medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-13-94-100medsovet-6403Research ArticleРепродуктивное здоровье и ВРТReproductive health and ARTСовременный подход к лечению пациенток с андрогензависимыми дерматопатиямиModern approach to the treatment of patients with androgen-dependent dermatopathieshttps://orcid.org/0000-0003-2576-4368МанухинаЕ. И.ManukhinaE. I.

Манухина Екатерина Игоревна, д.м.н., профессор кафедры акушерства и гинекологии лечебного факультета

127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1

Ekaterina I. Manukhina, Dr. Sci. (Med.), Professor of the Department of Obstetrics and Gynecology

20, Bldg. 1, Delegatskaya St., Moscow, 127473, Russia

katemanu@mail.ruhttps://orcid.org/0000-0002-2126-1264ГеворкянМ. А.GevorkyanM. A.

Геворкян Марианна Арамовна, д.м.н., профессор кафедры акушерства и гинекологии лечебного факультета

127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1

Marianna A. Gevorkyan, Dr. Sci. (Med.), Professor of the Department of Obstetrics and Gynecology

20, Bldg. 1, Delegatskaya St., Moscow, 127473, Russia

marianagevorkyan@mail.ruhttps://orcid.org/0000-0002-0724-6690СафарянИ. Р.SafaryanI. R.

Сафарян Ирма Романовна, к.м.н., ассистент кафедры акушерства и гинекологии лечебного факультета

127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1

Irma R. Safaryan, Cand. Sci. (Med.), Assistant of the Department of Obstetrics and Gynecology

20, Bldg. 1, Delegatskaya St., Moscow, 127473, Russia

safairma@yandex.ruМосковский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian Federation20211610202101394100Copyright © Манухина Е.И., Геворкян М.А., Сафарян И.Р., 20212021Манухина Е.И., Геворкян М.А., Сафарян И.Р.Manukhina E.I., Gevorkyan M.A., Safaryan I.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6403Введение

Введение. Среди женщин репродуктивного возраста около 10–20% пациенток страдают от проявлений избытка андрогенов – гиперандрогении, кожными проявлениями которой являются такие симптомы, как гирсутизм, акне, себорея и алопеция.

Цель

Цель. Оценить влияние ципротерона ацетата на кожные проявления гиперандрогении и улучшение качества жизни пациенток после проведенного лечения.

Материалы и методы

Материалы и методы. В исследование были включены 120 пациенток с кожными симптомами гиперандрогении. Возраст пациенток варьировался от 18 до 35 лет. Критериями включения являлись основные жалобы пациенток – акне, гирсутизм и алопеция. Пациенткам было проведено комплексное клинико-лабораторное обследование. Препаратом выбора для лечения андрогензависимых дерматопатий являлся ципротерона ацетат 50–100 мг в сутки.

Результаты и обсуждение

Результаты и обсуждение. Все пациентки были разделены на три группы: с гирсутизмом – 44 (37%) пациентки, акне – 55 (53%), алопецией – 12 (10%). При этом у 32 (27%) чел. наблюдалось сочетание нескольких симптомов одновременно. Такие пациентки были отнесены к группе в зависимости от преобладающей жалобы. Всем пациенткам назначался ципротерона ацетат в суточной дозировке 50–100 мг в зависимости от выраженности симптомов с 1-го по 10-й день менструального цикла, а 54 (52%) пациенткам – ципротерона ацетат 20 мг и этинилэстрадиол 35 мг с 1-го по 21-й день менструального цикла. У большинства пациенток после проведенного лечения отмечалась стабилизация психоэмоционального состояния, уменьшались тревожность, депрессивные расстройства, повышались самооценка и коммуникабельность и улучшалось качество жизни в ее различных проявлениях.

