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Cited by 35Ovarian function and disordersDermatologic Treatments and ResearchAcne and Rosacea Treatments and Effects

Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review including GRADE assessments

Zuuren, E.J., Fedorowicz, Z.·2016·British Journal of Dermatology
DOI 10.1111/bjd.14486
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Abstract

Hirsutism is a common disorder with a major impact on quality of life. The most frequent cause is polycystic ovary syndrome. Effects of interventions (except laser and light-based therapies) were evaluated, including Grading of Recommendations Assessment, Development and Evaluation assessments. Searches included Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase and five trials registers to June 2014. We included 157 randomized controlled trials (RCTs) with 10 550 participants. The majority were assessed as having a 'high risk' of bias (123 of 157). The quality of evidence was rated moderate to very low for most outcomes. Pooled data for an oral contraceptive (OCP) (ethinyl oestradiol and cyproterone acetate) compared with another OCP (ethinyl oestradiol and desogestrel) demonstrated that both treatments were effective in reducing Ferriman-Gallwey scores, but the mean difference (MD) was not statistically significant [-1·84, 95% confidence interval (CI): -3·86-0·18]. Flutamide was more effective than placebo in two studies (MD -7·60, 95% CI: -10·53 to -4·67 and MD -7·20, 95% CI: -10·15 to -4·25), as was spironolactone (MD -7·69, 95% CI: -10·12 to -5·26). Spironolactone appeared to be as effective as flutamide (two studies) and finasteride (two studies). However, finasteride and the gonadotropin-releasing analogues showed discrepant results in several RCTs. Metformin was ineffective. Cyproterone acetate combined with OCPs demonstrated greater reductions in Ferriman-Gallwey scores. Lifestyle interventions reduced body mass index but did not show improvement in hirsutism, and although cosmetic measures are frequently used, no RCTs investigating cosmetic treatments were identified. RCTs investigating OCPs in combination with antiandrogens or finasteride vs. OCP alone, or the different antiandrogens and 5α-reductase inhibitors are warranted.

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Crossref · 10.1111/bjd.14486

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193 of 193 references verified0 citation errors · 0 not checkable

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Authors
Zuuren, E. J., & Fedorowicz, Z.
Affiliations
  • Leiden University (NL)
  • Cochrane Canada (CA)
Corresponding author
Zuuren, E.J.
ORCID
Venue
British Journal of Dermatology
Publisher
Oxford University Press (OUP)
Published
2016-06-23
Volume
175
Issue
1
Pages
45-61
ISSN
  • 0007-0963 (ISSN-L)
  • 1365-2133
DOI
10.1111/bjd.14486
OpenAlex
W2274579684
Cited by
35
References
198
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 7 · 2019: 6 · 2018: 5 · 2017: 1 · 2016: 1 · 2015: 1
FWCI
0.62
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • British Journal of Dermatology (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Leiden Repository (Leiden University) (submittedVersion)
Funders
Universiteit Leiden
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
  • Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
Keywords
hirsutism, polycystic ovary syndrome, oral contraceptives, androgen receptor antagonists, spironolactone, flutamide, finasteride, cyproterone acetate, metformin, 5-alpha reductase inhibitors, lifestyle intervention, Ferriman-Gallwey score, quality of life
MeSH terms
Adolescent, Androgen Antagonists, Contraceptives, Oral, Drug Therapy, Combination, Female, Flutamide, Hirsutism, Humans, Hypoglycemic Agents, Gonadotropin-Releasing Hormone, Polycystic Ovary Syndrome, Quality of Life, Spironolactone, Body Mass Index, Randomized Controlled Trials as Topic, Treatment Outcome, Cyproterone Acetate, Hyperandrogenism, Finasteride, Risk Reduction Behavior, Young Adult, 5-alpha Reductase Inhibitors

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