI and BAI scores were significantly and positively correlated with BMI (r=0.348, p<0.001, and r=0.162, p=0.012, respectively) and waist circumference (r=0.326, p<0.001, and r=0.344, p<0.001, respectively). Six out of eight domains of the SF-36 QOL scores were significantly and negatively correlated with the mFG scores.

Conclusion

Patients diagnosed with IH have impaired HQOL, similar to patients diagnosed with PCOS. Improving HQOL should be a goal when deciding on a management approach for hirsutism, which is one of the most common reasons for referral to endocrinology and dermatology outpatient clinics.

Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

Hirsutism, which is characterized by excessive growth of terminal hair in a male pattern, may result from various causes including polycystic ovary syndrome (PCOS), non-classic congenital adrenal hyperplasia, adrenal or ovarian tumors or it may be idiopathic. Idiopathic hirsutism is currently defined as hirsutism associated with normal ovulatory function, normal serum androgen levels and normal ovarian morphology, however, the pathogenesis of idiopathic hirsutism is not clear. The androgens are the main hormones to stimulate growth of body hair, therefore, there should be any form of increased androgen effect irrespective of normal serum androgen levels in any patient with hirsutism. In accordance to this scientific truth, we have previously shown that, although within normal limits, patients with idiopathic hirsutism have relatively higher serum androgen levels (relative hyperandrogenemia) in comparison to healthy subjects which let as to think that is idiopathic hirsutism really idiopathic? In addition to relative hyperandrogenemia, we have previously shown that, in comparison to healthy subjects, women with idiopathic hirsutism demonstrated higher expression of steroid sulphatase and 17-beta hydroxysteroid dehydrogenase mRNA both in the subumbilical region and arm skin, which contributes to local androgen metabolism. Those results support the idea that, in some patients, although the adrenals or ovaries do not secrete increased amount of androgens leading to hyperandrogenemia, pilocebaceous unit locally produce increased amount of androgens leading to hirsutism without ovulatory dysfunction. Upon the demonstration of relative hyperandrogenemia and possible increase in local androgen synthesis in patients with idiopathic hirsutism, we think that idiopathic hirsutism is not idiopathic and it may be named as “normoandrogenic hirsutism”. Furthermore, it may not be a different entity but may be an early stage of hyperandrogenic disorders such as PCOS. Clinically, this can be find out by following-up patients with idiopathic hirsutism prospectively.

Comparative study of the clinico-trichoscopic response to treatment of hirsutism with long pulsed (1064 nm) Nd:YAG laser in idiopathic hirsutism and polycystic ovarian syndrome patients

Treatment of hirsutism is usually resistant, and from medical management to laser hair reduction, the treatment of hirsutism and its assessment are the most challenging. The aim of the study was to compare the response to treatment by laser hair reduction with long pulsed (1064 nm) Nd:YAG laser in patients of idiopathic hirsutism and polycystic ovarian syndrome (PCOS) by clinical and trichoscopic assessment. A hospital-based comparative, observational prospective study was carried out on female patients with hirsutism over a period of 18 months with two groups of participants: fifty women with idiopathic hirsutism (group A) and fifty with PCOS (group B). Laser hair reduction was done with long pulsed (1064 nm) Nd:YAG laser in both groups up to six sessions, 4 weeks apart and followed for 3 months post last laser session. After the sixth session of laser hair reduction, excellent response (> 75% reduction) from baseline was seen in 70% of patients in group A and in 54% of patients in group B. After 3 months of follow-up of the last laser session, it was found that the results persisted in patients with idiopathic cause than in those due to PCOS, seen both clinically and trichoscopically with decrease in hair shaft thickness, hair shaft colour, terminal vs. vellus hair ratio and hair density per cm². Hirsutism due to idiopathic cause responds better to laser hair reduction with long pulsed (1064 nm) Nd:YAG laser than that due to PCOS, due to underlying hormonal imbalance in the latter group. Follow-up of only up to 3 months after last laser session was done and tricoscan was not done.

Is There Any Association Between Hirsutism and Serum Zinc Levels in Adolescents?

