THE PREVALENCE OF HIRSUTISM AND ETHNICAL PECULIARITIES OF HAIR DISTRIBUTION IN GEORGIAN ADOLESCENT POPULATION IN TBILISI

Objective - the purpose of the study is evaluation of the Hirsutism prevalence and ethnical peculiarities of the hair distribution in Georgian female adolescents of Tbilisi, Georgia. 2592 randomly selected female adolescents of Tbilisi were included in the study. They completed standard questionnaires consisted of questions about the existence of hirsutism and its locations. For clinical assessment 2 groups were selected from them: group 1 - 117 adolescents with hirsutism and 178 without it. For clinical evaluation of hirsutism modified Ferriman-Gallwey score was used. Based on the self-estimation the hirsutism prevalence was 26.62% (690 out of 2592), while clinically established prevalence of hirsutism was 20.61%. The most prevalent areas of hair distribution by self-estimation were the face and the abdomen. Clinical assessment of patients with hirsutism showed that mean value of Ferriman-Gallwey Score was 12.87±5.94. Hair distribution by clinical assessment was most significantly observed in the lower abdomen (78.33%), upper lip (76.67%) and chest (68.33%). This is the first study of hirsutism prevalence in ethnically Georgian adolescent female population. The study has shown that the value of prevalence by self-estimation exceeds analogous value established clinically, and the sites with hair excess are lower abdomen, upper lip and the chest.

The effect of CAG repeats length on differences in hirsutism among healthy Israeli women of different ethnicities

PURPOSE

Variations in the degree of hirsutism among women of different ethnic backgrounds may stem from multiple etiologies. Shorter length of the polymorphic CAG repeats of the androgen receptor (AR) gene may be associated with increased activity of the receptor leading to hirsutism. We hypothesized that there are ethnic differences in the degree of hirsutism that is unrelated to androgen levels among Israeli women, and that the CAG repeats length may contribute to these differences. Anti-androgenic therapies, such as spironolactone, could be suggested if a shorter CAG repeats length is found to affect the difference in the degree of hirsutism between the ethnic groups.

METHODS

Healthy Israeli Jewish women aged 18-45 years of Ashkenazi and non-Ashkenazi origin were invited to participate. Hirsutism was assessed using the simplified Ferriman-Gallwey (sFG) score, and serum total testosterone levels were measured as well. The CAG repeats length was determined by PCR. Methylation-sensitive methods were used to detect the fractional activity of each allele, and the weighted mean was calculated for the CAG repeats length.

RESULTS

One-hundred and eight women were recruited (49 Ashkenazi and 59 non-Ashkenazi). The Ashkenazi women had a significantly lower degree of hirsutism (P<0.01), lower mean BMI (P = 0.003), total testosterone levels (P = 0.017), and longer weighted bi-allelic CAG repeats mean (P = 0.015) compared to non-Ashkenazi women. For the group as a whole, there was a significant negative correlation between the number of CAG repeats in the AR gene and the sFG score, while the number of repeats was not related to testosterone levels. Stepwise logistic regression revealed that ethnic origin and the CAG repeats length were the strongest factors affecting hirsutism (P<0.001, P = 0.03, respectively).

CONCLUSIONS

There is a significant difference in the degree of hirsutism between Ashkenazi and non-Ashkenazi women in Israel that is partially explained by CAG repeats length.

Women self-perception of excess hair growth, as a predictor of clinical hirsutism: a population-based study

PURPOSE

Hirsutism is the most common indicator of hyperandrogenism. Both, the sensitivity of the patients to the serum androgen levels and the responsiveness of women to the perceived excess hair growth vary among different populations. This report elaborates the relationship between the woman's discerned abnormal hair growths with the clinical diagnosis of hirsutism.

METHODS

The survey was conducted among 1160 women aged 18-45 and randomly selected from Tehran Lipid and Glucose Study for further detailed assessment of Hirsutism; using the m-FG scoring method. Data gathering was performed by interviews and physical examinations. The receiver operating characteristic curve was drawn and the new cutoff value, sensitivity, specificity and concordance percentage were calculated.

RESULTS

The results demonstrated that among 12 androgen-dependent body areas, the chin skin had the highest area under curve of 0.81 (CI; 0.78-0.84). According to the patient's evaluation, a threshold point of 4 had the optimum concordance percentage of 0.77 with the modified Ferriman-Gallwey scoring system.

CONCLUSIONS

Patient's self-identification of excess terminal hair based on the chin area has great sensitivity and reliability in predicting the clinical hirsutism.

