RESUMEN
Polycystic ovary syndrome (PCOS) and idiopathic hirsutism (IH) are androgen excess disorders requiring the determination of classic androgen levels for diagnosis. 11-oxygenated androgens have high androgenic potential, yet their clinical value in those disorders is not clear. Additionally, the role of endocrine disruptors (EDs), particularly in IH, remains understudied. We analyzed 25 steroids and 18 EDs in plasma samples from women with IH, PCOS, and controls using LC-MS/MS. Cytokine levels and metabolic parameters were assessed. Comparisons included non-obese women with PCOS (n = 10), women with IH (n = 12) and controls (n = 20), and non-obese versus obese women with PCOS (n = 9). Higher levels of 11-oxygenated androgens were observed in women with PCOS compared to those with IH, but not controls. Conversely, 11-oxygenated androgen levels were lower in women with IH compared to controls. Cytokine levels did not differ between women with IH and controls. Bisphenol A (BPA) levels were higher in obese women with PCOS compared to non-obese women with PCOS. Bisphenol S occurrence was higher in women with PCOS (90%) compared to controls (65%) and IH (50%). Significant correlations were found between androgens (11-ketotestosterone, androstenedione, testosterone) and insulin and HOMA-IR, as well as between immunomodulatory 7-oxygenated metabolites of DHEA and nine interleukins. Our data confirms that PCOS is a multiendocrine gland disorder. Higher BPA levels in obese women might exacerbate metabolic abnormalities. IH was not confirmed as an inflammatory state, and no differences in BPA levels suggest BPA does not play a role in IH pathogenesis.
Asunto(s)
Andrógenos , Disruptores Endocrinos , Hirsutismo , Síndrome del Ovario Poliquístico , Humanos , Femenino , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/metabolismo , Andrógenos/sangre , Andrógenos/metabolismo , Disruptores Endocrinos/sangre , Adulto , Hirsutismo/sangre , Hirsutismo/etiología , Hirsutismo/inducido químicamente , Obesidad/sangre , Obesidad/metabolismo , Citocinas/sangre , Citocinas/metabolismo , Espectrometría de Masas en Tándem , Compuestos de Bencidrilo/sangre , Hiperandrogenismo/sangre , Fenoles , Adulto JovenRESUMEN
BACKGROUND The immunomodulatory and pharmacokinetic effects of cyclosporine A are used to treat diverse disease entities in different medical fields, including organ transplantation and/or autoimmune diseases. It is also applied in patients with nephrotic range proteinuria as an adjunct to steroids and supportive antihypertensive/antiproteinuric medications. Cyclosporine has a small therapeutic window and is dosed with respect to the underlying disease entity and severity via trough level adaptations. Among its most frequent adverse effects are hypertension, nephrotoxicity, neurotoxicity, and electrolyte disturbances. Hypertrichosis and gingival hyperplasia are obvious and widely recognized adverse effects. CASE REPORT We report on a 66-year-old woman who was treated with cyclosporine A for primary membranous nephropathy. During treatment with cyclosporine, she developed hirsutism and gingival hyperplasia. Later, she reported having impaired nasal breathing and dyspnea on mild physical exercise. Clinical, rhinoscopic, and radiological evaluations showed marked conchal hyperplasia as a potential cause of her symptoms. An extensive medical work-up did not show evidence of allergic, immunologic, or other drug adverse effects, suggesting cyclosporine-induced hyperplasia of the turbinates as a hypothetical causative factor. Dose reductions did not lead to resolution of symptoms but resulted in increasing proteinuria. Therefore, cyclosporine was stopped, and the patient was treated with rituximab. Thereafter, hirsutism and gingival and conchal hyperplasia gradually regressed over 2-4 months, showing complete resolution of conchal hyperplasia on computed-tomography follow-up after 6 months. CONCLUSIONS Cyclosporine can not only result in gingival hyperplasia but also in hyperplasia of the turbinates leading to impaired nasal breathing and shortness of breath on exertion. An extensive search for many other known causes of conchal swelling is warranted to finally suggest an adverse effect of cyclosporine. Discontinuation of cyclosporine resulted in complete remission of conchal hyperplasia as well as other adverse effects.
