بررسی اثر لیزر و نور شدید پالسی در درمان هیرسوتیسم در زنان مبتلا به سندرم تخمدان پلی‌کیستیک: مرور سیستماتیک

نوع مقاله : مروری

نویسندگان

1 دکترای بهداشت باروری، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 استاد، مرکز تحقیقات اندوکرینولوژی تولید مثل، پژوهشکده علوم غدد درون‌ریز و متابولیسم، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: در طی دهه‌های اخیر لیزردرمانی یکی از روش‌های محبوب در درمان هیرسوتیسم در افراد مبتلا به سندرم تخمدان پلی‌کیستیک بوده است. مطالعه حاضر با هدف تعیین اثر درمانی لیزر بر هیرسوتیسم در زنان مبتلا به سندرم تخمدان پلی‌کیستیک به‌صورت مرور سیستماتیک انجام شد.
روش‌کار: در این مطالعه جستجوی مطالعات تجربی و نیمه‌تجربی فارسی و انگلیسی در پایگاه‌های PubMed، Scopus، Web of Science،Cochrane library ، Magiran، SID،IranDoc  در ماه جولای 2020 انجام شد. جستجو با استفاده از کلید واژه‌های فارسی سندرم تخمدان پلی‌کیستیک، هیرسوتیسم، لیزر، درمان، مو و کلید واژه‌های لاتین مرتبط انجام شد. پیامد اصلی مورد بررسی شامل: اثر مداخله بر کاهش موها، مدت زمان کاهش موها، مدت زمان رشد موهای جدید و عوارض جانبی لیزر درمانی بود.
یافته‌ها: پس از جستجوی پیشرفته، 11 مقاله (638 شرکت‌کننده) دارای معیارهای ورود بودند. نوع پوست شرکت‌کنندگان بر اساس معیار فیتزپاتریک بود. در اکثر مطالعات دستگاه لیزر الکساندیرت مورد استفاده قرار گرفته بود. مدت زمان درمان در مطالعات حداکثر 6 ماه با فواصل درمانی 6-4 هفته بود. پیامد اصلی مورد بررسی شامل: کاهش معنادار تعداد مو و شدت موهای زائد، افزایش میانگین زمان رشد موهای جدید، میزان انرژی در بازه 50-10 ژول بر سانتی‌متر‌ مربع و مدت زمان 50-20 میلی‌ثانیه و عوارض شامل هیپرپیگمانتاسیون و اریتم و درد بود.
نتیجه‌گیری: یافته‌ها حاکی از تأثیر فناوری‌های مبتنی بر نور بر انواع مختلف پیامدهای مرتبط با درمان هیرسوتیسم در بیماران مبتلا به سندرم تخمدان پلی‌کیستیک می‌باشد، اما هنوز اتفاق نظر در مورد مناسب‌ترین نوع لیزر، فلوئنس و تعداد جلسات درمانی وجود ندارد. مطالعات کارآزمایی بالینی گسترده‌ای جهت تدوین دستورالعمل بالینی نیاز می‌باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Effect of Laser and Intense Pulsed Light in treatment of hirsutism in women with polycystic ovary syndrome (PCOS): A systematic review

نویسندگان [English]

  • Marzieh Saei Ghare Naz 1
  • Fahimeh Ramezani Tehrani 2
1 PhD of Reproductive Health, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Professor, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: During recent decades, laser therapy has been one of the most popular methods in treatment of hirsutism in women with polycystic ovary syndrome (PCOS). This study was performed with aim to determine the therapeutic effect of laser on hirsutism in women with PCOS as a systematic review.
Methods: The search process of experimental and semi-experimental studies (Persian and English language) was performed in databases including PubMed, Scopus, Web of Science, Cochrane library, Magiran, SID, and IranDoc up to July 2020. The search was performed using the keywords of polycystic ovary syndrome, hirsutism, laser, treatment, hair, and the related latin keywords. The main outcomes were the effect of interventions on hair loss, hair loss duration, the duration of new hair growth, and the side effects of laser treatment.
Results: After the advanced search, 11 articles (638 participants) had inclusion criteria. The skin type of the participants was based on Fitzpatrick scale. The majority of studies used the Alexandrite laser device. The duration of treatment in the studies was a maximum of 6 months with treatment intervals of 4 to 6 weeks. The main outcomes of this study included: significant reduction in the number of hairs and the intensity of excess hair, an increase in the mean growth time of new hair, energy levels in the range of 10 to 50 j/cm2 and duration of 20-50 milliseconds. The complications included hyperpigmentation, erythema, and pain.
Conclusion: The findings indicated the impact of light-based technologies on different types of outcomes associated with the treatment of hirsutism in women with PCOS, but due to the limitations, there is no consensus on the most appropriate type of laser, fluorescence, and the number of treatment sessions. Greater clinical trial studies are needed to develop the clinical guidelines.

