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Hirsutism is the abnormal excessive growth of coarse terminal hair over androgen-sensitive body areas. It is a very common endocrine pathology, affecting up to 10% of young females and has been linked with multiple conditions. Polycystic ovary syndrome (PCOS) and Idiopathic hirsutism encompass 90% of the cases. Patients presenting with hirsutism may require additional investigations and a plan with options for treatment. Mechanical hair removal is first-line management, along with lifestyle changes. Laser and phototherapy have been gaining popularity. The combined contraceptive pill is the preferred initial medical treatment offered, if not contraindicated, followed by anti-androgen therapy. Other emerging therapeutic options are inositol and vitamin D, especially in patients with PCOS. Treatment options should be discussed with patients, irrespective of the clinical severity, as they could be addressing underlying psychosocial concerns. [ABSTRACT FROM AUTHOR]

Hair loss and hirsutism have been major complaints due to increased concentrations of dihydrotestosterone. The plant Platycladus orientalis, with 5-alpha reductase inhibitor properties, has been used to treat these disorders. Its formulation with lipophilic carriers in SLN possesses high loading capacity and greater permeability to hair follicles. The present study aimed to determine the content of active ingredients in the extract of P. orientalis L. and to prepare and characterize the solid lipid nanoparticles (SLN) of Platycladus orientalis L. extract as a 5-alpha reductase inhibitor. The total methanolic extract was obtained following the maceration technique. This preparation was analyzed by HPLC using Quercetin and Cedrol as standard components. SLNs were prepared by high-shear homogenization and ultrasound. Four Glucire-GMS-Compritol-Precirol lipids and three poloxamer-tween80-Labrasol surfactants were further used in the formulations. Particle size, zeta potential, nanoparticle morphology, encapsulation percentage, crystal structure, physical stability, size, and zeta potential were studied 0, 3, and 6 months after preparation. Within 1-7 days after preparation, formulations containing GMS and compritol lipids became solid and jelly. Meanwhile, the formulations with Precirol as the lipid and Poloxamer as the surfactant with 0.3% extract exhibited desirable properties such as average particle size (192 nm), the encapsulation of the extract inside the nanoparticles was almost 71%, and good zeta potential. This formulation containing precirol as a lipid, poloxamer as a surfactant, and 0.3% plant extract exhibited greater 5-alpha reductase inhibitor activity, and it can be recommended to treat hair loss and hirsutism. [ABSTRACT FROM AUTHOR]

Becker’s naevus (BN) presents as a unilateral, hyperpigmented patch with hypertrichosis over the upper trunk/proximal upper extremity. Usually, block-like/geographical pattern is seen; however, linear forms have also been reported. A 21-year-old man presented to us with a history of hyperpigmented, well to ill-defined discrete-to-coalescent plaques with brownish macules scattered at the periphery, over posteromedial aspect along Blaschko’s lines, extending from the buttock to the ankle of the right lower limb. No associated hypertrichosis/focal defects were seen. On dermoscopy (10×, DermLite DL4W, Dana Point, California) pigment network, scaling with perifollicular accentuation, perifollicular hypopigmentation, and uniform brown dots/globules/lines were seen. A skin biopsy revealed acanthosis and focal papillomatosis with increased pigment in the basal layer; pigment incontinence and melanophages were seen in the dermis. To the best of our knowledge, only one such case has been reported with Blaschko-linear BN over the lower limb. We present here an uncommon case of Blaschko-linear BN over the lower limb with dermoscopy and a concise literature review of BN over the lower limb. [ABSTRACT FROM AUTHOR]

This article provides a general overview of electrolysis permanent hair removal and explains how it relates to dermatology, with a specific focus on hirsutism and paradoxical hypertrichosis (laserstimulated hair growth). The causes of excess hair growth, electrolysis treatment options, and recent studies on this topic will be covered. [ABSTRACT FROM AUTHOR]

Background and Objective: Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. Therefore, in this study, the prevalence of hirsutism, overweight and menstrual disorders, which have a high comorbidity with this syndrome, and its relationship with age, marriage, and the use of related medications were investigated among students in the dormitory of Kerman University of Medical Sciences. Methods: This cross-sectional study was conducted among students in the dormitory of Kerman University of Medical Sciences in 2019-2020. The prevalence of hirsutism, menstrual disorders, polycystic ovary syndrome (based on NIH criteria) and overweight were calculated. The polycystic ovary syndrome screening questionnaire was used for screening and its relationship with age, marriage and the use of related medications was measured. Findings: 636 students with an average age of 21.99±3.61 participated in this study. 13.9% of students had a menstrual cycle of more than 35 days. 70.6% had a menstrual cycle of 25 to 34 days. In terms of the growth of thick dark hair, 17.1% experienced hair growth in more than two areas of the body, and most reports of hair growth were related to chin, chest, and abdomen with 31.4%, 29.9%, and 23.2%, respectively, and 45.3% of subjects did not report hirsutism. Moreover, 30.8% were overweight and 4.7% had galactorrhea. With a confidence interval of 95%, the prevalence of polycystic ovary syndrome was 10.6 (3.2-18.0). Age and the use of medications had a significant relationship with these symptoms. Conclusion: The results of this study showed that the prevalence of polycystic ovary syndrome among students is not higher than the average of the society, and it occurs more in people over 22 years of age and people who take medications. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effects of yoga exercises on anthropometric parameter and clinical sign of PCOS among women undergoing infertility treatment. This clinical trial study was performed on 61 women with PCOS who have undergone infertility treatment at Sarem Hospital in Tehran, Iran. The patients were first selecting based on purposeful and then randomly assigning to the intervention and control groups. In the intervention group, yoga exercises were performed for 6 weeks and the patients in the control group only received routine care. Anthropometric parameters and clinical signs were performed and recorded. After the intervention, here was a significant reduction in hirsutism, abdominal circumference, and hip circumference scores in the intervention group compared to the control group (P < 0.05). Given the effects of yoga exercises on the improvement of hirsutism, abdominal circumference, and hip circumference, it is suggested to use yoga as a treatment strategy in women with PCOS. [ABSTRACT FROM AUTHOR]