Заключение

Заключение. При оценке по дерматологическому индексу качества жизни все пациентки отмечали стабилизацию психоэмоционального состояния и улучшение качества жизни после проведенного лечения. У 109 (91%) пациенток уменьшались тревожность, депрессивные расстройства, что благоприятно влияло на различные сферы качества жизни, повышались самооценка и коммуникабельность с положительным воздействием на личностные взаимоотношения

Introduction

Introduction. About 10–20% of patients among women of reproductive age suffer from signs and symptoms of androgen excess in hyperandrogenism. Its skin symptoms may include hirsutism, acne, seborrhea and alopecia.

Aim

Aim. To assess the effect of cyproterone acetate on skin symptoms of hyperandrogenism and improvement in the patients’ quality of life after treatment.

Materials and methods

Materials and methods. The study included 120 patients with skin symptoms of hyperandrogenism. The patients ranged in age from 18 to 35 years. The inclusion criteria were the main complaints of the patients as follows: acne, hirsutism and alopecia. The patients underwent a comprehensive clinical and laboratory examination. The drug of choice for the treatment of androgendependent dermatopathies was cyproterone acetate at a dose of 50–100 mg daily.

Results and discussion

Results and discussion. All patients were divided into three groups: 44 (37%) patients with hirsutism, 55 (53%) with acne, 12 (10%) with alopecia. Moreover, 32 (27%) patients had a mix of symptoms at the same time. Such patients were assigned to one of the groups depending on the predominant complaint. All patients were prescribed cyproterone acetate at a dose of 50-100 mg once daily, depending on the severity of symptoms from day 1 to day 10 of the menstrual cycle, and 54 (52%) patients were prescribed cyproterone acetate 20 mg and ethinyl estradiol 35 mg from day 1 to day 21 of the menstrual cycle. The study showed stabilization of the psychoemotional state, relief of anxiety, depressive disorders, enhancement of self-esteem and sociability, and improvement of the quality of life in its various manifestations in the majority of patients after the treatment.

Сonclusion

Сonclusion. When assessed using the dermatology life quality index questionnaires, all patients reported the stabilization of the psychoemotional state and the improvement in the quality of life after the treatment. The anxiety and depressive disorders decreased in 109 (91%) patients, which favourably influenced various areas of quality of life, enhanced self-esteem and sociability with a positive effect on personal relationships.

