Clinician vs Self-ratings of Hirsutism in Patients With Polycystic Ovarian Syndrome
Authors: Lauri Pasch, Steven Y. He, Heather Huddleston, Marcelle I. Cedars, Abram Beshay, Lee T. Zane, Kanade Shinkai
Journal: JAMA Dermatology (2016)

<h3>Importance</h3> Qualitative evidence suggests that hirsutism inflicts significant negative impacts on quality of life and may be associated with depression. Quantitative research is essential to determine best practices in caring for hirsute patients. <h3>Objective</h3> To quantify quality-of-life impact of hirsutism and evaluate how the degree of hirsutism (as assessed by patients and clinicians) is associated with quality of life and depressive symptoms. <h3>Design, Setting, Participants</h3> This study included 229 patients aged 14 to 52 years consecutively recruited from a polycystic ovarian syndrome (PCOS) clinic between May 18, 2006, and October 25, 2012, who met the Rotterdam PCOS criteria. Data analysis was completed July 2015, and alterations were completed in response to reviewer comments in January 2016. <h3>Main Outcomes and Measures</h3> Clinicians and patients rated degree of hirsutism using the modified Ferriman-Gallwey (mFG) instrument, a visual scoring method assessing androgen-dependent hair growth in 9 body areas. Hirsutism-related quality of life was assessed using the Skindex-16, a validated quality of life instrument for skin disorders. Depressive symptoms were assessed using the Beck Depression Inventory-Fast screen. <h3>Results</h3> Overall, 229 patients aged 14 to 52 years who met the Rotterdam criteria for polycystic ovarian syndrome rated themselves and were rated by clinicians for hirsutism. Total mean self-rated mFG score for patients was 13.3 out of a total 36 possible points; total mean clinician-rated mFG score for patients was 8.63 (<i>P</i> &lt; .001); self-ratings for hirsutism were higher for all body areas except thigh. Hirsutism had a significant negative effect on quality of life; the mean (SD) Skindex-16 score for the emotion domain was 73.9 (29.8) and 44.3 (33.7) for the function domain. Higher degrees of hirsutism (determined by both patients and clinicians) were moderately associated with more negative quality-of-life impact; however, self-ratings (<i>r</i> = 0.19-0.46) were more strongly associated than clinician ratings (<i>r</i> = 0.14-0.32)(<i>P</i> &lt; .05 for all). Only self-ratings of hirsutism were significantly associated with risk of depression (<i>r</i> = 0.14;<i>P</i> &lt; .05). <h3>Conclusions and Relevance</h3> There is notable discordance in the perception of hirsutism between patients and clinicians; patients view their hirsutism as more severe than clinicians do. Quality-of-life impacts of hirsutism are consistent with that reported for other serious skin conditions. This negative impact is only partially associated with the degree of hirsutism, with self-ratings being more highly associated with quality of life impact than clinician ratings. These results support guidelines recommending that treatment be guided largely by patient distress with hair growth and subjective perceptions as opposed to clinician judgment of degree. Patient self-rating is critical information for patient-centered care for hirsute patients.