کلیدواژه‌ها [English]

  • Polycystic Ovary Syndrome
  • Laser
  • Hirsutism
  • Treatment
  • Systematic Review
  1.  

    1. Peng Q, Juzeniene A, Chen J, Svaasand LO, Warloe T, Giercksky KE, ET AL. Lasers in medicine. Reports on Progress in Physics 2008; 71(5):056701.
    2. Hohl A, Ronsoni MF, Oliveira MD. Hirsutismo: diagnóstico e tratamento. Arquivos Brasileiros de Endocrinologia & Metabologia 2014; 58(2):97-107.
    3. Burkman RT. Berek & Novak’s gynecology. JAMA 2012; 308(5):516-7.
    4. Hajmolarezaei E, Ebrahimi M, Moradi B, Seddigh L, Ghandi N. Relationship between menstruation regularity with total testosterone and ultrasonographic findings among hirsute women. Iran J Obstet Gynecol Infertil 2020; 22(11):22-8.
    5. Hafsi W, Badri T. Hirsutism.  StatPearls [Internet]: StatPearls Publishing; 2020.
    6. Akbarzadeh M, Naderi T, Dabaghmanesh MH, Tabatabaie H, Zare Z. The prevalence of hirsutism in girls 14 to 18 years old and its relationship with polycystic ovary syndrome in Shiraz, Iran. Iran J Obstet Gynecol Infertil 2013; 16(81):8-15.
    7. Barbieri RL. Treatment of hirsutism. UpToDate 2013; 17.
    8. Archer JS, Chang RJ. Hirsutism and acne in polycystic ovary syndrome. Best Practice & Research Clinical Obstetrics & Gynaecology 2004; 18(5):737-54.
    9. Koulouri O, Conway GS. Management of hirsutism. Bmj 2009; 338.
    10. Bode DV, Seehusen DA, Baird DC. Hirsutism in women. American family physician 2012; 85(4):373-80.
    11. Amini L, Hematian M, Montazeri A, Gharegozli K. Comparing the frequency and intensity of hirsutism in women with and without epilepsy. Iran J Obstet Gynecol Infertil 2016; 19(23):1-6.
    12. Aswini R, Jayapalan S. Modified Ferriman–Gallwey score in hirsutism and its association with metabolic syndrome. International journal of trichology 2017; 9(1):7.
    13. Mahmood KT, Ghafoor S, Tanveer S. Risk Factors Contributing to Hirsutism. J Biomed Sci and Res 2011; 3(1):347-52.
    14. Coskun A, Ercan O, Arikan DC, Özer A, Kilinc M, Kiran G, et al. Modified Ferriman–Gallwey hirsutism score and androgen levels in Turkish women. European Journal of Obstetrics & Gynecology and Reproductive Biology 2011; 154(2):167-71.
    15. Azziz R. Overview of long-term morbidity and economic cost of the polycystic ovary syndrome. InAndrogen Excess Disorders in Women 2006 (pp. 353-362). Humana Press.
    16. Ekbäck M, Wijma K, Benzein E. “It is always on my mind”: Women's experiences of their bodies when living with hirsutism. Health care for women international 2009; 30(5):358-72.
    17. Hahn S, Janssen OE, Tan S, Pleger K, Mann K, Schedlowski M, et al. Clinical and psychological correlates of quality-of-life in polycystic ovary syndrome. European Journal of Endocrinology 2005; 153(6):853-60.
    18. Khomami MB, Tehrani FR, Hashemi S, Farahmand M, Azizi F. Of PCOS symptoms, hirsutism has the most significant impact on the quality of life of Iranian women. PLoS One 2015; 10(4):e0123608.
    19. Lipton MG, Sherr L, Elford J, Rustin MH, Clayton WJ. Women living with facial hair: the psychological and behavioral burden. Journal of psychosomatic research 2006; 61(2):161-8.
    20. Alonso L, Fuchs E. The hair cycle. Journal of cell science 2006; 119(3):391-3.
    21. Pasquali R, Gambineri A. Therapy of Endocrine Disease: Treatment of hirsutism in the polycystic ovary syndrome. European journal of endocrinology 2014; 170(2):R75-90.
    22. Alizadeh N, Ayyoubi S, Naghipour M, Hassanzadeh R, Mohtasham-Amiri Z, Zaresharifi S, et al. Can laser treatment improve quality of life of hirsute women?. International Journal of Women's Health 2017; 9:777.
    23. Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. Journal of the American Academy of Dermatology 2003; 49(1):1-34.
    24. Swingler R, Awala A, Gordon U. Hirsutism in young women. The Obstetrician & Gynaecologist 2009; 11(2):101-7.
    25. Haedersdal M, Wulf HC. Evidence‐based review of hair removal using lasers and light sources. Journal of the European Academy of Dermatology and Venereology 2006; 20(1):9-20.