гиперандрогенияандрогензависимая дерматопатиягирсутизмакнеципротерона ацетатэтинилэстрадиолhyperandrogenismandrogen-dependent dermopathyhirsutismacnecyproterone acetateethinyl estradiolReferencesGoodman N.F., Cobin R.H., Futterweit W., Glueck J.S., Legro R.S., Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome – part 1. Endocr Pract. 2015;21(11):1291–1300. https://doi.org/10.4158/ep15748.dsc.Goodman N.F., Cobin R.H., Futterweit W., Glueck J.S., Legro R.S., Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome – part 1. Endocr Pract. 2015;21(11):1291–1300. https://doi.org/10.4158/ep15748.dsc.Besenek M., Gurlek B. Hyperandrogenism in Polycystic Ovary Syndrome Affects Psychological Well-Being Of Adolescents. J Obstet Gynaecol Res. 2021;47(1):137–146. https://doi.org/10.1111/jog.14444.Besenek M., Gurlek B. Hyperandrogenism in Polycystic Ovary Syndrome Affects Psychological Well-Being Of Adolescents. J Obstet Gynaecol Res. 2021;47(1):137–146. https://doi.org/10.1111/jog.14444.Lizneva D., Suturina L., Walker W., Brakta S., Gavrilova-Jordan L., Azziz R. Criteria, Prevalence, and Phenotypes of Polycystic Ovary Syndrome. Fertil Steril. 2016;106(1):6–15. https://doi.org/10.1016/j.fertnstert.2016.05.003.Lizneva D., Suturina L., Walker W., Brakta S., Gavrilova-Jordan L., Azziz R. Criteria, Prevalence, and Phenotypes of Polycystic Ovary Syndrome. Fertil Steril. 2016;106(1):6–15. https://doi.org/10.1016/j.fertnstert.2016.05.003.Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS). Hum Reprod. 2004;19(1):41–47. https://doi.org/10.1093/humrep/deh098.Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS). Hum Reprod. 2004;19(1):41–47. https://doi.org/10.1093/humrep/deh098.Манухин И.Б., Тумилович Л.Г., Геворкян М.А., Манухина Е.И. Гинекологическая эндокринология. Клинические лекции. 4-е изд. М.: ГЭОТАР-Медиа; 2020. 304 с. Режим доступа: https://medknigaservis.ru/wp-content/uploads/2020/07/NF0017580.files_.pdf.Manukhin I.B., Tumilovich L.G., Gevorkyan M.A., Manukhina E.I. Gynecological Endocrinology. Clinical Lectures. 4th ed. Moscow: GEOTARMedia; 2020. 304 p. (In Russ.) Available at: https://medknigaservis.ru/wpcontent/uploads/2020/07/NF0017580.files_.pdf.Ekbäck M.P., Lindberg M., Benzein E., Årestedt K. Health-Related Quality of Life, Depression and Anxiety Correlate with the Degree of Hirsutism. Dermatology. 2013;227(3):278–284. https://doi.org/10.1159/000355356.Ekbäck M.P., Lindberg M., Benzein E., Årestedt K. Health-Related Quality of Life, Depression and Anxiety Correlate with the Degree of Hirsutism. Dermatology. 2013;227(3):278–284. https://doi.org/10.1159/000355356.Zangeneh F.Z., Jafarabadi M., Naghizadeh M.M., Abedinia N., Haghollahi F. Psychological Distress in Women with Polycystic Ovary Syndrome from Imam Khomeini Hospital, Tehran. J Reprod Infertil. 2012;13(2):111–115. Available at: https://pubmed.ncbi.nlm.nih.gov/23926533/.Zangeneh F.Z., Jafarabadi M., Naghizadeh M.M., Abedinia N., Haghollahi F. Psychological Distress in Women with Polycystic Ovary Syndrome from Imam Khomeini Hospital, Tehran. J Reprod Infertil. 2012;13(2):111–115. Available at: https://pubmed.ncbi.nlm.nih.gov/23926533/.Jones G.L., Hall J.M., Balen A.H., Ledger W.L. Health-Related Quality of Life Measurement in Women with Polycystic Ovary Syndrome: A Systematic Review. Hum Reprod Update. 