Asunto(s)
Hiperplasia Gingival , Glomerulonefritis Membranosa , Obstrucción Nasal , Anciano , Ciclosporina/efectos adversos , Femenino , Hiperplasia Gingival/inducido químicamente , Hiperplasia Gingival/tratamiento farmacológico , Glomerulonefritis Membranosa/inducido químicamente , Glomerulonefritis Membranosa/complicaciones , Glomerulonefritis Membranosa/tratamiento farmacológico , Hirsutismo/inducido químicamente , Hirsutismo/tratamiento farmacológico , Humanos , Hiperplasia , Inmunosupresores/efectos adversos , Proteinuria/tratamiento farmacológico , Cornetes NasalesRESUMEN
Cardiovascular diseases are the most common cause of death worldwide, with cardiovascular medications being amongst the most common medications prescribed. These medications have diverse effects on the heart, vascular system, as well as other tissues and organ systems. The extra cardiovascular effects have been found to be of use in the treatment of non-cardiovascular diseases and pathologies. Minoxidil is used to manage systemic hypertension with its well-known side effect of hirsutism used to treat alopecia and baldness. Sildenafil was originally investigated as a treatment option for systemic hypertension; however, its side effect of penile erection led to it being widely used for erectile dysfunction. Alpha-1 blockers such as terazosin are indicated to treat systemic hypertension but are more commonly used for benign prostatic hyperplasia and post-traumatic stress disorder. Beta blockers are the mainstay treatment for congestive heart failure and systemic hypertension but have been found useful to help in patients with intention tremors as well as prophylaxis of migraines. Similarly, calcium channel blockers are indicated in medical expulsion therapy for ureteric calculi in addition to their cardiovascular indications. Thiazides are commonly used for treating systemic hypertension and as diuretics. Thiazides can cause hypocalciuria and hypercalcemia. This side effect has led to thiazides being used to treat idiopathic hypercalciuria and associated nephrolithiasis. Spironolactone is commonly utilized in treating heart failure and as a diuretic for edema. It's well described anti-androgen side effects have been used for acne vulgaris and hirsutism in polycystic ovarian syndrome. This review article discusses how the various extracardiovascular effects of commonly used cardiovascular medications are put to use in managing non-cardiovascular conditions.
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Enfermedades Cardiovasculares , Insuficiencia Cardíaca , Hipertensión , Antagonistas Adrenérgicos beta/uso terapéutico , Enfermedades Cardiovasculares/tratamiento farmacológico , Diuréticos/efectos adversos , Insuficiencia Cardíaca/tratamiento farmacológico , Hirsutismo/inducido químicamente , Hirsutismo/tratamiento farmacológico , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Tiazidas/uso terapéuticoRESUMEN
First-line treatment of aplastic anemia(AA) and for AA patients ineligible for hematopoietic stem cell transplantation (HSCT) has consisted of antithymocyte globulin (ATG), the calcineurin inhibitor cyclosporine A (CsA), and more recently eltrombopag. However, at our institution, we have successfully substituted another calcineurin inhibitor, tacrolimus, as a part of immunosuppressive threatment (IST) for AA due to more favorable toxicity profile. Since there is limited data on the use of tacrolimus in aplastic anemia, we conducted a retrospective review of twenty patients treated with tacrolimus-based immunosuppressive therapy (IST) as a first- or second-line treatment. The overall response rate was comparable to that of patients treated with CsA (18 patients). However, there were no cutaneous side effects observed in patients receiving tacrolimus, a relatively common finding with CsA use. Our data suggest that tacrolimus-based IST is a potential option in AA and might have a more favorable toxicity profile compared to CsA.
