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- Title
Laser and Light-Based Therapies for Hirsutism Management in Women With Polycystic Ovarian Syndrome: A Systematic Review.
- Authors
Tan, Katrina; Coster, Thisara; Mousa, Aya; Mar, Adrian; Piltonen, Terhi; Boyle, Jacqueline A.; Teede, Helena; Joham, Anju; Romualdi, Daniela; Tay, Chau Thien
- Abstract
Key Points: Question: Are laser and light-based hair reduction therapies, either as stand-alone treatments or in combination with other systemic therapies, effective in addressing hirsutism in adults and adolescents with polycystic ovary syndrome (PCOS)? Findings: In this systematic review of 6 studies reporting data on 423 patients, laser and light-based therapies were found to be effective in reducing hirsutism severity, improving psychological well-being, and enhancing quality of life in women with PCOS, with generally tolerable adverse effects. Simultaneous use of metformin or the combined oral contraceptive pill may offer additional benefits. Meaning: These findings alongside broader efficacy data and patient preference informed the 2023 International Evidence-based PCOS Guideline, which has now introduced new recommendations on the use of laser and light-based hair reduction therapies for women with PCOS and hirsutism. This Systematic Review synthesizes the existing literature regarding the effectiveness of laser and light hair reduction therapies, either as stand-alone treatments or in combination with systemic agents, in treating hirsutism for women with polycystic ovary syndrome. Importance: Hirsutism represents a significant concern for women with polycystic ovary syndrome (PCOS), with deleterious psychological effects warranting acknowledgment and a clear imperative to provide effective management. To our knowledge, this is the first review to exclusively examine the effectiveness of laser and light-based therapies in addressing hirsutism in women with PCOS. Objective: To synthesize the existing literature regarding the effectiveness of laser and light hair reduction therapies, either as stand-alone treatments or in combination with systemic agents, in treating hirsutism for women with PCOS. Evidence Review: A systematic literature review was performed using MEDLINE, Embase, EMCARE, and CINAHL according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Articles written in English, reporting on patients who met pre-established inclusion criteria were selected. Objective and subjectively measured outcomes relating to the effect of laser or light-based hair reduction therapies on hirsutism were abstracted. Heterogeneity among included studies precluded a meta-analysis, necessitating a narrative synthesis. Findings: Six studies reporting data on 423 individual patients with PCOS who underwent laser or light-based hair reduction therapies were included: 4 randomized clinical trials and 2 cohort studies. Alexandrite laser demonstrated significant improvements in hirsutism severity and psychological outcomes, particularly at high-fluence application. Alexandrite laser was also found to be more effective than intense pulsed light (IPL). The combination of diode laser with either metformin or combined oral contraceptive pill was superior to the application of diode laser alone, just as the addition of metformin to IPL demonstrated superior results to IPL treatment alone. Overall, most interventions were well tolerated. The overall certainty of evidence across all outcomes and comparisons was limited in part due to the observational nature of some studies. Conclusions and Relevance: This systematic review highlights the potential of laser and light hair reduction therapies, both as stand-alone treatments and in combination with other pharmacological agents in PCOS. However, this review was limited by low certainty of the evidence, few studies evaluating effectiveness and safety in those with skin of color, and heterogeneity in outcome assessment. Future studies are needed to provide more robust evidence among diverse individuals with PCOS and hirsutism.
- Publication
JAMA Dermatology, 2024, Vol 160, Issue 7, p746
- ISSN
2168-6068
- Publication type
Article
- DOI
10.1001/jamadermatol.2024.0623