2008;14(1):15–25. https://doi.org/10.1093/humupd/dmm030.Jones G.L., Hall J.M., Balen A.H., Ledger W.L. Health-Related Quality of Life Measurement in Women with Polycystic Ovary Syndrome: A Systematic Review. Hum Reprod Update. 2008;14(1):15–25. https://doi.org/10.1093/humupd/dmm030.Diamanti-Kandarakis E., Dunaif A. Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications. Endocr Rev. 2012;33(6):981–1030. https://doi.org/10.1210/er.2011-1034.Diamanti-Kandarakis E., Dunaif A. Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications. Endocr Rev. 2012;33(6):981–1030. https://doi.org/10.1210/er.2011-1034.Kashanian M., Fazy Z., Pirak A. Evaluation of the Relationship between Gestational Diabetes and a History of Polycystic Ovarian Syndrome. Diabetes Res Clin Pract. 2008;80(2):289–292. https://doi.org/10.1016/j.diabres.2007.12.022.Kashanian M., Fazy Z., Pirak A. Evaluation of the Relationship between Gestational Diabetes and a History of Polycystic Ovarian Syndrome. Diabetes Res Clin Pract. 2008;80(2):289–292. https://doi.org/10.1016/j.diabres.2007.12.022.Fauser B.C., Tarlatzis B.C., Rebar R.W., Legro R.S., Balen A.H., Lobo R. et al. Consensus on Women’s Health Aspects of Polycystic Ovary Syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97(1):28–38.e25. https://doi.org/10.1016/j.fertnstert.2011.09.024.Fauser B.C., Tarlatzis B.C., Rebar R.W., Legro R.S., Balen A.H., Lobo R. et al. Consensus on Women’s Health Aspects of Polycystic Ovary Syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97(1):28–38.e25. https://doi.org/10.1016/j.fertnstert.2011.09.024.Escobar-Morreale H.F., Carmina E., Dewailly D., Gambineri A., Kelestimur F., Moghetti P. et al. Epidemiology, Diagnosis and Management of Hirsutism: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012;18(2):146–170. https://doi.org/10.1093/humupd/dmr042.Escobar-Morreale H.F., Carmina E., Dewailly D., Gambineri A., Kelestimur F., Moghetti P. et al. Epidemiology, Diagnosis and Management of Hirsutism: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012;18(2):146–170. https://doi.org/10.1093/humupd/dmr042.Azziz R., Sanchez L.A., Knochenhauer E.S., Moran C., Lazenby J., Stephens K.C. et al. Androgen Excess in Women: Experience with Over 1000 Consecutive Patients. J Clin Endocrinol Metab. 2004;89(2):453–462. https://doi.org/10.1210/jc.2003-031122.Azziz R., Sanchez L.A., Knochenhauer E.S., Moran C., Lazenby J., Stephens K.C. et al. Androgen Excess in Women: Experience with Over 1000 Consecutive Patients. J Clin Endocrinol Metab. 2004;89(2):453–462. https://doi.org/10.1210/jc.2003-031122.Ozdemir S., Ozdemir M., Görkemli H., Kiyici A., Bodur S. Specific Dermatologic Features of the Polycystic Ovary Syndrome and Its Association with Biochemical Markers of the Metabolic Syndrome and Hyperandrogenism. Acta Obstet Gynecol Scand. 2010;89(2):199–204. https://doi.org/10.3109/00016340903353284.Ozdemir S., Ozdemir M., Görkemli H., Kiyici A., Bodur S. Specific Dermatologic Features of the Polycystic Ovary Syndrome and Its Association with Biochemical Markers of the Metabolic Syndrome and Hyperandrogenism. Acta Obstet Gynecol Scand. 2010;89(2):199–204. https://doi.org/10.3109/00016340903353284.Orfanos C.E., Adler Y.D., Zouboulis C.C. The SAHA Syndrome. Horm Res. 2000;54(5–6):251–258. https://doi.org/10.1159/000053267.Orfanos C.E., Adler Y.D., Zouboulis C.C. The SAHA Syndrome. Horm Res. 2000;54(5–6):251–258. https://doi.org/10.1159/000053267.Bhattacharya S.M., Jha A. Comparative Study of the Therapeutic Effects of Oral Contraceptive Pills Containing Desogestrel, Cyproterone Acetate, and Drospirenone in Patients with Polycystic Ovary Syndrome. Fertil Steril. 