Asunto(s)
Anemia Aplásica/tratamiento farmacológico , Benzoatos/uso terapéutico , Hidrazinas/uso terapéutico , Inmunosupresores/uso terapéutico , Pirazoles/uso terapéutico , Tacrolimus/uso terapéutico , Adulto , Anciano , Suero Antilinfocítico/efectos adversos , Suero Antilinfocítico/uso terapéutico , Benzoatos/efectos adversos , Ciclosporina/efectos adversos , Ciclosporina/uso terapéutico , Erupciones por Medicamentos/etiología , Femenino , Hipertrofia Gingival/inducido químicamente , Hirsutismo/inducido químicamente , Humanos , Hidrazinas/efectos adversos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Pirazoles/efectos adversos , Estudios Retrospectivos , Tacrolimus/efectos adversosRESUMEN
BACKGROUND: Although the effect of isotretinoin use on hormonal changes in acne pathogenesis is not fully known, there are limited studies on its effects on the development of hirsutism. In this study, it was aimed to evaluate the effect of isotretinoin use on hirsutism and hormonal parameters in patients with acne vulgaris. METHODS: In this study, 30 female acne patients and 30 healthy females were evaluated prospectively. Menstrual irregularity, LH, FSH, prolactin, progesterone, 17-OH progesterone, oestradiol, total testosterone, DHEA-S, insulin, glucose, TSH levels, Ferriman-Gallwey (FG) score and ultrasonography (USG) findings of control group and patient group were recorded. RESULTS: Pre-treatment progesterone (P = .007) and oestradiol (P = .001) levels of the patients were statistically lower than the control group. In the patient group, menstrual irregularity (P < 001) and FG hirsutism score at the third month of treatment were significantly higher than before treatment. In 10% of the patients, there were abnormal findings on pelvic USG in the third month of treatment. CONCLUSION: In our study, it could not be revealed that isotretinoin has a significant effect on pituitary, adrenal hormones and insulin resistance. We found that 3 months of isotretinoin treatment caused an increase in menstrual irregularity and FG hirsutism score.
Asunto(s)
Acné Vulgar , Síndrome del Ovario Poliquístico , Acné Vulgar/tratamiento farmacológico , Femenino , Hirsutismo/inducido químicamente , Humanos , Isotretinoína/efectos adversos , Testosterona , UltrasonografíaRESUMEN
Cantu syndrome is an autosomal dominant disorder, first described by Cantu in 1982, that is characterized by congenital hypertrichosis, characteristic facial anomalies and cardiomegaly. Recent investigations have revealed that this syndrome is caused by mutations of ABCC9, which encodes a regulatory subunit of SUR2, an adenosine triphosphate-mediated potassium channel opener, expressed not only in smooth muscle but also in hair follicles. However, the abnormalities of skin and hair in patients with Cantu syndrome have not been well explored. We herein report three Japanese patients with Cantu syndrome and describe their specific skin manifestations and alterations in the histopathology of their hair follicles and sebaceous glands. Similar alterations were shared among those three patients and may be related to the function of SUR2, namely the regulation of hair follicle growth, because SUR2 is a known pharmacological target of minoxidil.
Asunto(s)
Cardiomegalia/patología , Folículo Piloso/patología , Hipertricosis/patología , Osteocondrodisplasias/patología , Glándulas Sebáceas/patología , Antihipertensivos/efectos adversos , Biopsia , Cardiomegalia/genética , Niño , Preescolar , Femenino , Hirsutismo/inducido químicamente , Humanos , Hipertricosis/genética , Masculino , Minoxidil/efectos adversos , Mutación , Osteocondrodisplasias/genética , Receptores de Sulfonilureas/genéticaRESUMEN
Transgender persons receiving gender-affirming hormone therapy and procedures may face specific skin conditions. Skin diseases in transgender patients often are underdiagnosed and underrecognized despite their important impact on quality of life and mental health. This article discusses pathophysiology, diagnosis, and treatment of common skin diseases in the transgender populations. For transmasculine patients, conditions include acne vulgaris and male pattern hair loss. For transfeminine patients, conditions include hirsutism, pseudofolliculitis barbae, and melasma. Postprocedural keloids and other cutaneous complications are discussed. Unique aspects of skin health in transgender persons should be considered in the context of multidisciplinary gender-affirming care.