    26. Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS med 2009; 6(7):e1000097.
    27. Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Archives of dermatology 1988; 124(6):869-71.
    28. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj 2011; 343:d5928.
    29. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. bmj 2016; 355.
    30. Tabaie SM, Berenji Ardestani H, Nasri E, Naderi MS, Dabiran S. Effect of Alexandrite Laser on Hair Removal in Women with and without Polycystic Ovary Syndrome. Journal of Lasers in Medicine 2018; 15(1):9-2.
    31. Rasi A, Zamani S. The comparison between efficacy of Alexandritis Laser between women with polycystic ovary syndrome (PCO) and women without polycystic ovary syndrome. Laser in Medicine 2013; 10(1):8-12.
    32. Haak CS, Nymann P, Pedersen AT, Clausen HV, Feldt Rasmussen U, Rasmussen ÅK, et al. Hair removal in hirsute women with normal testosterone levels: a randomized controlled trial of long‐pulsed diode laser vs. intense pulsed light. British journal of Dermatology 2010; 163(5):1007-13.
    33. Pai GS, Bhat PS, Mallya H, Gold M. Safety and efficacy of low-fluence, high-repetition rate versus high-fluence, low-repetition rate 810-nm diode laser for permanent hair removal–A split-face comparison study. Journal of Cosmetic and Laser Therapy 2011; 13(4):134-7.
    34. Rezvanian H, Adibi N, Siavash M, Kachuei A, Shojaee-Moradie F, Asilian A. Increased insulin sensitivity by metformin enhances intense-pulsed-light-assisted hair removal in patients with polycystic ovary syndrome. Dermatology 2009; 218(3):231-6.
    35. McGill DJ, Hutchison C, McKenzie E, McSherry E, Mackay IR. A randomised, split‐face comparison of facial hair removal with the alexandrite laser and intense pulsed light system. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery 2007; 39(10):767-72.
    36. McGill DJ, Hutchison C, McKenzie E, McSherry E, Mackay IR. Laser hair removal in women with polycystic ovary syndrome. Journal of plastic, reconstructive & aesthetic surgery 2007; 60(4):426-31.
    37. Harris K, Ferguson J, Hills S. A comparative study of hair removal at an NHS hospital: luminette intense pulsed light versus electrolysis. Journal of dermatological treatment 2014; 25(2):169-73.
    38. Clayton WJ, Lipton M, Elford J, Rustin M, Sherr L. A randomized controlled trial of laser treatment among hirsute women with polycystic ovary syndrome. British Journal of Dermatology 2005; 152(5):986-92.
    39. Karn D, KC S, Timalsina M, Gyawali P. Hormonal profile and efficacy of long pulse Nd-YAG laser in treatment of hirsutism. Journal of Nepal Health Research Council 2014.
    40. Roche A, Sedgwick PM, Harland CC. Laser treatment for female facial hirsutism: are quality‐of‐life benefits sustainable?. Clinical and Experimental Dermatology 2016; 41(3):248-52.
    41. Lepselter J, Elman M. Biological and clinical aspects in laser hair removal. Journal of Dermatological Treatment 2004; 15(2):72-83.
    42. Jowkar F, Radgoodarz N, Saki N, Heiran A. Evaluation of patient satisfaction after treatment with the alexandrite laser for hirsutism. Iranian Journal of Dermatology 2016; 19(1):11-5.
    43. Tulpule MS, Bhide DS, Bharatia P, Rathod NU. 810 nm diode laser for hair reduction with Chill-tip technology: prospective observational analysis of 55 patients of Fitzpatrick skin types III, IV, V. Journal of Cosmetic and Laser Therapy 2020; 22(2):65-9.
    44. Nilforoushzadeh MA, FatemiNaieni F, Siadat AH, Rad L. Comparison between sequentional treatment with diode and alexandrite lasers versus alexandrite laser alone in the treatment of hirsutism. Journal of Isfahan Medical School 2012; 29(172).
    45. White L, Lai S, Yoo S, Alam M. Hair removal in hirsute patients with polycystic ovarian syndrome: 212. Lasers in Surgery And Medicine 2006; 38.
    46. Dorgham NA, Dorgham DA. Lasers for reduction of unwanted hair in skin of colour: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2020; 34(5):948-955.