2012;98(4):1053–1059. https://doi.org/10.1016/j.fertnstert.2012.06.035.Bhattacharya S.M., Jha A. Comparative Study of the Therapeutic Effects of Oral Contraceptive Pills Containing Desogestrel, Cyproterone Acetate, and Drospirenone in Patients with Polycystic Ovary Syndrome. Fertil Steril. 2012;98(4):1053–1059. https://doi.org/10.1016/j.fertnstert.2012.06.035.Arowojolu A.O., Gallo M.F., Lopez L.M., Grimes D.A. Combined Oral Contraceptive Pills for Treatment of Acne. Cochrane Database Syst Rev. 2012;(7):CD004425. https://doi.org/10.1002/14651858.cd004425.pub6.Arowojolu A.O., Gallo M.F., Lopez L.M., Grimes D.A. Combined Oral Contraceptive Pills for Treatment of Acne. Cochrane Database Syst Rev. 2012;(7):CD004425. https://doi.org/10.1002/14651858.cd004425.pub6.Тихомиров А.Л., Геворкян М.А., Манухина Е.И., Прохорова М.В. Гормональная терапия женщин с андрогенозависимыми дерматопатиями. Трудный пациент. 2017;15(8–9):17–21. Режим доступа: https://t-pacient.ru/wp-content/uploads/2017/12/4.pdfTikhomirov A.L., Gevorkyan M.A., Manukhina E.I., Prokhorova M.V. Hormonal Therapy in Women with Androgen-Dependent Dermatopathy. Trudnyy patsiyent = Difficult Patient. 2017;15(8–9):17–21. (In Russ.) Available at: https://t-pacient.ru/wp-content/uploads/2017/12/4.pdf.Fugère P., Percival-Smith R.K., Lussier-Cacan S., Davignon J., Farquhar D. Cyproterone Acetate/Ethinyl Estradiol in the Treatment of Acne. A Comparative Dose-Response Study of the Estrogen Component. Contraception. 1990;42(2):225–234. https://doi.org/10.1016/0010-7824(90)90106-6.Fugère P., Percival-Smith R.K., Lussier-Cacan S., Davignon J., Farquhar D. Cyproterone Acetate/Ethinyl Estradiol in the Treatment of Acne. A Comparative Dose-Response Study of the Estrogen Component. Contraception. 1990;42(2):225–234. https://doi.org/10.1016/0010-7824(90)90106-6.Геворкян М.А., Манухина Е.И., Смирнова С.О. Лечение дерматопатий у пациенток с синдромом поликистозных яичников (клиническая лекция). Медицинский совет. 2015;(7):28–31. https://doi.org/10.21518/2079-701X-2015-7-28-31.Gevorkyan M.A., Manukhina E.I., Smirnova S.O. Treatment of Dermopathy in Patients with Polycystic Ovary Syndrome (Clinical Lecture). Meditsinskiy sovet = Medical Council. 2015;(7):28–31. (In Russ.) https://doi.org/10.21518/2079-701X-2015-7-28-31.Badawy A., Elnashar A. Treatment Options for Polycystic Ovary Syndrome. Int J Womens Health. 2011;3:25–35. https://doi.org/10.2147/ijwh.s11304.Badawy A., Elnashar A. Treatment Options for Polycystic Ovary Syndrome. Int J Womens Health. 2011;3:25–35. https://doi.org/10.2147/ijwh.s11304.Bitzer J., Römer T., Lopes da Silva Filho A. The Use of Cyproterone Acetate/ Ethinyl Estradiol in Hyperandrogenic Skin Symptoms – A Review. Eur J Contracept Reprod Health Care. 2017;22(3):172–182. https://doi.org/10.1080/13625187.2017.1317339.Bitzer J., Römer T., Lopes da Silva Filho A. The Use of Cyproterone Acetate/ Ethinyl Estradiol in Hyperandrogenic Skin Symptoms – A Review. Eur J Contracept Reprod Health Care. 2017;22(3):172–182. https://doi.org/10.1080/13625187.2017.1317339.Wu H., Ruan X., Jin J., Mueck A.O. Metabolic Profile of Diane-35 versus Diane-35 plus Metformin in Chinese PCOS Women under Standardized Life-Style Changes. Gynecol Endocrinol. 