Asunto(s)
Acné Vulgar , Alopecia , Hirsutismo , Terapia de Reemplazo de Hormonas , Queloide , Procedimientos de Reasignación de Sexo , Personas Transgénero , Transexualidad , Acné Vulgar/inducido químicamente , Acné Vulgar/etiología , Alopecia/inducido químicamente , Alopecia/etiología , Hirsutismo/inducido químicamente , Hirsutismo/etiología , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Queloide/inducido químicamente , Queloide/etiología , Procedimientos de Reasignación de Sexo/efectos adversos , Transexualidad/tratamiento farmacológico , Transexualidad/cirugíaRESUMEN
Transgender individuals may transition to their identified gender through social, hormonal, and procedural methods by using a multidisciplinary team of health care providers, including dermatologists. In this review, we discuss the medical and aesthetic dermatologic needs related to the transitioning of transgender patients and provide therapeutic and procedural recommendations. In addition to routine cutaneous conditions, dermatologists may need to treat hormonal therapy-related complications. Acumen for genital dermatology and familiarity with gender reassignment surgery is important for the dermatologist caring for a transgender patient. From a structural standpoint, transgender beauty poses a unique aesthetic task. We identify key differences in the facial structure and physique of males versus those of females. Dermatologists may have a tremendous impact on the lives of transgender individuals who seek to realize their gender identity.
Asunto(s)
Técnicas Cosméticas , Estética , Personas Transgénero , Tejido Adiposo/trasplante , Alopecia/inducido químicamente , Alopecia/tratamiento farmacológico , Contorneado Corporal , Distribución de la Grasa Corporal , Rellenos Dérmicos/efectos adversos , Rellenos Dérmicos/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Cara/anatomía & histología , Cara/cirugía , Femenino , Identidad de Género , Hormonas Esteroides Gonadales/efectos adversos , Hormonas Esteroides Gonadales/farmacología , Remoción del Cabello/métodos , Hirsutismo/inducido químicamente , Hirsutismo/tratamiento farmacológico , Humanos , Masculino , Neurotoxinas/uso terapéutico , Complicaciones Posoperatorias/terapia , Procedimientos de Cirugía Plástica , Caracteres Sexuales , Cirugía de Reasignación de Sexo , Piel/efectos de los fármacos , Personas Transgénero/psicologíaRESUMEN
With increasing survival rates across all cancers, survivors represent a growing population that is frequently affected by persistent or permanent hair growth disorders as a result of systemic therapies, radiotherapy, surgical procedures, and therapeutic transplants. These hair disorders include persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, endocrine therapy-induced alopecia and hirsutism, postsurgery alopecia and localized hypertrichosis, and persistent stem cell transplantation and targeted therapy-induced alopecia. The information contained in this continuing medical education series should facilitate a better understanding on hair disorders in cancer survivors so that adequate support and therapies may be provided.