Hirsutism is a common condition affecting women of reproductive age and is associated with significant psychological morbidity. This abnormal excess growth of terminal hair is usually driven by hyperandrogenism, most commonly, polycystic ovarian syndrome. Numerous other causes exist including idiopathic, endocrine or malignant pathologies. This review outlines the aetiology of hirsutism, the clinical assessment of a patient presenting with hirsutism, and treatment options. Mechanical hair removal methods have usually been tried already before a patient seeks medical attention. Other treatment options include suppression of endogenous androgen secretion or action. At least 6 months of treatment is usually required before improvement in symptoms can be expected. [ABSTRACT FROM AUTHOR]

Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is often a sign of excessive androgen levels. Although many conditions can lead to hirsutism, polycystic ovary syndrome and idiopathic hyperandrogenism account for more than 85% of cases. Less common causes include idiopathic hirsutism, nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, medications, hyperprolactinemia, thyroid disorders, and Cushing syndrome. Women with an abnormal hirsutism score based on the Ferriman-Gallwey scoring system should be evaluated for elevated androgen levels. Women with rapid onset of hirsutism over a few months or signs of virilization are at high risk of having an androgen-secreting tumor. Hirsutism may be treated with pharmacologic agents and/or hair removal. Recommended pharmacologic therapies include combined oral contraceptives, finasteride, spironolactone, and topical eflornithine. Because of the length of the hair growth cycle, therapies should be tried for at least six months before switching treatments. Hair removal methods such as shaving, waxing, and plucking may be effective, but their effects are temporary. Photoepilation and electrolysis are somewhat effective for long-term hair removal but are expensive. [ABSTRACT FROM AUTHOR]

Objectives: 1. To study the efficacy of exercise in improving clinical symptoms, anthropometry, glucose tolerance and laboratory profile in women with Polycystic ovarian syndrome. 2. To study the combined efficacy of exercise and metformin on above parameters in women with polycystic ovary syndrome.Study Design: A Randomised double blinded placebo controlled trial was performed at a district hospital in New Delhi. Sixty six women were included in the study. Block randomisation was done to divide the women into two groups. Women were treated with fixed exercise schedule along with oral placebo in Group A and exercise with oral metformin in Group B. Outcomes stated in objectives were studied and statistically analysed. Quantitative variables were compared using unpaired t-test and Paired t-test within the groups across follow-ups. Qualitative variable has been compared using Chi-Square test /Fisher's exact test.Results: In Group A and B significant improvement was noted in menstrual cycles, mean waist circumference, mean waist-hip ratio and body mass index. The mean weight loss was 0.78 ± 0.19 kg and 1.71 ± 0.19 kg in group A and B respectively after 3 months. The mean weight loss was 1.08 ± 0.30 kg and 1.71 ± 0.19 kg in group A and B respectively. The mean difference in modified Ferriman Gallwey score at 0, 3 and 6 months were statistically significant in both groups. On comparing group A with group B at 6 months, significant improvement was found in menstrual cycle symptoms (55.17% vs 83.33%), mean weight loss (1.08 kg vs 2.5 kg), waist circumference reduction (2.56 cm vs 4.75 cm) and change in mean waist hip ratio (0.02 vs 0.04). Significant changes were noted in OGTT and Serum testosterone level at 6 months in Group B, but not in Group A. Statistically no significant differences were found in acne, acanthosis nigricans and other biochemical parameters.Conclusion: Regular exercise should be recommended for the women with PCOS. It results in statistically significant improvement in menstrual cycle pattern, hirsutism, body mass index, weight, waist circumference waist-hip ratio. Addition of metformin resulted in added benefits on menstrual cycle, hirsutism, weight, body mass index, waist circumference, waist hip ratio, serum testosterone and Oral Glucose Tolerance Test (OGTT). [ABSTRACT FROM AUTHOR]

Hirsutism is a common endocrine disorder affecting 5–10% of women of reproductive age and is commonly associated with acne and oily skin. It may be a source of social embarrassment and can negatively affect quality of life. A thorough history, physical examination and selected laboratory evaluations will confirm the diagnosis. This article reviews various causes and management of hirsutism. The most common cause of hirsutism is polycystic ovary syndrome, accounting for three out of every four cases. Pharmacologic interventions can suppress ovarian or adrenal androgen production and block androgen receptors in the hair follicle. Hair removal methods and lifestyle modifications may improve the therapeutic response. Considering the long life cycle of a hair follicle, prolonged treatment with pharmaceutical agents is required to produce improvement in hirsutism. [ABSTRACT FROM AUTHOR]

Unwanted facial and body hair presents as a common finding in many patients, such as females with hirsutism. With advances in laser and light technology, a clinically significant reduction in hair can be achieved in patients with light skin. However, in patients with darker skin, Fitzpatrick skin types (FST) IV-VI, the higher melanin content of the skin interferes with the proposed mechanism of laser-induced selective photothermolysis, which is to target the melanin in the hair follicle to cause permanent destruction of hair bulge stem cells. Many prospective and retrospective studies have been conducted with laser and light hair-removal devices, but most exclude patients with darkly pigmented skin, considering them a high-risk group for unwanted side effects, including pigmentation changes, blisters, and crust formation. We reviewed the published literature to obtain studies that focused on hair reduction for darker skin types. The existing literature for this patient population identifies longer wavelengths as a key element of the treatment protocol and indicates neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, alexandrite, and ruby lasers as well as certain intense pulsed light sources for safe hair reduction with minimal side effects in patients with FST IV-VI, so long as energy settings and wavelengths are appropriate. Based on the findings in this review, safe and effective hair reduction for patients with FST IV-VI is achievable under proper treatment protocols and energy settings. [ABSTRACT FROM AUTHOR]

