Nevine Dorgham MD PhD Dept of Dermatology Faculty of Medicine Cairo University Cairo Egypt Key messages Globally hirsutism affects up to 20 of women and has a major impact on quality of life ID: 1045284
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2. The Effect of Adding Combined Oral Contraceptives or Metformin to Laser Hair Removal Treatment on the Quality of Life of Polycystic Ovarian Patient with Hirsutism: A Randomized Control TrialNevine Dorgham, MD, PhDDept. of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
3. Key messagesGlobally, hirsutism affects up to 20% of women, and has a major impact on quality of life.Treatment should aim to ameliorate symptoms, but also treat the underlying disease.Where polycystic ovarian syndrome is the cause, a combined oral contraceptive with adjunct laser treatment may be the best option.
4. BackgroundWhat do we already know about this topic?Hirsutism is growth of excessive terminal hair in androgen-dependent sites.1This can be hormonal, idiopathic, or drug-induced – but in 75% of cases, polycystic ovarian syndrome (PCOS) is the cause.21. Lumezi BG, Berisha VL, Pupovci HL, et al. Grading of hirsutism based on the Ferriman-Gallwey scoring system in Kosovar women. Postepy Dermatol Alergol 2018;35(6):631–5.2. Gainder S, Sharma B. Update on Management of Polycystic Ovarian Syndrome for Dermatologists. Indian Dermatol Online J 2019;10(2):97–105
5. BackgroundHow was this study conducted?150 patients with PCOS were recruited from clinics in Egypt and randomized into three groups for this 6-month trialAll three groups received 6 laser sessions with a diode laser, 810 nm; Group 2 also received metformin, and Group 3 a combined oral contraceptive containing cyproterone and ethinyl estradiol.Patient quality of life was measured (Dermatological Life Quality Index and health-related quality of life), and physician assessment of hirsutism performed using a 5-point visual analogue scale.
6. FindingsWhat does this study add?After 6 months, all three groups showed improvement across clinical measures, with good initial increases in quality of life.However, laser-only patients did not maintain their quality of life improvements over time.Results from Groups 2 and 3 suggest that metformin and combined oral contraceptives both affect the underlying mechanism of the disease.Patients in the contraceptive group showed the biggest overall improvement in quality of life, and this continued to increase out to 6 months.
7. PerspectivesHow does this study impact clinical practice?Physicians should investigate all patients presenting with hirsutism to establish the underlying cause.This study confirms that all hirsute patients will benefit from laser treatment, but the initial symptom relief may not be long-lived.To maintain long-term results in patients with PCOS, laser treatment should be given alongside a combined oral contraceptive.