Epidemiologic investigation of polycystic ovarian syndrome (PCOS) in Han ethnic women of reproductive age in Liaoning Province, China

OBJECTIVE

To determine the incidence of polycystic ovary syndrome (PCOS) among Han women of reproductive age in Liaoning Province in Northeastern China, based on the Revised Rotterdam 2003 criteria.

MATERIALS AND METHODS

A retrospective cohort study was carried out on 1,600 women using questionnaires, physical examination, ultrasonography, and biochemical indices (aged = 19 to 45 years; n = 1,600). PCOS patients were identified using the Revised Rotterdam 2003 criteria.

RESULTS

A total of 132 Han women of reproductive age were diagnosed with PCOS, with a prevalence of 8.25%. The prevalence of menstrual dysfunction was as follows: 97 patients (73.48%) had abnormal menstruation, three (2.27%) had polymenorrhea, and 94 (71.21%) had oligomenorrhea. Up to 64 patients (48.48%) had androgen excess, 42 (31.82%) had biochemical evidence of androgen excess, and 34 (25.76%) had clinical androgen excess. Up to 34 patients (25.76%) were obese (body mass index [BMI] > or = 25) and 19 (14.39%) had hirsutism (F-G scoring > or = 6). A total of 127 patients (96.22%) were diagnosed with PCOS via ultrasonography, 67 of whom (50.76%) had a unilateral polycystic ovary and 60 (45.46%) had bilateral polycystic ovaries.

CONCLUSIONS

The prevalence of PCOS in this study population was 8.25%, with an infertility rate of 27.8%. The classical manifestation of PCOS is PCO, abnormal menstruation, and obesity. The high-risk factors of PCOS include high free testosterone index, homeostasis model assessment-insulin resistance (HOMA-IR), increased serum testosterone and androstenedione, decreased sex hormone-binding globulin, long history of infertility, menarche later than 16 years old, and failure to have regular menstruation within two years.

Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: a large-scale case-control study

AIM

The Rotterdam criteria extend the phenotypic spectrum of polycystic ovary syndrome (PCOS). The study was to investigate the clinical and biochemical features of a large-scale clinic based on the samples of Chinese women and to evaluate the value of Rotterdam criteria on Chinese PCOS women.

METHODS

One thousand four hundred and four Chinese women were involved in our study, among whom, 719 cases were diagnosed as PCOS based on 2003 Rotterdam criteria, and 685 women without history of hyperandrogenism and with regular menstrual cycles were recruited as control. Clinical features, ultrasonographic (ovarian follicle number and volume), hormonal and metabolic parameters were commenced as outcome measures.

RESULTS

Among 719 PCOS women, 6.1 % had hirsutism, 13.3 % had acne, 21.1 % had hyperandrogenism, 94.2 % had polycystic ovaries on ultrasonographic examination, and 88.6 % had menstrual abnormality. About one-third of the total PCOS patients were insulin resistant. The most frequent PCOS phenotype is the non-hyperandrogenic phenotype (O + P). Total testosterone, LH/FSH ratio, body mass index (BMI), and Ferriman and Gallwey scores (F-G) were all significantly higher in PCOS groups compared with non-PCOS group. Women with PCOS and obesity had higher serum testosterone, fasting insulin, longer menstrual cycle and larger ovarian follicle number, and LH/FSH ratio, estradiol or ovarian volume were similar between obese and normal BMI women. The LH level was statistically lower in the obese PCOS group.

CONCLUSIONS

Rotterdam criteria are generally applicable to Chinese population. Chinese women with PCOS showed lower rates of hyperandrogenemia, hirsutism, obesity, and insulin resistance. Obesity aggravates menstrual irregularity and increases the follicle number and serum total testosterone level.

Three-dimensional ultrasound features of the polycystic ovary in Chinese women

OBJECTIVES

To quantify the three-dimensional (3D) ultrasound characteristics of ovaries in Chinese women with polycystic ovarian syndrome (PCOS) and to compare these with previous data on a Caucasian cohort with PCOS.

METHODS

3D pelvic ultrasound was performed in 40 Chinese women with PCOS and 40 controls. Ovarian volume, stromal volume and echogenicity, and antral follicle count (AFC) were measured and ovarian blood flow was quantified using both 3D power Doppler and two-dimensional (2D) pulsed wave Doppler. These data were compared with previously published data on a Caucasian cohort with PCOS.