Background and objectives Hirsutism or excess hair growth is a common dermatological problem in females, affecting up to 10% of females worldwide. We aimed this study to compare the two hair-shortening methods shaving vs. snipping among hirsute women regarding the outcome of the therapy and also the paradoxical hypertrichosis phenomenon (terminal hair regrowth) 6 months after the final therapy session. Materials and Methods In this study, 129 premenopausal women affected by hirsutism were randomly divided into two study groups according to hair-shortening method: shaving as group A (66 patients) and hair shortening by scissor as group B (63 patients). Each patient received six alexandrite laser therapy sessions every month for six consecutive months. Chin hairs in a 5 × 5 cm2 zone were counted, and the paradoxical hair regrowth was evaluated four times during the study: once at baseline, once before the third session, once before the sixth session, and once 6 months after the last laser session. Results Before the third session, the counts were 15.06 ± 5.20 in group A and 13.07 ± 4.44 in group B ( P = 0.022); both counts were meaningfully less than the baseline count ( P < 0.001). The counts before the sixth session were 2.80 ± 1.16 in group A and 2.71 ± 1.12 in group B ( P = 0.673); the counts were significantly lower than the previous session ( P < 0.001). Six months after the last laser session, the counts were 11.27 ± 9.30 in group A and 8.15 ± 3.12 in group B ( P = 0.012). Paradoxical hypertrichosis was observed in three patients of group A vs. no patients in group B. Conclusion We found that alexandrite laser therapy is really effective for treating hirsutism. Both shaving and using a scissor for hair shortening showed similar short-term results, but in one-year follow-up, paradoxical hypertrichosis was only observed in shaving group and also a lower hair count was observed in the snipping group. [ABSTRACT FROM AUTHOR]

Background: Hirsutism means excessive terminal hair growth in a female in male pattern distribution. Perception of hirsutism is subjective. Permanent laser hair reduction is a slow process taking many sessions and tracking of improvement parameters is tedious. Hence, a lot of confusion still exists regarding the type of laser most beneficial for treatment. Aim: The aim of this study was to compare the effectiveness and safety profile of long-pulsed Nd: YAG laser (1064 nm) and intense pulse light (IPL)-755 nm in management of idiopathic facial hirsutism. Settings and Design: Open-labelled, randomly allocated experimental study. Subjects and Methods: The study included 33 cases of idiopathic facial hirsutism. Patients were randomly divided into Group A, treated with long-pulsed Nd: YAG laser and Group B, treated with IPL-755 for a total of six sessions at 1 month interval. Statistical Analysis: Chi-square test was used in Medcalc® version 9.0 and the test of significance was taken to be P < 0.05. Results: Average percentage of improvement in Group A, according to patients at each sessions were 46.33%, 70.66%, 81.66%, 84.67%, 85.33%, 87.33% and that in Group B were 28.06%, 39.72%, 52.22%, 64.72%, 67.78%, 71.11%, respectively. Excellent response (>75% reduction in hair) after six sessions in Group A was seen in fourteen (93.33%) out of fifteen patients, whereas in Group B, it was seen only in three (16.66%) out of eighteen patients. In Group A, erythema was seen in 26.67%, perifollicular edema and hyperpigmentation in 13.33% each. In Group B, erythema was seen in 50% patients, perifollicular edema in 16.67% and hyperpigmentation in 38.89% patients. Conclusions: Long-pulsed Nd: YAG Laser (1064 nm) is better than IPL-755 nm in terms of safety and effectiveness in the management of idiopathic facial hirsutism. [ABSTRACT FROM AUTHOR]

Congenital melanocytic nevi ( CMNs) naturally evolve throughout life, growing proportionately with the child, darkening, and exhibiting textural or surface changes (e.g., papillomatous, verrucous, cerebriform), hypertrichosis, and, later in life, lightening of pigmentation. We report the case of a 5-year-old child with complete resolution of a medium-sized CMN involving the distal left leg and foot via sclerosis and in the absence of any halo phenomenon. Spontaneous regression of CMN via sclerosis is rare, and it is thought that an immunologic mechanism different from the mechanism that the halo phenomenon induces mediates this regression. We reviewed the literature on this phenomenon and discuss how it might lead to regression of the nevus. [ABSTRACT FROM AUTHOR]

Many cutaneous complications have been described in patients treated with cyclosporin. Alterations of the pilosebaceous unit such as hypertrichosis are particularly frequent. However, the occurrence of sebaceous hyperplasia is exceptional. These lesions seem to be specific to cyclosporin rather than secondary to immunosuppression. Here, we report an exceptional case of eruptive and disseminated sebaceous hyperplasia arising in a bone marrow transplant recipient only a few months after starting immunosuppressive treatment with cyclosporin. [ABSTRACT FROM AUTHOR]

Context: Facial hirsutism is a cosmetic concern for women and can lead to significant anxiety and lack of self-esteem. Eflornithine cream is indicated for the treatment of facial hirsutism. However, limited success rate and overall patient's satisfaction, even with a long-term and high-frequency application, leave room for improvement. Objective: The objective of this study is to test the effect of microneedle treatment on thein vitroskin permeation and thein vivoefficacy of eflornithine cream in a mouse model. Materials and method: In vitropermeation study of eflornithine was performed using Franz diffusion cell.In vivoefficacy study was performed in a mouse model by monitoring the re-growth of hair in the lower dorsal skin of mice after the eflornithine cream was applied onto an area pretreated with microneedles. The skin and the hair follicles in the treated area were also examined histologically. Results and discussion: The hair growth inhibitory activity of eflornithine was significantly enhanced when the eflornithine cream was applied onto a mouse skin area pretreated with microneedles, most likely because the micropores created by microneedles allowed the permeation of eflornithine into the skin, as confirmed in anin vitropermeation study. Immunohistochemistry data revealed that cell proliferation in the skin and hair follicles was also significantly inhibited when the eflornithine cream was applied onto a skin area pretreated with microneedles. Conclusion: The integration of microneedle treatment into topical eflornithine therapy represents a potentially viable approach to increase eflornithine's ability to inhibit hair growth. [ABSTRACT FROM PUBLISHER]

