Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society
Human Reproduction UpdatePublished 6 November 2011
Héctor F. Escobar‐Morreale, Enrico Carmina, Didier Dewailly, Alessandra Gambineri, Fahrettin Keleştimur, Paolo Moghetti
Citations478
SJR quartileQ1
SJR score5.36
SNIP5.38
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TL;DR
Evidence-based diagnostic and treatment strategies that address not only the amelioration of hirsutism but also the treatment of the underlying etiology is essential for the proper management of affected women, especially considering that hirsUTism is, in most cases, a chronic disorder needing long-term follow-up.
Abstract
Following evidence-based diagnostic and treatment strategies that address not only the amelioration of hirsutism but also the treatment of the underlying etiology is essential for the proper management of affected women, especially considering that hirsutism is, in most cases, a chronic disorder needing long-term follow-up. Accordingly, we provide evidence-based guidelines for the etiological diagnosis and for the management of this frequent medical complaint.
Keywords
Medicine
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Finasteride and spironolactone treatment resulted in a similar clinical effect on hirsutism, and further studies with finasteride are needed to verify its effectiveness as a treatment for hirsUTism.
Gynecologic and Obstetric InvestigationPrevalence of Polycystic Ovary Syndrome and Related Disorders in Mexican Women
151 Citations2010Carlos Morán, Gilberto Tena +4 more
The prevalence of PCOS in Mexican women is approximately 6.0%, similar to other populations, but lower than 12.8% reported in Mexican-American women.
Diabetes CareEffects of Medical Therapy on Insulin Resistance and the Cardiovascular System in Polycystic Ovary Syndrome
148 Citations2007Caroline Meyer, Barry P. McGrath +1 more
In overweight women with PCOS, metformin and low- and high-dose OCP preparations have similar efficacy but differential effects on insulin resistance and arterial function, suggesting that a low- doses of OCP preparation may be preferable if contraception is needed and that met formin should be considered for symptomatic management.
The Journal of Clinical Endocrinology & MetabolismComparison of Efficacy of Spironolactone with Metformin in the Management of Polycystic Ovary Syndrome: An Open-Labeled Study
147 Citations2004Mohd Ashraf Ganie, Madan Lal Khurana +4 more
Both drugs are effective in the management of PCOS and spironolactone appears better than metformin in the treatment of hirsutism, menstrual cycle frequency, and hormonal derangement and is associated with fewer adverse events.
Journal of the American Academy of DermatologyElectrolysis: Observations from 13 years and 140,000 hours of experience
143 Citations1995Robert N. Richards, Gay E Meharg
The blend method is found to be the most effective modality for permanent hair removal, and the recent availability of EMLA (eutectic mixture of local anesthetics) has been beneficial in reducing the sensations of electrolysis.
The Journal of Clinical Endocrinology & MetabolismA Prospective Randomized Trial Comparing Low Dose Flutamide, Finasteride, Ketoconazole, and Cyproterone Acetate-Estrogen Regimens in the Treatment of Hirsutism
143 Citations1999Stefano Venturoli, O. Marescalchi +6 more
Despite different modalities of action and significantly different effects on androgen levels, low doses of flutamide, finasteride, and EE-CPA constitute very satisfactory alternative therapeutic regimens in the treatment of hirsutism.
Human ReproductionIndicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria
135 Citations2008Anne Goverde, A.J.B. van Koert +5 more
Waist circumference combined with FAI was identified as an efficient combination test to select those PCOS women who should be screened for the presence of MetS and/or IR and offered a reduction in the necessity of screening for metabolic derailments of about 50%.
The Journal of Clinical Endocrinology & MetabolismFamilial Study of Hirsutism
131 Citations1970E. Moncada Lorenzo
A significant familial aggregation of hirsutism was found and propositi with their relatives set the basis for a genetic etiology, a multifactorial pattern of inheritance being a plausible one.
Journal of the American Academy of DermatologyA randomized bilateral vehicle-controlled study of eflornithine cream combined with laser treatment versus laser treatment alone for facial hirsutism in women
130 Citations2007Iltefat Hamzavi, Eileen Tan +2 more
It is demonstrated that the addition of eflornithine to laser hair removal results in a more rapid and complete reduction of unwanted facial hair in women when the combination is used for up to 6 months.
