الفهرس 
Hair Biology.Only 14 pages are availabe for public view
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Abstract
Introduction: Hirsutism is the presence of excess terminal (coarse) hair in women in anatomic sites where growth is considered a secondary male characteristic. Causes of hirsutism are many. They can be classified as ovarian e.g. polycystic ovary syndrome (PCOS), adrenal, pituitary, developmental disorders, obesity, menopausal, pregnancy-related, idiopathic (IH), iatrogenic, and others. There are many therapeutic modalities for hirsutism. If an identifiable cause hirsutism exists e.g. androgen secreting tumors, it should be corrected. Other lines of treatment include hormonal therapy, insulin sensitizers, topical eflornithine, and others. Aim or work: The present work aimed to evaluate clinical, endocrinal, metabolic and radiological aspects of hirsute females and some therapeutic trials. Patients and Methods: Fifty-three female patients with hirsutism were collected. Ten carefully selected normal, age- and BMI- matched females were chosen to act as a control group. All patients and controls were subjected to history taking, general and dermatological examination with assessment of hirsutism according to modified Ferriman-Gallwey scoring system. Laboratory investigations included measurement of serum LH, FSH, free testosterone (T), fasting insulin, DHEAS, complete blood count, serum creatinine, serum bilirubin and SGPT. Pelvi-abdominal ultrasound was done to detect any ovarian or suprarenal glands changes. Patients were divided into five groups according to results of investigations and each group submitted to treatment for six months. Our patients were either PCOS (n= 39) (73.6%) or IH (n= 14) (26.4%) arranged into 5 groups: group I included 4 patients (all had PCOS) with high blood free T treated with oral finasteride (3 mg/day); group II included 3 patients with hyperinsulinemia (2 patients had PCOS and one patient had IH) treated with oral metformin (1500 mg/day); group III included 13 patients with IH treated with oral finasteride (3 mg/day); group IV included 17 patients with PCOS treated with metformin (1500 mg/day), and group V included 16 patients with PCOS treated with finasteride (3 mg/day). Patients in groups III, IV, and V had normal hormonal assays. The patients were followed up for six months, then re-assessed regarding clinical improvement, hirsutism score, improvement of associating manifestations of hyperandrogenism or insulin resistance, and state of menses, ultrasound, free T, fasting insulin, complete blood count, serum creatinine, serum bilirubin and SGPT. Results: After 6 months of treatment, hirsutism score, according to modified Ferriman-Gallwey scoring system, showed noticeable improvement in most of patients with very highly significant (p < 0.001) percentage of improvement in their score ranged from zero to 64.29%. There was improvement in 9 out of 10 patients with androgenetic alopecia (AGA) as there was noticeable cessation of hair loss. In addition, 5 out of 11 patients with acne vulgaris showed obvious improvement with treatment. Regarding ultrasound assessment, 14 patients out of 38 patients had PCOS changes showed improvement while 24 patients were unchanged. Normal ultrasound in 15 patients was still normal during re-assessment. After treatment, free T and fasting insulin levels showed a non-significant difference in patients groups compared with before treatment assays except for significant decrease in fasting insulin in groups II and III. In groups I, III, and V, treated with finasteride, significant declines in hirsutism score were found. Highest percentage of improvement was in group I (all patients had PCOS). Therefore, finasteride can efficiently ameliorate hirsutism in both PCOS and IH in agreement with many studies. Improvement in polycystic ovaries in groups I and V and decrease of fasting insulin in group III need further evaluation and explanation. There was also acceptable improvement in associating AGA and acne. Yet, development of oligomenorrhea with finasteride needs also further evaluation and investigations. Teratogenicity can be overcome by using the drug in single patients and using of contraception in married patients. In groups II and IV, treated with metformin, percentage of improvement in hirsutism score was more in group II (all members had hyperinsulinemia). These changes were associated with regulation of menstruation, improvement in ultrasound findings and decline in fasting insulin levels (especially in group II). Therefore, metformin can efficiently ameliorate hirsutism in mainly when associated with hyperinsulinemia and insulin resistance in agreement with many studies. In addition, this improvement is associated with improvement in polycystic ovaries and acceptable improvement in associating acne. In married patients, contraception must be recommended. Comparing groups IV and V with each other revealed regulation of menstruation, improvement of polycystic ovaries in ultrasound, and decline in fasting insulin were more with metformin therapy in group IV. Improvement of hirsutism and associating manifestation of hyperandrogenism were more in group V with finasteride therapy. Combination of both medications in treatment of hirsutism is thought to be effective. Conclusion: PCOS and IH were the commonest causes of hirsutism in our locality and some cases of hirsutism might have hormonal disturbances , yet, many cases had normal hormonal assays. Finasteride or metformin was effective in treatment of hirsutism and led to significant declines in hirsutism score with improvement in polycystic ovaries and associating manifestations such as acne and AGA. To get better results, it was preferable to use finasteride in hirsutism associated with hyperandrogenemia and metformin in cases associated with hyperinsulinemia. Married hirsute women must use suitable method of contraception during treatment with finasteride or metformin while both drugs are completely safe in single patients. Combination of oral finasteride and metformin is thought to be highly effective in treatment of hirsutism as each medication has its own properties that completing each other. This suggestion needs further studies.