2015;31(7):548–551. https://doi.org/10.3109/09513590.2015.1029447.Wu H., Ruan X., Jin J., Mueck A.O. Metabolic Profile of Diane-35 versus Diane-35 plus Metformin in Chinese PCOS Women under Standardized Life-Style Changes. Gynecol Endocrinol. 2015;31(7):548–551. https://doi.org/10.3109/09513590.2015.1029447.Conway G., Dewailly D., Diamanti-Kandarakis E., Escobar-Morreale H.F., Franks S., Gambineri A. et al. The Polycystic Ovary Syndrome: A Position Statement from the European Society of Endocrinology. Eur J Endocrinol. 2014;171(4):P1–P29. https://doi.org/10.1530/eje-14-0253.Conway G., Dewailly D., Diamanti-Kandarakis E., Escobar-Morreale H.F., Franks S., Gambineri A. et al. The Polycystic Ovary Syndrome: A Position Statement from the European Society of Endocrinology. Eur J Endocrinol. 2014;171(4):P1–P29. https://doi.org/10.1530/eje-14-0253.Hutchison S.K., Stepto N.K., Harrison C.L., Moran L.J., Strauss B.J., Teede H.J. Effects of Exercise on Insulin Resistance and Body Composition in Overweight and Obese Women with and without Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2011;96(1):E48–E56. https://doi.org/10.1210/jc.2010-0828.Hutchison S.K., Stepto N.K., Harrison C.L., Moran L.J., Strauss B.J., Teede H.J. Effects of Exercise on Insulin Resistance and Body Composition in Overweight and Obese Women with and without Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2011;96(1):E48–E56. https://doi.org/10.1210/jc.2010-0828.Кузнецова Е. М., Манухин И. Б., Геворкян М. А., Манухина Е. И. Оценка качества жизни пациенток с андрогензависимыми дерматопатиями. Проблемы репродукции. 2012;(2):33–37. Режим доступа: https://www.mediasphera.ru/issues/problemy-reproduktsii/2012/2/031025-7217201228.Kuznetsova E.M., Manukhin I.B., Gevorkian M.A., Manukhina E.I. The Analysis of Life Quality in Patients with Androgenic Dermopathy before and after Treatment. Problemy reproduktsii = Russian Journal of Human Reproduction. 2012;(2):33–37. (In Russ.) Available at: https://www.mediasphera.ru/issues/problemy-reproduktsii/2012/2/031025-7217201228Ferriman D., Gallwey J.D. Clinical Assessment of Body Hair Growth in Women. J Clin Endocrinol Metab. 1961;21:1440–1447. https://doi.org/10.1210/jcem-21-11-1440.Ferriman D., Gallwey J.D. Clinical Assessment of Body Hair Growth in Women. J Clin Endocrinol Metab. 1961;21:1440–1447. https://doi.org/10.1210/jcem-21-11-1440.Buzney E., Sheu J., Buzney C., Reynolds R.V. Polycystic Ovary Syndrome: A Review for Dermatologists: Part II. Treatment. J Am Acad Dermatol. 2014;71(5):859.e1–874.e1. https://doi.org/10.1016/j.jaad.2014.05.009.Buzney E., Sheu J., Buzney C., Reynolds R.V. Polycystic Ovary Syndrome: A Review for Dermatologists: Part II. Treatment. J Am Acad Dermatol. 2014;71(5):859.e1–874.e1. https://doi.org/10.1016/j.jaad.2014.05.009.Chung J.P., Yiu A.K., Chung T.K., Chan S.S. A Randomized Crossover Study of Medroxyprogesterone Acetate and Diane-35 in Adolescent Girls with Polycystic Ovarian Syndrome. J Pediatr Adolesc Gynecol. 2014;27(3):166–171. https://doi.org/10.1016/j.jpag.2013.09.011.Chung J.P., Yiu A.K., Chung T.K., Chan S.S. A Randomized Crossover Study of Medroxyprogesterone Acetate and Diane-35 in Adolescent Girls with Polycystic Ovarian Syndrome. J Pediatr Adolesc Gynecol. 