RESULTS

Compared with controls, women with PCOS had a higher AFC (median (range), 15 (11-30) vs. 5.5 (1-10) per ovary, P < 0.01), ovarian volume (12.32 (8.10-16.16) mL vs. 5.64 (2.62-8.81) mL, P < 0.01) and stromal volume (9.74 (6.44-13.56) mL vs. 4.07 (1.52-6.67) mL, P < 0.01) but were comparable in stromal echogenicity and ovarian blood flow as measured by 3D power Doppler or 2D pulsed wave Doppler indices. However, in comparison with a previously reported Caucasian cohort with PCOS, the ovaries of Chinese women with PCOS had a significantly smaller stromal volume (median (range), 9.74 (6.44-13.56) mL vs. 10.79 (5.65-17.12) mL, P < 0.05), were less echogenic as reflected in a lower mean gray value (22.43 (13.13-35.50) vs. 32.36 (19.35-53.71), P < 0.01), and had reduced ovarian blood flow as reflected in a lower flow index (30.19 (23.32-44.88) vs. 33.54 (21.88-51.65), P < 0.05).

CONCLUSION

Based on 3D ultrasound measurements, Chinese women with PCOS have an increased stromal volume compared with controls. However, their stromal volume, echogenicity and vascularity is significantly lower than that in Caucasian women with PCOS. The possible etiology for these differences is discussed.

The use of a constant spectrum, uniform temporal profile intense pulsed light source for long‐term hair removal in Asian skin

Phototherapy has become a treatment of choice in many areas of medicine. Light can deliver energy to tissue selectively, targeting specific structures in order to induce the desired therapeutic outcome. For the safe and effective removal of unwanted hair, the key optical parameters are wavelength, pulse duration and energy density, and can vary dependent upon skin and hair color. In recent years, the use of broad spectrum white light sources has proved to be safe and efficacious in the removal of hair with minimal short- or long-term side effects. Whilst these highly flexible devices can achieve the desired results, there is scope for improvement. There are two key limitations to these devices: an inability to produce a 'true' long pulse matched to the thermal relaxation time of the hair structure and fluctuations in the output spectrum can lead to ineffective treatment with an increased risk of side effects. This paper describes an alternative approach to producing long pulse, constant spectrum optical pulses and presents clinical data showing improved efficacy in long-term hair removal.

[Investigation of body hair assessment of Chinese women in Shandong region and its preliminary application in polycystic ovary syndrome patients]

OBJECTIVE

To determine a suitable standard of hirsutism for Chinese polycystic ovary syndrome (PCOS) patients living in Shandong region.

METHODS

A total of 623 unbiased women from the general population in Jinan city, 131 PCOS patients and 84 controls from outpatients in Shandong region were studied with questionnaires, physical and pelvic ultrasound examination, body hair on 11 sites were evaluated, and 9 (lip, chin, arm, thigh, chest, upperbelly, lowerbelly, upperback, lowback) of them which were called hormone Ferriman-Gallwey (F-G) score and 2 (forearm, leg) sites of indifferent hormone score were calculated according to the score system described by Ferriman and Gallwey.

RESULTS

(1) Both body hair F-G score and indifferent hormone score distribution mode in the <or= 40 years old population were un-normal and both the 95th percentages of score were 2. (2) The hirsutism was significantly higher in PCOS patients [48.1% (63/131)] than in controls [4.8% (4/84)] by F-G score >or= 2 (chi(2) = 47.68, P < 0.01), but no statistic difference by F-G score >or= 6 criterion (chi(2) = 0.64, P = 0.42). (3) F-G scores were declined with age increase. The hair score on the lip, chest, lowerbelly in general population were positively correlated with F-G score (r = 0.712, 0.594, 0.522; P < 0.01) and in PCOS patients (r = 0.879, 0.682, 0.710; P < 0.01), and on the lip in controls (r = 0.950, P < 0.01). (4) The correlation contingency coefficient between hirsutism (F-G score >or= 2) and lip, chest, lowerbelly site in general population was 0.461, 0.420, 0.489 and was 0.560, 0.532, 0.503 in PCOS group respectively.

CONCLUSIONS

(1) Both body hair F-G score and indifferent hormone score distribution mode are significantly different from Ferriman-Gallwey's report; according to our investigation the suitable criterion of hirsutism for Chinese women in Shandong region should be >or= 2 scores. (2) By F-G score >or= 2 standard, hirsutism is more common in PCOS than in control. (3) Lip, chest, and lowerbelly are the main sites to determine the hirsutism status of women, and the later two sites are more specific for PCOS hirsutism. Forearm and leg score can indicate hirsutism status in some degree but are not specific and sensitive for PCOS hirsutism.

