Association of ethnicity, Fitzpatrick skin type, and hirsutism: A retrospective cross-sectional study of women with polycystic ovarian syndrome

Abstract

BackgroundThe complex interplay between ethnicity, Fitzpatrick skin type (FST), and hirsutism in patients with polycystic ovarian syndrome (PCOS) is poorly understood.ObjectiveIn this cross-sectional, retrospective analysis, we examined the prevalence, severity, and distribution of hirsutism with clinician-rated site-specific and total modified Ferriman-Gallwey (mFG) visual scoring in a diverse cohort of American patients with PCOS.MethodsIndependent analyses were conducted on the basis of patient-reported FST ratings and ethnicity.ResultsIn this PCOS cohort, a correlation was found between hirsutism and ethnicity and the highest prevalence of hirsutism and total mFG scores was observed in Hispanic, Middle Eastern, African American, and South Asian patients. A positive correlation between hirsutism and FST was also observed with an increasing prevalence of hirsutism in the group of patients with higher FSTs. Significant trends in the anatomic distribution of hirsutism were observed between ethnic groups as well. A higher facial mFG score was found in African American patients but higher mFG scores in the truncal and extremity regions were observed in Middle Eastern patients. Truncal hirsutism was also associated with higher FSTs.ConclusionsEthnicity and FST may be important variables in both the quantitative and qualitative presentations of hirsutism in women with PCOS and should be considered in the diagnostic evaluation of any patient who is suspected of having the condition. Previously published studies that examined ethnicity, FST, and hirsutism in homogeneous cohorts limited comparison and generalizability but the strength of this study lies in its detailed analysis within a single large and diverse PCOS cohort. Validated studies are needed to determine whether clinical criteria for hirsutism should be adjusted for ethnicity and FST in the PCOS population and particularly within diverse cohorts and patients of mixed ancestry.

Low intakes of dietary fiber and magnesium are associated with insulin resistance and hyperandrogenism in polycystic ovary syndrome: A cohort study

“…Clinical androgen excess was assessed, depending on ethnicity, by a self‐reported modified Ferriman–Gallwey score. For those of European, Aboriginal, and South American descent, a score of 8 or higher constituted hyperandrogenism while a score of 6 or higher for East Asian participants, and 10 or higher for South Asian participants sufficed (Afifi et al, ; Karimah & Hestiantoro, ; Wijeyaratne, Balen, Barth, & Belchetz, ). The remaining 38 women, with both oligo‐/anovulation and PCO on ultrasound, were categorized as “non‐hyperandrogenic PCOS (Non‐HA).” “PCO on ultrasound” was defined by the Rotterdam criteria as (a) having 12 or more follicles measuring 2–9 mm in diameter in one or both ovaries, or (b) the ovarian volume exceeding 10 cm 3 .…”

Effect of Diet Control Therapy on the Dermatological Symptoms of Obese Polycystic Ovarian Syndrome Women: Repeated Measure Design

“…[28], however, an exact explanation of the mechanism of action for this treatment or any other treatment is difficult due to the controversiality of the PCOS definition [29] and the lacking of an exact explanation of the pathophysiological changes accompanied with it. So, it's better to consider PCOS as a vicious cycle syndrome , triggered at any point, and finally ends with hyperandrogen, anovulation [1,30], and polycystic ovary morphology [31]. This vicious cycle can lead us to Insulin resistance (IR) and hyperinsulinemia which play a central role in PCOS pathogenesis [23], PCOS women are at a high risk of developing impaired glucose tolerance (IGT), type 2 diabetes mellitus (DM2), and cardiovascular disease (CVD) [29].…”

“…The current experiment is limited to the mentioned diet therapy protocol, it's also limited to 12 weeks and 24 weeks measuring intervals, and to the exact measured dermatological, biochemical, and anthropometric parameters that were gathered. The symptoms of PCOS can be quite variable depending on the patients' ethnicity [1], this study was conducted and limited to adult Egyptian PCOS females. To the best of our knowledge, only one study on Egyptian females was performed, it investigating the effect of diet only on PCOS [13] with differences in the design, sample characteristics, and the measured outcomes.…”

“…as the most common endocrinal disorder [1,2]. PCOS is a heterogeneous disorder, characterized by menstrual irregularities or infertility, metabolic, and cutaneous disorders as clinical signs of excess androgen that include acne and Affecting between 2-7% [1] or 5-10 % [2] of reproductive-aged women, and with a prevalence rate of 20-30% among Caucasian women [3], Polycystic ovary syndrome (PCOS) is considered hirsutism [4].…”

“…PCOS is a heterogeneous disorder, characterized by menstrual irregularities or infertility, metabolic, and cutaneous disorders as clinical signs of excess androgen that include acne and Affecting between 2-7% [1] or 5-10 % [2] of reproductive-aged women, and with a prevalence rate of 20-30% among Caucasian women [3], Polycystic ovary syndrome (PCOS) is considered hirsutism [4]. In those women with PCOS, 92% shows cutaneous manifestations with hyperandrogenism associated signs [1,5] Hirsutism, a reliable cutaneous marker for hyperandrogenism [6], is a feminine condition of excessive terminal hair growth in an androgen-sensitive skin distribution [1], causing lack of self-confidence and a remarkable amount of emotional stress. As the sense of self-consciousness is originated from the concept "ideal hair pattern" known inside the patients' social and cultural environment [4].…”