Laser en pelo junto con OC

Combined Oral Contraceptives or Metformin Plus Laser Treatment in Polycystic Ovarian Syndrome Hirsute Patients

Journal of Drugs in Dermatology

 1 Expert Comment

TAKE-HOME MESSAGE

• In this study 150 patients with polycystic ovarian syndrome (PCOS) and hirsutism were divided into treatment groups undergoing laser hair removal (LHR) alone, LHR plus metformin, or LHR plus combined oral contraceptives.

• All patients showed improvement in visual analog scale scores and quality of life scores after treatment, but those treated with LHR in combination with oral contraceptives showed significantly more improvement in quality of life than other treatment groups.

–  Caroline K. Crabtree, MD

Dermatology

Written by



Dee Anna Glaser MD

Hirsutism in women is a common clinical problem in the dermatologist's office. Medical management alone be inadequate in my experience, and hair removal procedures are helpful but need long-term maintenance.

This study from Egypt evaluated 150 females with facial hirsutism with a confirmed diagnosis of polycystic ovarian syndrome (PCOS) and no contraindication to receiving laser or hormonal therapy. They were randomized into treatment with diode 810 nm laser only (group 1), laser plus metformin 500 mg daily (group 2), or laser plus oral contraceptive containing 35 μg ethinyl estradiol and 2 mg cyproterone daily (group 3). There were 6 monthly laser sessions in all groups, with follow-up at 3 and 6 months post laser.

Quality measures (DLQI), a hirsutism questionnaire (HLQI) and a visual analog scale were used throughout, with no significant differences among groups prior to treatment. All three groups had improvement in the DLQI and HLQI relative to pretreatment, and this continued at 3 and 6 months of follow-up. Group 3, however, had a higher level of improvement in DLQI and HQLI at each session and at 3 and 6 months post treatment when compared with groups 1 and 2. In this study, laser hair removal let to improvement in the quality measures, but it was not maintained 6 months following the laser sessions. Also, the addition of metformin to laser hair removal failed to induce a greater improvement in quality measures with laser sessions or at 3 and 6 months' follow-up.

This study is limited by small numbers in each group and the short follow-up period, but does reinforce current practice that laser hair removal alone may not be sufficient to treat hirsutism in the setting of PCOS and that hormonal therapy as used in this study with ethinyl estradiol / cyproterone when combined with laser hair removal is superior. Finding non-hormonal therapy is still needed as, in my experience, many of patients with PCOS have fertility issues and can spend significant time trying to get pregnant. A key take-home point is that therapy for hirsutism must be maintained even with laser systems, and that combination therapies can be beneficial; good counseling about expectations is very important.

abstract

This abstract is available on the publisher's site.

Background

Hirsutism is estimated to affect 10% to 20% of females, provoking significant psychological damage and social embarrassment. Polycystic ovary syndrome is a major cause of hirsutism.

Aim

Assessing the impact of adding combined oral contraceptives (COCs) or metformin to laser hair removal on the quality of life of polycystic ovarian syndrome (PCOS) patients with hirsutism.

Methodology

One-hundred-fifty PCO patients diagnosed with hirsutism were included in this study. Patients were randomized into three groups: group 1 received laser hair removal alone, group 2 received metformin and laser hair removal, and group 3 received COCs and laser hair removal. A diode laser with a wavelength of 810 nm was used for hair removal in all patients according to a protocol of 6 monthly sessions followed by another two sessions after three and six months. Patients were assessed using a visual analog scale (VAS) and Dermatology Life Quality Index (DLQI) and a customized questionnaire (Hirsutism Life Quality Index; HLQI).

Results

All patients showed a significant improvement in both quality indices (DLQI and HLQI) after treatment relative to pretreatment. Group 3 showed significantly better improvements when compared with group 2 and group 1. At three and six months, group 3 showed non-significantly better DLQI and HLQI as compared with at zero months. On the other hand, group 2 patients displayed significant worsening of both DLQI and HLQI scores at three months, with subsequent improvements again at six. Finally, group 1 patients showed nonsignificant worsening at three months, and significant worsening at 6 months.

Conclusion

Combining hormonal treatment with laser hair removal can achieve greater hair reduction, significant improvements in patients' QOL, and better maintenance as compared with when combining metformin with laser hair removal or conducting alone.

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Journal of Drugs in Dermatology

Adding Combined Oral Contraceptives or Metformin to Laser Treatment in Polycystic Ovarian Syndrome Hirsute Patients

J Drugs Dermatol 2021 Mar 01;20(3)302-306, N Dorgham, A Sharobim, H Haggag, M El-Kalioby, D Dorgham