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Supervivientes de Cáncer , Enfermedades del Cabello/etiología , Enfermedades del Cabello/terapia , Alopecia/etiología , Alopecia/patología , Alopecia/terapia , Antineoplásicos/efectos adversos , Supervivientes de Cáncer/psicología , Hirsutismo/inducido químicamente , Hirsutismo/terapia , Humanos , Hipertricosis/etiología , Hipertricosis/terapia , Calidad de Vida , Radioterapia/efectos adversosRESUMEN
The main clinical feature associated with hyperandrogenism in polycystic ovary syndrome (PCOS) in humans is hirsutism, where hair increases its length, pigmentation, and particularly its diameter. Currently, it is not known whether PCOS animal models also exhibit changes in the hair. Therefore, the aim of this study was to explore the wool characteristics in sheep prenatally androgenized (PA) with testosterone propionate. After 4 and 13 months of life, wool was collected from the top of the shoulder of both females and males (both androgenized and controls). The offspring sheep were followed for up to 19 months of life to evaluate testosterone and androstenedione serum levels by ultra-high-performance liquid chromatography-tandem mass spectrometry, determine insulin and glucose response to intravenous glucose tolerance test, and address estrus cyclicity during the second breeding season. PA male animals showed a reduction in wool fiber diameter at 4 months of age compared with controls (P = 0.02) but not at 13 months, whereas PA females showed increased hair diameter at 13 months (P = 0.002), with no difference at 4 months. No substantial changes in other hair parameters (length, color, and medullation) were identified. In addition, increased levels of serum testosterone were observed in PA female sheep compared with controls at 12 months (P = 0.03). Our results indicate for the first time, to our knowledge, that changes in wool fiber diameter observed in PA ewes replicate, at the translational level, the increase in hair diameter in hirsute women with PCOS.
Asunto(s)
Andrógenos , Modelos Animales de Enfermedad , Hirsutismo , Síndrome del Ovario Poliquístico , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Ovinos , Virilismo/inducido químicamente , Animales , Femenino , Prueba de Tolerancia a la Glucosa , Hirsutismo/sangre , Hirsutismo/inducido químicamente , Hirsutismo/complicaciones , Hirsutismo/patología , Hiperandrogenismo/sangre , Hiperandrogenismo/inducido químicamente , Hiperandrogenismo/patología , Masculino , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/patología , Embarazo , Efectos Tardíos de la Exposición Prenatal/sangre , Efectos Tardíos de la Exposición Prenatal/patología , Propionato de Testosterona , Virilismo/sangre , Virilismo/patologíaAsunto(s)
Acné Vulgar/inducido químicamente , Alopecia/inducido químicamente , Hirsutismo/inducido químicamente , Dispositivos Intrauterinos Medicados , Levonorgestrel/efectos adversos , Menorragia/tratamiento farmacológico , Acné Vulgar/epidemiología , Alopecia/epidemiología , Femenino , Hirsutismo/epidemiología , Humanos , Incidencia , Levonorgestrel/administración & dosificación , Levonorgestrel/uso terapéutico , Encuestas y CuestionariosRESUMEN
BACKGROUND: Bimatoprost has known adnexal activity and was observed to increase nail growth at two clinical centers. OBJECTIVES: In this randomized, double-blinded, placebo-controlled pilot study, we examine the effect of bimatoprost (Lumigan 0.01%), applied bid to the proximal nail fold on nail growth, nail brittleness, and intraocular pressure. METHODS: Bimatoprost drops were placed on the proximal nail folds of 45 subjects on one hand (medication group) and vehicle drops to the other hand (control group). Baseline and final nail growth measurements, Goldmann applanation tensions of both eyes, and photos at 30 days were performed. Nail brittleness was subjectively graded. RESULTS: For the 38 subjects completing the study, the final mean nail growth of the hands, the net individual nail growth of the digits (excluding chipped nails), nail brittleness, and eye pressure readings were NS at P<.05. Photos revealed no increased hirsutism, but one subject with increased skin pigmentation. The drops were well tolerated without adverse effects. Nail chipping was a limitation of the study. CONCLUSIONS: Despite the negative results in this pilot study on nail growth and brittleness, further studies with higher bimatoprost concentration (0.03%) are warranted. We recommend monitoring nail growth by etching or marking the nail rather than measuring the full nail length due to our chipped nail findings.