Background Photoepilation is the treatment of choice for hair removal in patients with hirsutism, but it remains a challenge to prevent regrowth of hairs. Objectives The objective of this study was to investigate whether topical eflornithine maintains hair reduction in hirsute patients after cessation of intense pulsed light ( IPL) therapy. Methods A randomized, split-face, single-blinded controlled trial on topical eflornithine vs. no eflornithine treatment (control) after 5-6 IPL-treatments in 22 women with facial hirsutism. Application of eflornithine was initiated after the final IPL-treatment (baseline) and applied twice daily for 6 months to half of the face. Patients were assessed at baseline and 1, 3 and 6 months after the final IPL-treatment. The primary endpoint was difference in facial hair counts between eflornithine vs. no treatment. Secondary endpoints were patient-evaluated efficacy, patient satisfaction and safety. Results A total of 18 patients completed the study protocol. At 1 month after final IPL-treatment, eflornithine reduced hair regrowth by 14% ( P = 0.007, n = 20 patients), at 3 months by 9% ( P = 0.107, n = 19) and at 6 months by 17% ( P = 0.048, n = 18) compared to no treatment. Patient-evaluated efficacy supported blinded hair counts and patients were satisfied with eflornithine treatment throughout the study (median VAS 5-6). Eflornithine was generally well tolerated, but blinded evaluation demonstrated deterioration of acne in two patients at final assessment. Conclusion Topical eflornithine provides a self-administered treatment with a potential to maintain IPL-induced hair reduction in hirsute patients. [ABSTRACT FROM AUTHOR]

Background:Undesirable hair growth presents a significant problem for many patients. Photoepilation has become a very popular procedure in esthetic and cosmetic practice. Among the systems used are the long-pulsed alexandrite laser (755 nm) (ALX) and intense pulsed light (IPL).Objective:To compare the safety and efficacy of long-pulsed ALX and IPL for hair removal.Patients and methods:This comparative study was carried out in the outpatient Department of Dermatology and Venereology, Al-Sadir Teaching Hospital, Al Najaf City during the period from June 2009 to July 2010. Thirty-five patients were included; thirty of them completed the study. They received six treatment sessions with the ALX on the left side of the face and IPL on the right side of face with 4-week intervals between sessions. Response to treatment on both sides of the face was assessed at 1, 3, and 6 treatment sessions. Hair-free intervals and patient's satisfaction were recorded in each visit.Results:After six treatment sessions, IPL-treated sides showed longer median hair-free intervals compared with ALX-treated sides. Reduction in hair counts was significantly larger on the IPL compared with that on the ALX-treated sides at 1, 3, and 6 sessions. Three patients (10%) developed postinflammatory hyperpigmentation, one of them on the left side and the others on the right side. It was more severe on the right side and both the patients were of skin type IV. Slight stinging and burning sensation at time of the treatment were recorded in all patients. All reported side effects were transient and tolerated by the patients except postinflammatory hyperpigmentation which persisted and was decreasing gradually toward the end of the study.Conclusions:The results of this study suggested that IPL is more effective in reducing excessive facial hair growth, with longer hair-free intervals and greater patient satisfaction than the ALX. [ABSTRACT FROM AUTHOR]

Hirsutism is excess terminal hair growth with a male pattern distribution. It can be one of the most distressing conditions for women. Occasionally it is underlined by serious pathology, hence the importance of thorough history, examination and investigation. This article first examines the underlying physiology associated with human hair growth and relevant to the understanding of the causes and treatment of hirsutism. Causes of hirsutism are discussed, the most common being polycystic ovarian syndrome. Other causes of disordered androgen metabolism are also discussed. Treatment of hirsutism includes treatment of the underlying cause and often lifestyle modifications such as weight loss are needed. Cosmetic measures are helpful for existing hair while prevention of new hair growth often requires pharmacological intervention. This is most commonly achieved using the combined oral contraceptive pill, while anti-androgens are reserved for more severe and resistant cases. [ABSTRACT FROM AUTHOR]

Introduction: Lasers are widely used for the treatment of hirsutism. But the choice of the right laser for the right skin type is very important. Before starting with laser therapy, it is important to assess the skin type, the fluence, the pulse duration and the type of laser to be used. Aims: To compare the efficacy and side effects of Diode laser, Neodymium-yttrium aluminum — garnet (Nd: YAG) laser and intense pulsed light (IPL) on 30 female patients of hirsutism. Materials and Methods: Thirty female patients with hirsutism were selected for a randomised controlled study. The patients were divided into three groups of 10 patients each. In group I patients diode laser was used, in group II patients long pulsed Nd: YAG laser was used and in group III, IPL was used. The patients were evaluated and result graded according to a 4-point scale as excellent, >75% reduction; good, 50-75% reduction; fair; 25-50% reduction; and poor, <25% reduction in hair density. Results: It was seen that the percentage of hair reduction after two sessions of treatment was maximum (40%) in the diode laser group, followed by 35% hair reduction in the Nd: Yag laser group and 10% hair reduction in the IPL group. The percentage of hair reduction after four sessions of treatment was maximum (64%) in the diode laser group, followed by 62% hair reduction in the Nd: Yag laser group and 48% hair reduction in the IPL group. The percentage of hair reduction after eight sessions of treatment was maximum (92%) in the diode laser group, followed by 90% hair reduction in the Nd: YAG group and 70% hair reduction in the IPL group. Conclusions: To conclude for the Indian skin with dark hairs, the diode laser still stands the test of time. But, since the diode laser has a narrow margin of safety, proper pre and post-procedure cooling is recommended. Although, the side effects of Nd: YAG laser are less as compared to the diode laser, it is less efficacious as compared to the diode laser. [ABSTRACT FROM AUTHOR]

The role of insulin resistance (IR) is well-documented in obese women with polycystic ovary syndrome (PCOS). Controversies exist concerning the presence of IR in idiopathic hirsutism (IH) or if it is a manifestation of high body mass index (BMI). We aimed to investigate the presence/absence of IR in lean hirsute women. One-hundred fifty-one lean women with hirsutism [96 PCOS (group 1) and 55 IH (group 2)] and 58 age-and BMI-matched healthy controls (group 3) were recruited in the study (mean age 25.21 ± 6.1 versus 26.26 ± 4.6years; BMI 21.79 ± 1.7 versus 22.02 ± 2.2 kg/m2, respectively). Significantly higher insulin and HOMA-IR, and significantly lower fasting glucose insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), reciprocal insulin, and Raynaud index were detected in groups 1 and 2 than in group 3 ( p < 0.05). These IR indices were similar between groups 1 and 2. The number of patients with IR (HOMA-IR > 2, FGIR < 7.2, or QUICKI < 0.357) was significantly higher in groups 1 and 2 than in group 3, but was similar between groups 1 and 2. A higher frequency of IR occurs in lean hirsute women regardless of they having PCOS or IH. IR may contribute to aetiopathogenesis of IH, or may cause some metabolic abnormalities in these patients. [ABSTRACT FROM AUTHOR]