Fertility and SterilityPrevalence of endocrine diseases and abnormal glucose tolerance tests in 340 caucasian premenopausal women with hirsutism as the referral diagnosis
125 Citations2004Dorte Glintborg, Jan Erik Henriksen +6 more
Initial evaluation of hirsute patients with irregular menses should include serum (s)-17alpha-hydroxyprogesterone, s-prolactin, S-Testosterone (T), and s-sex hormone-binding globulin, and further evaluation is needed in patients with markedly elevated s-T or with clinical Cushing's syndrome.
American Journal of Clinical DermatologyTopical Eflornithine
125 Citations2001Julia A. Balfour, Karen J. McClellan
In clinical studies in women with excessive, unwanted facial hair, eflornithine 15% cream was superior to placebo in reducing hair growth, as demonstrated by objective and subjective methods, after 2 to 8 weeks’ treatment.
Fertility and SterilityIdiopathic hirsutism: an uncommon cause of hirsutism in Alabama
124 Citations1998Ricardo Azziz, W. Waggoner +3 more
Clinical EndocrinologySpironolactone as a single agent for long‐term therapy of hirsute patients
122 Citations2000Poli Mara Spritzer, Karen O. Lisboa +2 more
The androgen‐suppressing effect of spironolactone is assessed and the use of this drug as a single agent in the long‐term therapy of hirsute patients with either polycystic ovary syndrome (PCOS) or idiopathic hirsutism (IH).
Hormone ResearchClinical Utility of Sex Hormone-Binding Globulin Measurement
120 Citations2008Michel Pugeat, Jean Charles Crave +2 more
The measurement of SHBG in clinical practice can be a useful diagnostic tool for correctly interpretating testosterone and estradiol serum concentrations; investigating androgen-estrogen balance in gonadal and sexual dysfunctions; assessing the peripheral effect of the hormones which regulate SHBG productions, and evaluating insulin resistance and cardiovascular risk.
Reviews in Endocrine and Metabolic DisordersAndrogen synthesis in adrenarche
119 Citations2008Walter L. Miller
Qualitative regulation, which determines the type of steroid produced in a cell, is principally at the level of P450c17 (CYP17), while acute regulation is mediated by the steroidogenic acute regulatory protein (StAR), which facilitates the rapid influx of cholesterol into mitochondria, where P450scc resides.
Archives of DermatologyThe Relationship of Mild Hirsutism or Acne in Women to Androgens
119 Citations1987Stewart B. Reingold
A model in which variation in apparent skin sensitivity and the level of androgen seem to contribute about equally to the pathogenesis of mild hirsutism and acne is proposed, which is based on a comparison of pilosebaceous overactivity and plasma fT levels.
The Journal of Clinical Endocrinology & MetabolismAdditive Effects of Insulin-Sensitizing and Anti-Androgen Treatment in Young, Nonobese Women with Hyperinsulinism, Hyperandrogenism, Dyslipidemia, and Anovulation
117 Citations2002Lourdes Ibáñez, Carme Valls +4 more
The data from this small study suggest that dyslipidemia is secondary to excess androgen action in concert with the hyperinsulinemia associated with insulin resistance, and combined anti-androgen and insulin-sensitizing treatment in young, nonobese women with hyperinsulinemic hyperandrogenism had additive benefits on insulin sensitivity, hyper androgenemia, and dyslipids.
Journal of Psychosomatic ResearchPsychological morbidity in women referred for treatment of hirsutism
112 Citations1993Julian H. Barth, José Catalán +2 more
It is suggested that a proportion of women with hirsutism experiences psychological and social difficulties, and that factors other than their dermatological status play an important part in their psychological difficulties.
Cochrane Database of Systematic ReviewsLaser and photoepilation for unwanted hair growth
111 Citations2006Merete Hædersdal, Peter C Gøtzsche
There appeared to be a short-term effect of approximately 50% hair reduction with alexandrite and diode lasers up to six months after treatment, whereas little evidence was obtained for an effect of intense pulsed light, neodymium:YAG or ruby lasers.
Dermato-EndocrinologyHormones and the pilosebaceous unit
108 Citations2009WenChieh Chen, Christos C. Zouboulis
More work is needed to explain the regional difference within and between the androgn-mediated dermatoses, and the pilosebaceous unit can act as an ideal model for studies in dermato-endocrinology.
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