Zinc has shown to have an anti-androgenic effect through 5 alpha-reductase enzyme activity inhibition in skin. However, there are contradicting findings concerning the effect of zinc on hirsutism mainly from studies including adult women with polycystic ovary syndrome (PCOS). The aim of our study was to investigate the association between serum zinc levels and hirsutism in adolescents. Between October 2017 and June 2018, 51 female adolescents with hirsutism (mean age: 16.11 ± 1.47 years) and 51 healthy female controls were included in the study (mean age: 15.5 ± 1.40 years). Adolescents with hirsutism were classified under two groups; PCOS (n = 34, 66.7%) and idiopathic causes of hirsutism (idiopathic hirsutism (n = 9, 17.6%) and idiopathic hyperandrogenemia (n = 8, 15.7%)). The serum zinc levels were measured via atomic absorption spectrophotometry. The mean zinc levels of adolescents with hirsutism (102.02 ± 11.64 μg/dl) and the control group (101.72 ± 16.71 μg/dl) were similar (p = 0.915). Additionally, there was no significant difference among the mean zinc levels of the hirsutism sub-groups and the control group (p = 0.979). While some studies demonstrated low zinc levels in women with hirsutism, some studies similar to ours showed no association. Adolescence is a developmental phase where generally isolated mild hirsutism is not associated with hyperandrogenism and more studies are needed to evaluate the effect of zinc on hirsutism in this age group.

A population-based study of the relationship between idiopathic hirsutism and metabolic disturbances

PURPOSE

To evaluate the association of idiopathic hirsutism, insulin resistance and metabolic disorders.

METHODS

Participants of this study included 137 women with idiopathic hirsutism and 698 women as controls selected from two large population-based cross-sectional studies including 1,772 reproductive-aged women. Anthropometric and biochemical characteristics of the participants were measured and compared; for instance, insulin resistance was estimated through the homeostatic model assessment and the metabolic syndrome was detected using the Joint Interim Statement.

RESULTS

Mean age, body mass index and other anthropometric measures including waist and hip circumferences were statistically higher in women with idiopathic hirsutism. No differences were observed in blood pressure, glucose and lipid profiles, homeostatic model assessment or the prevalence of insulin resistance, obesity and metabolic syndrome in women with idiopathic hirsutism and controls after adjustment of age and body mass index. In the subgroup of women with metabolic syndrome, fasting glucose levels of those with idiopathic hirsutism were significantly higher than controls, after adjustment of age and body mass index as 114 ± 25.85 vs. 103.52 ± 41.90 mg/dL, P = 0.003. Furthermore, the age and body mass index-adjusted prevalence of impaired fasting glucose in women with idiopathic hirsutism were higher than controls as 16.8 vs. 4.6%, OR = 2.26, 95% CI 1.59-5.38. A threshold of 74.5 cm for waist circumference had the optimal combined sensitivity and specificity for prediction of insulin resistance in women with idiopathic hirsutism, though this value was 90.5 cm for controls.

CONCLUSIONS

Our data suggest that although the overall metabolic characteristics were similar in women with idiopathic hirsutism and controls, glycemic disturbances were more often seen in those suffered from metabolic syndrome and idiopathic hirsutism simultaneously.

Preparation and clinical evaluation of Finastride gel in the treatment of idiopathic Hirsutism

OBJECTIVE

Hirsutism is the presence of excess terminal hairs in females in a male-like pattern. The most accepted hypothesis for the development of hirsutism is increased 5α-reductase activity in hair follicles of hirsute women. Finasteride partially blocks the conversion of testosterone to dihydrotestosterone through inhibition of 5α-reductase in hair follicles. This study was designed to determine the efficacy of finasteride gel 0.25% in management of idiopathic hirsutism and treatment of hirsutism with topical finasteride to lessen the side-effects.

METHODS

Women after puberty that have idiopathic hirsutism criteria are divided randomly in two groups; treatment and control. The number of patients in each group is 15 and received finasteride and placebo gel once a day on their skins. The patients were visited every month by a dermatologist and the amount of response to the treatment and the patient satisfaction was recorded. Ferriman-Gallwey score of the treated area was determined.

RESULTS

After 6-months, mean thickness hairs in treating group were decreased from 102.00 ± 9.58 µm to 86.4 ± 11.4 µm (p < 0.05), this difference was statistically significant. Gel application did not indicate any type of side-effects.

LIMITATIONS

Inclusion and exclusion criteria.

CONCLUSION

Finasteride partially blocks 5α-reductase. Because of the good absorption through the skin and good solubility of this medicine, the prepared gel formulation applied on the hirsutism area showed a significant decrease in hair growth locally, so finasteride gel is an efficient and harmless therapy in patients with idiopathic hirsutism.