Diagnostic evaluation of women with hirsutism is essential to identify and manage the underlying cause of the condition, which is often an endocrine disorder. Physical and pharmacological treatments for hirsutism are available, and should be individualized according to the needs and preferences of the patient, the severity and extent of hirsutism, and the potential benefits and harms of therapy. [ABSTRACT FROM AUTHOR]

Aim: Hyperinsulinemia and insulin resistance are commonly seen in patients with hirsutism and polycystic ovary syndrome (PCOS), and are associated with cardiovascular disease risk. However, it is not yet known whether insulin-like growth factor I (IGF-I) and alanine transaminase (ALT) produced by the liver play roles in hyperinsulinemia and subclinical atherosclerotic process in patients with PCOS and idiopathic hirsutism (IH). Materials and methods: This was a prospective case-controlled study. The study population consisted of 25 reproductive-age PCOS women, 33 women with IH, and 25 control subjects. Results: Mean IGF-I levels and median ALT levels were higher in patients with IH and PCOS than controls, but these differences were not statistically significant. The participants who had a homeostasis model assessment insulin resistance index (HOMA-IR) greater than 2.7 had significantly higher IGF-1 and ALT levels. ALT levels were positively correlated with body mass index, FG, insulin and HOMA-IR. Conclusion: The study illustrated that IGF-1 and ALT levels were significantly higher in patients with increased insulin resistance. Due to short disease duration in younger participants, we did not observe any correlation between IGF-1 and hyperinsulinemia. These findings suggest that increased hepatic production of IGF-I and ALT might be an early indicator of insulin resistance in hirsutism. [ABSTRACT FROM AUTHOR]

Background: Hirsutism has a relatively high prevalence among women. Depending upon societal and ethnic norms, it can cause significant psychosocial distress. Importantly, hirsutism may be associated with underlying disorders and co-morbidities. Hirsutism should not simply be looked upon as an issue of cosmesis. Patients require appropriate evaluation so that underlying etiologies and associated sequelae are recognized and managed. Treatment of hirsutism often requires a multidisciplinary approach, and a variety of physical or pharmacologic modalities can be employed. Efficacy of these therapies is varied and depends, among other things, upon patient factors including the underlying etiology, hormonal drive, and local tissue sensitivity to androgens. Objective: The objective of this paper is to review and summarize current evidence evaluating the efficacy of various treatment modalities for hirsutism in premenopausal women. Methods: Online databases were searched to identify all relevant prior systematic reviews and meta-analyses as well as recently published (2012-present) randomized controlled trials (RCTs) on hirsutism treatment. Results: Four recently published RCTs met criteria for inclusion in our review. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Topical eflornithine can be used as monotherapy for mild hirsutism and as an adjunct therapy with lasers or pharmacotherapy in more severe cases. Combined OCPs as a class are superior to placebo; however, antiandrogenic and low-dose neutral OCPs may be slightly more efficacious in improving hirsutism compared with other types of OCPs. Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes. Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. Lifestyle modification counseling is recommended. Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances. Additional therapies without sufficient supportive evidence of efficacy are ovarian surgery, statins (HMG-CoA reductase inhibitors), and vitamin D supplementation. Limitations: In general, most therapies garner recommendations that are weak (where the estimates of benefits versus risks of therapy are either closely balanced or uncertain) and are based on low- to moderate-quality evidence. Conclusions: Risks and benefits of treatment must be carefully considered and discussed with the patient. Expectations for efficacy should be appropriately set. A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: Hirsutism has negative impact on adolescent psychosocial development for both cosmetic and endocrine reasons. This study evaluated the effectiveness of a new intermittent, low-dose finasteride regimen consisting of 2.5 mg of drug given every 3 days (1 day of treatment, 2 days of drug withdrawal) for 6 months in girls with hirsutism by polycystic ovarian syndrome (PCOS) or idiopathic hirsutism (IH). Design and Participants: Twenty-eight girls (15-19 y old) with hirsutism were randomly assigned to 2 treatment groups and treated for 6 months. Fourteen patients (7 with IH, 7 with PCOS) received finasteride; fourteen patients (7 with IH, 7 with PCOS) received placebo. Hirsutism score (HS), clinical, and hormonal effects were compared between the 2 groups. Results: In patients treated with finasteride, the HS value at 6 months was 52.9% lower than that observed at baseline in girls with IH, and 52.8% lower in girls with PCOS (P < .0001 for both). Similarly, the 3α-17 β-androstenediol glucuronide serum levels were decreased by 34.8% in patients with IH, and by 47.5% in patients with PCOS (P < .0001, respectively). Finasteride treatment was well tolerated and did not alter values of BMI, serum levels of sexual hormones, metabolic parameters related to liver and kidney function as well as glycemic and lipidic asset. Conclusions: A low-dose of finasteride, given every 3 days, reduces the HS in young patients affected by PCOS or IH. Compared with conventional continuous finasteride administration, the intermittent low-dose regimen has similar efficacy with the advantage to be safer and less expensive. [Copyright &y& Elsevier]

Twenty-five women, referred for hair removal by electrolysis, were enrolled in a split face study to treat facial hirsutism. Each patient was treated on six occasions: one-half of the face with electrolysis and the other side with an intense pulsed light source. Patients were evaluated with respect to reduction in hair counts, side effects and discomfort during treatment. Re-growth was assessed at 3, 6 and 9 months following treatment. All patients, except one with very sparse, fair hair growth, preferred treatment with the Intense Pulsed Light and rated their average hair reduction with this method as 77% after five treatments. The overall patient satisfaction rates as determined by visual analogue scales were 8.3 out of 10 for IPL and 5.4 out of 10 for electrolysis. [ABSTRACT FROM AUTHOR]