    47. Haedersdal M, Gøtzsche PC. Laser and photoepilation for unwanted hair growth. Cochrane Database of Systematic Reviews 2006(4).
    48. Garcia C, Alamoudi H, Nakib M, Zimmo S. Alexandrite laser hair removal is safe for Fitzpatrick skin types IV-VI. Dermatol Surg 2000; 26(2):130-4.
    49. Cameron H, Ibbotson SH, Dawe RS, Ferguson J, Moseley H. Within-patient right-left blinded comparison of diode (810 nm) laser therapy and intense pulsed light therapy for hair removal. Lasers Med Sci 2008; 23(4):393-7.
    50. Alijanpoor R, Poorsattar BejehMir A, Mokmeli S. Successful white hair removal with combined coloring and intense pulsed Light (IPL): a randomized clinical trial. Photomed Laser Surg 2011; 29(11):773-9.
    51. Al-Dhalimi MA, Kadhum MJ. A split-face comparison of facial hair removal with the long-pulsed alexandrite laser and intense pulsed light system. J Cosmet Laser Ther 2015; 17(5):267-72.
    52. Ghaderi R, Asghari M, Bakhshaee M. Efficacy of intense pulsed light in hirsutism treatment: A clinical trail study. Journal of Surgery and Trauma 2018; 6(3):86-9.
    53. Gan SD, Graber EM. Laser hair removal: a review. Dermatol Surg 2013; 39(6):823-38.
    54. Bouzari N, Tabatabai H, Abbasi Z, Firooz A, Dowlati Y. Laser hair removal: comparison of long-pulsed Nd:YAG, long-pulsed alexandrite, and long-pulsed diode lasers. Dermatol Surg. 2004; 30(4 Pt 1):498-502.
    55. Jane SD, Mysore V. Effectiveness of short‐pulse width Nd: YAG in laser hair reduction. Journal of Cosmetic Dermatology 2018; 17(6):1046-52.
    56. Lévy JL, Trelles MA, de Ramecourt A. Epilation with a long-pulse 1064 nm Nd:YAG laser in facial hirsutism. J Cosmet Laser Ther 2001; 3(4):175-9.
    57. Puri N. Comparative Study of Diode Laser Versus Neodymium-Yttrium Aluminum: Garnet Laser Versus Intense Pulsed Light for the Treatment of Hirsutism. J Cutan Aesthet Surg 2015; 8(2):97-101.
    58. Alijanpour R. The effect of topical finasteride 0.5% on the outcome of diode laser therapy in the treatment of excess facial hairs in the women with hirsutism. J Pak Med Assoc 2016; 66(9):1107-1110.
    59. Faghihi G, Iraji F, Abtahi-Naeini B, Saffar B, Saffaei A, Pourazizi M, et al. Complementary therapies for idiopathic hirsutism: topical licorice as promising option. Evidence-Based Complementary and Alternative Medicine 2015; 2015.
    60. Rosenfield RL. Hirsutism. New England Journal of Medicine 2005; 353(24):2578-88.
    61. Sanchez LA, Perez M, Azziz R. Laser hair reduction in the hirsute patient: a critical assessment. Human Reproduction Update 2002; 8(2):169-81.
    62. Lin TY, Dierickx CC, Campos VB, Farinelli WA, Rosenthal J, Anderson RR. Reduction of regrowing hair shaft size and pigmentation after ruby and diode laser treatment. Archives of dermatological research 2000; 292(2-3):60-7.
    63. Lin TY, Manuskiatti W, Dierickx CC, Farinelli WA, Fisher ME, Flotte T, et al. Hair growth cycle affects hair follicle destruction by ruby laser pulses. Journal of investigative dermatology 1998; 111(1):107-13.
    64. Bouzari N, Tabatabai H, Abbasi Z, Firooz A, Dowlati Y. Hair removal using an 800-nm diode laser: comparison at different treatment intervals of 45, 60, and 90 days. Int J Dermatol 2005; 44(1):50-3.
    65. Karimah P, Hestiantoro A. The cut off of Ferriman Gallwey score for PCOS in Asia and the degree of hyperandrogenism indicator. KnE Medicine 2016: 186-92.
    66. Sadighha A, Mohaghegh Zahed G. Meta-analysis of hair removal laser trials. Lasers Med Sci 2009; 24(1):21-5.
    67. Buzney E, Sheu J, Buzney C, Reynolds RV. Polycystic ovary syndrome: a review for dermatologists: Part II. Treatment. J Am Acad Dermatol 2014;71(5):859.e1-859.e15.
    68. Lee CM. Laser-assisted hair removal for facial hirsutism in women: A review of evidence. J Cosmet Laser Ther 2018; 20(3):140-144.
    69. Khalkhal E, Razzaghi M, Rostami-Nejad M, Rezaei-Tavirani M, Heidari Beigvand H, Rezaei Tavirani M. Evaluation of Laser Effects on the Human Body After Laser Therapy. J Lasers Med Sci 2020; 11(1):91-97.