The prevalence and features of the polycystic ovary syndrome in an unselected population

Notwithstanding the potential public health impact of the polycystic ovary syndrome (PCOS), estimates regarding its prevalence are limited and unclear. Between July 1998 and October 1999, 400 unselected consecutive premenopausal women (18-45 yr of age) seeking a preemployment physical at the University of Alabama at Birmingham were studied (223 Black, 166 White, and 11 of other races). Evaluation included a history and physical examination, a modified Ferriman-Gallwey hirsutism score, and serum screening for hyperandrogenemia, hyperprolactinemia, and 21-hydroxylase-deficient nonclassical adrenal hyperplasia. PCOS was diagnosed by the presence of the following: 1) oligoovulation, 2) hyperandrogenemia and/or hirsutism (modified Ferriman-Gallwey score > or = 6), and 3) the exclusion of related disorders. Confirmed PCOS was established in those individuals whose evaluation was complete and indicative of PCOS, and possible PCOS was established when the hormonal evaluation was not complete or was unavailable, but the clinical phenotype was otherwise suggestive of the disorder. The individual probability of PCOS in women with possible PCOS was assigned a weight based on the findings in similar subjects whose evaluation was complete, and the total number of PCOS cases arising from these individuals was calculated (i.e. individual probability of PCOS x total number of subjects in the group). The cumulative prevalence of PCOS in our population was 6.6% (26.5 of 400), including 15 subjects among the 347 women completing their evaluation and a calculated prevalence of 11.5 subjects among the remainder. The prevalence rates of PCOS for Black and White women were 8.0 and 4.8%, respectively, not significantly different. These data from a large representative unselected population support the concept that PCOS is the most common endocrine abnormality of reproductive-aged women in the United States.

Clinical diagnosis of hirsutism in Thai women

OBJECTIVE

To determine the cutoff score for identifying hirsute, Thai women, by using modified Ferriman-Gallwey-Lorenzo (mF-G-L) method.

MATERIAL AND METHOD

Hirsutism was defined as an amount of terminal hair in the androgen-sensitive skin areas that the women themselves would consider obviously abnormal, and their mF-G-L score was above 97.5 percentile of general population. The subjects were consecutive unselected premenopausal women who came to our hospital for their yearly Papanicolaou smear check up, without any complaint. Acne and oily skin were also assessed.

RESULTS

Five hundred and thirty-one women underwent a physical exam. The women who had the total hair-growth score of 0, 1 and 2 by mF-G-L method accounted for 97.8% of all the subjects. All of the 11 subjects with a total score of 3 or more considered themselves to have excessive growth of hair. None of these 11 women had acne.

CONCLUSION

The authors purposed that the cutoff score to diagnose Thai hirsutism may be 3 or more by mF-G-L method.

Ethnic hair update: past and present

Hair and scalp disorders in African American patients are challenging because of the lack of pathophysiologic explanations for many of the disorders that occur in this population. To understand the clinical appearance of these disorders and to design an effective treatment plan, the dermatologist must have a clear knowledge of the basic hair-care practices and concerns of this group of patients. Given that patients of African American heritage are not a homogeneous group, this overview describes many of the common hair-care practices of African Americans and how they affect patients' health. The common hair and scalp disorders are discussed, with a specific focus on inflammatory disorders that result in significant pigmentation alteration or scarring.

Hirsutism in the United Arab Emirates: a hospital study

In a study of 102 women (Arabs and Asians) with hirsutism, polycystic ovary syndrome was diagnosed in 93 patients (91%) including 26 cases with hirsutism and regular menstrual periods. In more than half of the cases the diagnosis was made on the basis of transabdominal ultrasonography, which was the single test with the highest yield. Luteinising hormone hyperresponsiveness to gonadotropin-releasing hormone was positive in only seven of 50 patients tested. Late onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency was identified in two cases, thus forming a prevalence of 8% in those who underwent adrenocorticotropin stimulation. In one case, polycystic ovary syndrome was an associated condition. In this study of a population of women with hirsutism and regular menses, the majority had polycystic ovaries. It is suggested that the term 'idiopathic or racial' hirsutism should not be applied unless a thorough evaluation has failed to reveal a diagnosable underlying disorder.

[Characteristics of hirsutism in fertile Russian and Armenian women and in infertile patients]

The authors investigated the characteristic features of pubescence in healthy fertile women of Russian (n = 300) and Armenian nationality (n = 150) and in infertile patients (n = 300). They assessed the criteria or normal female pubescence, liminal pubescence and hirsutism in the two populations. In healthy Armenian women the criteria of normal female pubescence and hirsutism are more marked (p less than 0.001) than in Russian women. In Armenian women significantly more frequently (p less than 0.05) an increased sensitivity of the skin to testosterone was observed, as compared with Russian women. In infertile patients hirsutism was found in 20%.