Hirsutism is a common medical complaint among women of reproductive age, and it affects the majority of women with the polycystic ovary syndrome (PCOS). Increased rate of androgen production and its availability in tissue represent the main pathophysiological mechanisms responsible for hirsutism. In addition, androgens may be generated de novo in the hair follicle; therefore, circulating androgen levels do not quantify the real exposure of the hair follicle to androgens, as a quota is locally generated. Hirsutism is a clinical sign and not a disease in itself; its presence does not therefore necessarily require treatment, particularly in mild-to-moderate forms, and when an affected woman does not worry about it. Physicians should decide whether hirsutism is to be treated or not by evaluating not only the severity of the phenomenon but also the subjective perception of the patient, which does not necessarily correspond to the true extent of hair growth. In any case, a physician should manage a woman with hirsutism only on the basis of a diagnosis of the underlying cause, and after a clear explanation of the efficacy of each therapeutic choice. Cosmetic procedures and pharmacological intervention are commonly used in the treatment of hirsutism and are discussed in this paper. Importantly, there are different phenotypes of women with hirsutism and PCOS that may require specific attention in the choice of treatment. In particular, when obesity is present, lifestyle intervention should be always considered, and if necessary combined with pharmacotherapy. [ABSTRACT FROM AUTHOR]

Despite the large number of patients presenting with hirsutism and high prevalence of polycystic ovary syndrome, for which hirsutism is an important sign, no national guidelines are currently available to Iranian primary-care and family physicians for its diagnosis and management. We have integrated highest levels of evidence and expert consensus to provide a national guideline to standardize and unify the Iranian primary-care and family physician's approach to hirsutism. [ABSTRACT FROM AUTHOR]

Background and Aim: Hirsutism is one of the most common reasons for which women visit dermatology and beauty clinics. Lasers have got considerable popularity during last two decades because they can reduce unwanted hairs. This study was conducted to evaluate the satisfaction of patients with hirsutism traeted with diode laser, IPL or combination of both. Methods: In this retrospective study, hirsute patients referred to Yazd Laser Center from October 2011 until October 2012 were studied. Patient satisfaction from the amount of hair loss one month after starting treatment, one month after the end of treatment and 6 months after treatment were asked using telephone. Results: Patient satisfaction one month after the end of the treatment with diode laser was higher than the other two methods (P=0.034). Patient satisfactions at one month after initiation of the treatment and six months after the end of the treatment were not the statistically significant. The number of laser sessions was similar in the three groups. Conclusion: Results of the current study revealed that there was no significant difference in the patient satisfaction with diode laser, IPL and combination of both methods in the treatment of hirsutism 6 months after the end of the treatment. [ABSTRACT FROM AUTHOR]

Although hirsutism is a frequent and distressing disorder often signaling an underlying endocrine disorder, a systematic approach to evaluation and the use of combination therapy will provide satisfactory treatment for most patients. [ABSTRACT FROM AUTHOR]

Metabolic Syndrome (MS) is defined as a constellation of metabolic disturbances including central obesity, insulin resistance, dyslipidemia and hypertension leading to type II diabetes and cardiovascular diseases. The objective of the present study is to assess the risk of MS among children (9-12yrs) and adolescents (13-15 years) residing in urban Mumbai. Out of 368 participants screened for BMI, WC and family history of lifestyle diseases, eighty nine including 49 children and 40 adolescents were identified to be at risk of developing MS. Information on anthropometry, body composition, biochemical and clinical markers of MS was obtained using suitable methodologies. Results showed normal BMI, but high WC, WHR and total body fat percent among the participants along with interesting gender and/ or age specific differences. Boys had a significantly higher mean waist circumference as compared to girls (x²= 10.913, p=0.001) indicating a trend of abdominal obesity. The total body fat percent was higher among younger boys than adolescents where as girls showed an opposite trend. Varied trends in biochemical profile included higher TG levels in Girls (9-12 yrs) than boys and lower HDL cholesterol level in boys . Various clinical markers of MS such as Acanthosis Nigricans (90%), hirsutism ( >50%) and rebound obesity were identified among the participants. Thus the study emphasizes a need for identification of MS early in life that would facilitate effective prevention strategies to ensure healthy future for youngsters. [ABSTRACT FROM AUTHOR]

Introduction. The role of oral contraceptives (OC) in psychiatry illness has been object of little attention. In particular, there is scarce scientific literature regarding its influence in the pathogenesis and treatment of eating psychopathology. Clinical Case. We describe the case of a 16 years-old woman, who developed an anorexia nervosa after the administration of an OC for the treatment of a mild hyperandrogenic hirsutism. After the implementation of cognitive-behavioral and psychopharmacological (SSRI) interventions, weight restoration was attained, disappearing anorectic cognitions and dysfunctional eating behaviors. Conclusions. The study of OC in eating psycho- pathology is in an early stage, being androgenic regulation postulated as main factor mediating this association. In patients with anorexia nervosa, is mandatory carrying out longitudinal research, given preliminary evidence suggesting the involvement of OC as a risk factor, either through decreased levels of testosterone or greater fear of gaining weight among those users with weight gain after its administration. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates whether women who ovulate in response to treatment with clomiphene citrate, metformin, or both would have greater improvement in hirsutism compared with those who did not ovulate. The study found no significant difference in the degree to which the hirsutism score changed when comparing the three groups. It suggests that the change in hirsutism was not associated with the duration of treatment or with the presence or absence of ovulation.

