Effect of the gonadotrophin releasing hormone analogue, goserelin, and oestradiol replacement on sebum excretion rates and hair size in mildly hirsute women

Abstract

Gonadotrophin releasing hormone analogues (GnRH-A) suppress ovarian activity resulting in lowering of plasma oestrogens and androgens of ovarian origin, thus reducing androgen drive to target organs in the skin. They may be of value in the treatment of hirsuties. Sixteen female patients with mild idiopathic hirsuties and normal menstrual cycles were studied. Patients received depot implants of GnRH-A (goserelin) at 4-weekly intervals for 6 months initiated in early follicular phase as well as a single oestradiol implant at the time of the first goserelin implant. Hair measurements, by a global scoring system and microscopy (hair diameter, growth rate and presence of medulla), sebum excretion rates, and measurements of circulating testosterone, sex hormone binding globulin, and free androgen index were made at 8-weekly intervals throughout the trial. The treatment was well tolerated. Seven patients had amenorrhoea and the remaining nine had reduced menstrual bleeding. Only one patient complained of mild flushing. Patients did not notice significant improvement over the active study period. There was a 10-15% fall in sebum excretion rate compared with baseline during the treatment period (week 8 to 24) with a rebound 8 weeks after the last treatment, but these changes did not reach statistical significance. There was no consistent change in hair diameter or hair growth rate or in the numbers of hairs in which the medulla was intact, partially present or absent. There was a significant fall in Ferriman and Gallwey hirsuties score during the treatment period (p < 0.05). The study demonstrated that although the GnRH-A caused suppression of testosterone and free testosterone index, this effect was not sufficient to influence hair growth rate or hair diameter in a group of patients with mild idiopathic hirsuties. (J Dermatol Treat (1991) 1: 289-292)