2014;27(3):166–171. https://doi.org/10.1016/j.jpag.2013.09.011.Finlay A.Y., Khan G.K. Dermatology Life Quality Index (DLQI) – A Simple Practical Measure for Routine Clinical Use. Clin Exp Dermatol. 1994;19(3):210–216. https://doi.org/10.1111/j.1365-2230.1994.tb01167.x.Finlay A.Y., Khan G.K. Dermatology Life Quality Index (DLQI) – A Simple Practical Measure for Routine Clinical Use. Clin Exp Dermatol. 1994;19(3):210–216. https://doi.org/10.1111/j.1365-2230.1994.tb01167.x.Kahraman K., Sükür Y.E., Atabekoğlu C.S., Ateş C., Taşkin S., Cetinkaya S.E. et al. Comparison of Two Oral Contraceptive Forms Containing Cyproterone Acetate and Drospirenone in the Treatment of Patients with Polycystic Ovary Syndrome: A Randomized Clinical Trial. Arch Gynecol Obstet. 2014;290(2):321–328. https://doi.org/10.1007/s00404-014-3217-5.Kahraman K., Sükür Y.E., Atabekoğlu C.S., Ateş C., Taşkin S., Cetinkaya S.E. et al. Comparison of Two Oral Contraceptive Forms Containing Cyproterone Acetate and Drospirenone in the Treatment of Patients with Polycystic Ovary Syndrome: A Randomized Clinical Trial. Arch Gynecol Obstet. 2014;290(2):321–328. https://doi.org/10.1007/s00404-014-3217-5.Carmina E., Lobo R.A. Gonadotrophin-Releasing Hormone Agonist Therapy for Hirsutism Is as Effective as High Dose Cyproterone Acetate but Results in a Longer Remission. Hum Reprod. 1997;12(4):663–666. https://doi.org/10.1093/humrep/12.4.663.Carmina E., Lobo R.A. Gonadotrophin-Releasing Hormone Agonist Therapy for Hirsutism Is as Effective as High Dose Cyproterone Acetate but Results in a Longer Remission. Hum Reprod. 1997;12(4):663–666. https://doi.org/10.1093/humrep/12.4.663.Gupta M.A., Gupta A.K. Depression and Suicidal Ideation in Dermatology Patients with Acne, Alopecia Areata, Atopic Dermatitis and Psoriasis. Br J Dermatol. 1998;139(5):846–850. https://doi.org/10.1046/j.1365-2133.1998.02511.x.Gupta M.A., Gupta A.K. Depression and Suicidal Ideation in Dermatology Patients with Acne, Alopecia Areata, Atopic Dermatitis and Psoriasis. Br J Dermatol. 1998;139(5):846–850. https://doi.org/10.1046/j.1365-2133.1998.02511.x.Гродницкая Е.Э., Курцер М.А. Гирсутизм: патогенез, клиника, диагностика, лечение. Акушерство и гинекология. 2012;(4–1):87–90. Режим доступа: https://aig-journal.ru/articles/Girsutizm-patogenezklinika-diagnostika-lechenie.html.Grodnitskaya E.E., Kurtser M.A. Hirsutism: Pathogenesis, Clinical Presentation, Diagnosis, Treatment. Akusherstvo i ginekologiya = Obstetrics and Gynecology. 2012;(4–1):87–90. (In Russ.) Available at: https://aig-journal.ru/articles/Girsutizm-patogenez-klinika-diagnostika-lechenie.html.Белова И.С., Хащенко Е.П., Уварова Е.В. Современные аспекты роли инсулинорезистентности, системного воспаления и оксидативного стресса в патогенезе гиперандрогении и нарушений фолликулогенеза у пациенток с синдромом поликистозных яичников. Акушерство и гинекология. 2021;(5):55–63. https://doi.org/10.18565/aig.2021.5.55-63.Belova I.S., Khashchenko E.P., Uvarova E.V. Current Aspects of the Role of Insulin Resistance, Systemic Inflammation, and Oxidative Stress in the Pathogenesis of Hyperandrogenism and Abnormal Folliculogenesis in Patients with Polycystic Ovary Syndrome. Akusherstvo i ginekologiya = Obstetrics and Gynecology. 2021;(5):55–63. (In Russ.) https://doi.org/10.18565/aig.2021.5.55-63.

The authors declare that there are no conflicts of interest present.