Background: Laser systems that are commonly used for the treatment of hirsutism include the ruby laser (694 nm), the diode laser (800 nm), the alexandrite laser (755 nm) and the Nd:YAG laser (1084 nm). The diode laser and alexandrite laser are considered effective in treatment of hirsutism in darkskinned patients. The response of hairs to these laser systems is variable and not complete. In this study, we compared the efficacy of these two laser systems for permanent hair removal. Methods: This was a randomized, controlled clinical trial that was performed with women of the age range 15-45 years old. After obtaining informed consent, the samples were randomized into two groups using random allocation software. The first group was treated with alexandrite laser alone (four sessions, two months apart). The second group was treated sequentially with diode laser for the first two sessions and alexandrite laser for the next two sessions. Findings: Overall, 111 patients (57 patients in the alexandrite laser group and 54 patients in the sequentia l diode-alexandrite laser group) were evaluated. There was no significant difference regarding mean of hair reduction between the two groups during the courses of treatment. Except for the first session, there was no significant difference regarding percent of patient satisfaction between the two groups (P value >0.05). Comparison between the two groups showed no significant difference one month, three months and six months after the last treatment (P value >0.05). Conclusion: Regarding the results of our study, there is no significant difference between sequential treatment with diode and alexandrite lasers versus alexandrite laser alone in the treatment of hirsutism. We suggest that in further studies, the efficacy of sequential treatment with other laser systems is evaluated against single treatment methods. [ABSTRACT FROM AUTHOR]

Background: Intense pulse light (IPL) with square pulse technology is one of the latest hair removal technologies to be marketed in India. However, there is no literature on use of IPL in Indian skin. Objective: A preliminary descriptive study to ascertain the efficacy of an IPL device with square pulse technology for hair removal in Indian patients. Materials and methods: The IFL i200 system (Cyden Ltd, Swansea, UK) was used for hair removal on 12 patients of skin type III, IV and V up to a maximum of six sessions. Hair removal efficacy (HRE) was calculated and photographs taken after each session. Results: Treatment was done for 12 patients. Mean HRE was 69.6%; 83% were satisfied with the procedure; 66% had excellent results; 16% had good results. No permanent adverse effects were seen. Conclusion: With standard precautions, IPL is a safe and effective tool for hair removal in Indian patients. Further studies to compare square pulse technology with traditional IPL systems and lasers are required. [ABSTRACT FROM AUTHOR]

Objective: Platycladus orientalis or Thuja orientalis is a native plant of Iran different parts of which are used in the treatment of various diseases such as: gout, rheumatoid arthritis, common cold, cough, bronchitis, asthma, high blood pressure and hormonal disorders like hirsutism and baldness. Also, various organs of this species have been used as appetizer. The purpose of this study was to prepare and characterize liposomal formulations that contain methanol extract of aerial parts of P. orientalis for hirsutism treatment. Material and Methods: Plant's leaves were dried in room temperature, and powdered by grinding. Then, methanol extract was prepared by maceration method. Liposomes containing mathanol extract were produced by two methods of fusion and solvent evaporation. To evaluate mathanol extract and encapsulation efficiency of liposomes, quercetin was chosen as standard. The amount of quercetin in samples was determined by high pressure liquid chromatography (HPLC) method. Results: Mean size of liposomes prepared by solvent evaporation and fusion methods was 373 and 320 nm, respectively. According to the quercetin concentration, encapsulation efficiency of liposomes containing menthanol extract was 69.3±3.1% for solvent evaporation and 62.2±4.9% for fusion method. Conclusion: In the current study, a suitable liposomal formulation was prepared. The pharmacological activity of these carriers should be evaluated in the future study. [ABSTRACT FROM AUTHOR]

Abstract: Background: A prospective randomized trial was conducted to compare the clinical efficacy of two oral contraceptives containing drospirenone in the treatment of hirsutism in women. Study Design: Fifty women with moderate to severe hirsutism were recruited. Three women were lost to follow-up. Twenty-four patients received oral 0.03 mg ethinyl estradiol and 3 mg drospirenone 21/7 regimen (Group 1) for 6 months. Another group of 23 patients received oral 0.02 mg ethinyl estradiol and 3 mg drospirenone 24/4 regimen (Group 2) for 6 months. Hirsutism was assessed after 6 months using the Ferriman–Gallwey (F-G) scoring system. Hormonal levels after 6 months of both therapies were compared with baseline values and each other. Results: An improvement in the F-G scores for hirsutism (mean±SD) was observed in Group 1 (17.3±5.2 to 8.7±2.5, p<.001) and in Group 2 (17.5±4.8 to 7.9±2.8, p<.001). Pre- and post-treatment hirsutism scores were comparable between the groups (p>.05). Total and free testosterone levels decreased significantly after the therapy in both groups. The sex hormone-binding globulin levels increased significantly in both groups during the 6-month period. Conclusion: The treatment of hirsutism with both combined oral contraceptives (COCs) containing drospirenone offered comparable effects and was well tolerated. [Copyright &y& Elsevier]

Hirsutism is defined as an androgen-dependent, male pattern of hair distribution in women. It affects between 5-15% of all women across all ethnic backgrounds (Azziz, 2003). The presence of unwanted female facial hair (and male hair patterns in other body areas) is the devastating consequence of hirsutism. It is also estimated that up to 40% of the general female population have some degree of unwanted facial hair (Hamzavi et al, 2007). The treatment of hirsutism is twofold; treating the underlying cause and reducing visible hair. This article will seek to define the causes of hirsutism, explore current treatment options for the removal of unwanted hair and discuss the psychosocial effects for the woman with hirsutism. [ABSTRACT FROM AUTHOR]

Summary Evidence of clinical and/or biochemical androgen excess connotes a unique differential diagnosis in postmenopausal women. Providers need to be able to discriminate between changes of the normal ageing process compared to potential pathology in older women. The evaluation and treatment of postmenopausal hirsutism and hyperandrogenism is reviewed. Androgen excess may have long-term negative health consequences and as such should be detected and treated. [ABSTRACT FROM AUTHOR]

The article presents the management and diagnosis of hirsutism. According to the Endocrine Society Clinical Practice Guideline, patients having moderate to severe hirsutism and hirsutism related to features suggestive of hyperandrogenism and malignancy need laboratory evaluation. Patient education concerning the underlying cause, should adopt prolong treatment and a healthy life style is vital, and emotional support to assure adherence to the therapy.

