An evaluation of the management of hirsutism in public versus private outpatient departments in Saudi Arabia

Background: Hirsutism is the excessive body or facial terminal (coarse) hair growth in females in a male-like pattern, carries a worldwide prevalence of 5%–20%, and requires careful evaluation and long-term management. Purpose: The study aims to critically appraise public and private institutions' practices in managing hirsutism, compared against international standards. The purpose of this study was to assess how frequently patients receive counseling to address the causes of hirsutism and to determine if disease severity, screening, and outpatient management vary between public and private clinics in Saudi Arabia. Methods: Patients were recruited from gynecology, endocrine, dermatology, and women's skin care clinics in public (n = 119) and private outpatient clinics (n = 238). Sociodemographics, body mass index (BMI), menstrual cycle rhythm, hirsutism site and scores, associated acne and/or alopecia, family history, and treatment modality received were queried. This study had two groups: Group 1 (n = 119) patients who were seen at public outpatient clinics and Group 2 (n = 238) patients who were seen at private outpatient clinics. Results: The median age was 27 years (range 18–45) and median BMI was 25 kg/m2 (range 16–44). The total mean hirsutism score was 9.3 ± 3.8. The severity of hirsutism was categorized into three groups: mild cases were recorded in 224 women (62.7%), moderate cases were recorded in 94 women (26.3%), and severe cases were recorded in 39 women (10.9%). There was no significant correlation between total mean hirsutism scores, age and BMI, P = 0.5 and P = 0.2, respectively. Approximately one-third of women were seen and investigated by physicians either at public or private clinics and about 70% of women were seen and treated by nonphysician skin care specialist without prior medical investigations in either public or private outpatient departments (OPDs). Conclusion: Assessment and management of hirsutism are similar in the public and private setting. Most patients presented to private rather than public OPDs and were not appropriately investigated for hirsutism. Weight reduction can be beneficial for the management of hirsutism for those with raised BMI and advice should be given accordingly in the OPD setting.