Background: Hirsutism is one of the pravalent problems of human and so far many procedures have been suggested to treat it. Intense pulsed light (IPL) considered as one of the procedures with fewer side effects. This study aimed to compare the effect of the first generation of IPL (Lumina) with its second generation (Ellipse) on hirsutism. Methods: In this retrospective study, medical files of the patients who refered to Isfahan Espadana Lasers Center for hair removal were evaluated. Patients were divided into two groups: those treated with Lumina and those treated with Ellipse. The patients' treatment satisfaction was evaluated during 6 months follow-up period. Finding: Medical files of 235 women were studied; 107 treated with Lumina and 128 with Ellipse. Mean satisfaction of patients in Ellipse and Lumina groups were 78.11 ± 44.49 and 71.13 ± 36.78 respectively (P < 0.05). Conclusion: Hair removal and hirsutism treatment using second generation intense pulsed light (Ellipse) is more effective than the first generation of it (Lumina). [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the evaluation and treatment of hirsutism.

Objective: The aim of the study was to evaluate the long-term effects and tolerability of flutamide (Flu) in hirsute women. To the best of our knowledge, this study represents the largest report, concerning the population studied and the duration of treatment, to evaluate Flu use in hirsutism treatment. Design, patients and methods: Over a 15-year period spanning from January 1991 to January 2006, a total of 414 premenopausal women with hirsutism of different aetiopathogeneses received yearly reducing doses (250, 125 and 62.5 mg/day) of Flu alone or in combination with oral contraceptives for a period varying from at least 3 to 8 years and more. Clinical and endocrine evaluations were assessed half-yearly and yearly respectively in the first 3 years of the study, and yearly in the following years. Liver function evaluations were assessed quarterly. Results: Both the groups of patients under Flu therapy showed a marked decrease in hirsutism scores after 12 months compared with basal values. The maximum drug effect was observed after 2 years, and it was maintained during the following years of treatment. Androgens were strongly suppressed during treatment. During the first year of treatment, 6.0% of patients abandoned the study due to hepatic disorders related to the drug. During the following years with the lowest treatment regimen, none of the patients abandoned the study due to hepatic discomfort. Conclusions: Flu is a satisfactory therapeutic regimen for any form of hirsutism in the long run. Moreover, the use of very low doses of Flu is associated with minimal side-effects and high compliance. [ABSTRACT FROM AUTHOR]

AbstractBackground:Faun tail is a rare cutaneous marker of spinal dysraphism. This neurological abnormality may lead to difficulties such as severe pain and burning sensations in treatment of hypertrichosis of faun tail with laser or laser-like devices. Objective:We evaluated outcomes of an intense pulsed light source in two patients with faun tail. Methods:The Lumina intense pulsed light system [650-nm handpiece (550–1100 nm)] was used for the treatment. Magnetic resonance imaging and neurological examination were done. Results:Tethered cord syndrome was detected as a neurological abnormality. The patients were treated with an energy fluence of 18– 26 J/cm2, pulse sequencing of 3 to 4, and a delay time of 20–35 ms. Local anesthesia was applied in one patient during treatment for severe pain sensation. A mean of 85% hair reduction was achieved. Conclusion:A good cosmetic result with intense pulsed light treatment was achieved in the patients with faun tail. Local anesthesia may be required before treatment of faun tail with laser or laser-like systems due to associated neurological abnormalities. [ABSTRACT FROM AUTHOR]

Hirsutism is a common clinical condition seen in female patients of all ages. It affects around 5-10% of the women and is a common presenting complaint in the dermatological out patient department for cosmetic reasons. The cause is mainly hyperandrogeneism, which may be ovarian or adrenal. It may be part of a rare metabolic syndrome, drug induced, or just idiopathic. Hirsutism has a huge psychosocial impact, especially in the young females. This article reviews the current evaluation guidelines and management of hirsutism. [ABSTRACT FROM AUTHOR]

Henna is the powdered leaf of Lawsonia Inermis, and has been widely used as a dye for the skin, hair and nails. Black henna is composed of henna itself with p-phenylenediamine (PPD) and used for temporary black henna tattoos. The PPD compound of the henna transforms the harmless henna to an allergenic material and generalized erythema multiforme, Sweet's syndrome, acquired leucoderma, urticaria and angioneurotic edema are the other reported rare complications of black henna tattoos. Localized hypertrichosis on the temporary henna tattoo is not a usual side effect and there are a few reports about this topic. The common point of these cases is disappearance of the hypertrichosis within 4-5 months. Notwithstanding the fact that the treatment is not certainly necessary, it could be a problem for some patients because of its cosmetic concern. This case is an example of localized hypertrichosis after henna tattoo and treated immediately with 755 nm Alexandrite Laser in one session. [ABSTRACT FROM AUTHOR]

The article discusses a review of treatment methods for hirsutism. Hirsutism is a condition in women that results in excessive hair growth and can affect the psychological well-being of patients. Causes for hirsutism can include polycystic ovary syndrome, congenital adrenal hyperplasia and Cushing's syndrome. The authors note that androgen excess that can indicate hirsutism can be detected through serum testosterone measurement. They recommend screening for congenital adrenal hyperplasia and Cushing's syndrome in hirsutism. Hirsutism can be treated with electrolysis or laser epilation in addition to the drugs metformin, finasteride or an oral contraceptive.

Objective: To evaluate the long-term safety and tolerability of flutamide therapy for hirsutism. Design: Prospective observational study. Setting: Gynecology department in a teaching hospital. Patient(s): Hyperandrogenic women presenting for hirsutism treatment were followed between January 2000 and January 2007. Intervention(s): Women received flutamide 250 mg/day alone (n = 27) or combined with a fixed dose of an oral contraceptive containing 0.020 mg of ethinyl estradiol (EE) and 0.15 mg of desogestrel (n = 56). Main Outcome Measure(s): Adverse events, safety, tolerability and efficacy were assessed every 6 months during the follow-up. Liver and lipid profiles were also recorded. Result(s): Patients under flutamide therapy showed, compared with basal values, a significant progressive decrease in hirsutism scores after 6 months of treatment with a maximum effect at 12 months that was maintained during the 84 months of follow-up. A total of 40.96% women presented one or more adverse effects during the follow-up; 33.73% showed at least one adverse effect possibly related with the study drug, and 24.09% withdrew from the study because of adverse effects. During the follow-up, as many as 59% of patients abandoned the study. Conclusion(s): Flutamide is very effective for hirsutism treatment; however, adverse effects are very frequent and associated with low long-term compliance. [Copyright &y& Elsevier]