Asunto(s)
Antihipertensivos/farmacología , Bimatoprost/farmacología , Presión Intraocular/efectos de los fármacos , Uñas/efectos de los fármacos , Uñas/crecimiento & desarrollo , Administración Cutánea , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Bimatoprost/administración & dosificación , Bimatoprost/efectos adversos , Método Doble Ciego , Femenino , Hirsutismo/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pigmentación de la Piel/efectos de los fármacosAsunto(s)
Hirsutismo/inducido químicamente , Hipertricosis/inducido químicamente , Corticoesteroides/efectos adversos , Andrógenos/efectos adversos , Anticonvulsivantes/efectos adversos , Ciclosporina/efectos adversos , Dinoprost/análogos & derivados , Receptores ErbB/antagonistas & inhibidores , Humanos , Inmunosupresores/efectos adversos , Minoxidil/efectos adversos , Oxitócicos/efectos adversos , Fenitoína/efectos adversos , Inhibidores de Proteínas Quinasas/efectos adversos , Vasodilatadores/efectos adversosRESUMEN
Corticosteroid injections are used as a nonoperative modality to combat acute inflammation when conservative treatments fail. As female patients are regularly seen by orthopedic physicians, it is essential to identify and understand potential sex-related side effects. The aim of this article is to examine available literature for sex-related side effects of orthopedic-related corticosteroid injections. Although the incidence is low, sex-related side effects, such as abnormal menstruation, lactation disturbances, facial flushing, and hirsutism, are associated with corticosteroid injections. Physicians should be aware of these female-specific side effects and relay this information as part of the informed consent process. [Orthopedics. 2017; 40(2):e211-e215.].
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Corticoesteroides/efectos adversos , Rubor/inducido químicamente , Glucocorticoides/efectos adversos , Hirsutismo/inducido químicamente , Trastornos de la Lactancia/inducido químicamente , Trastornos de la Menstruación/inducido químicamente , Corticoesteroides/administración & dosificación , Femenino , Glucocorticoides/administración & dosificación , Humanos , Inyecciones/efectos adversos , Factores SexualesRESUMEN
Twenty percent of children with immune thrombocytopenia (ITP) develop a chronic course where treatment strategy is less established. Cyclosporin A (CSA) has been shown to be effective in small series of children with chronic ITP and might reduce the need for chronic steroid therapy and/or splenectomy. We reviewed consecutive patients below 18 years old with persistent or chronic ITP treated with CSA in our unit between January 1998 and June 2015. Thirty patients (14 boys and 16 girls) were included. The median age at initial diagnosis of ITP was 5 years (range 0.5-16.2 years). CSA was started at a median of 13.9 months (range 3.4-124 months) after initial diagnosis and given for a median duration of 9.3 months (range 0.2-63.9 months). The median platelet count before commencement was 12 × 10(9)/L (range 4-199 × 10(9)/L). The median dose of CSA was 6 mg/kg/day (range 2.4-7.5 mg/kg/day). Complete response (CR) or response (R) was achieved in 17 patients (57 %), and 7 (23 %) had sustained response. Side effects (most commonly hirsutism) were tolerable and reversible. CSA appeared effective in about half of persistent or chronic ITP patients and safe as a second-line agent in managing these children.
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Ciclosporina/uso terapéutico , Inmunosupresores/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Adolescente , Niño , Preescolar , Enfermedad Crónica , Ciclosporina/efectos adversos , Evaluación de Medicamentos , Femenino , Hirsutismo/inducido químicamente , Humanos , Inmunosupresores/efectos adversos , Lactante , Masculino , Recuento de Plaquetas , Inducción de Remisión , Estudios RetrospectivosRESUMEN
Tamoxifen, a selective estrogen receptor modulator, has been used in the treatment of peripheral precocious puberty. A 5-year and 3-month-old girl, diagnosed with McCune-Albright syndrome, came in with abnormal hair growth approximately 2 months after the initiation of tamoxifen. The pattern of terminal hair on the skin following the administration of the drug and the exclusion of other causes suggested tamoxifen-induced hirsutism.
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Displasia Fibrosa Poliostótica/tratamiento farmacológico , Hirsutismo/inducido químicamente , Moduladores Selectivos de los Receptores de Estrógeno/efectos adversos , Tamoxifeno/efectos adversos , Preescolar , Femenino , Humanos , Moduladores Selectivos de los Receptores de Estrógeno/uso terapéutico , Tamoxifeno/uso terapéuticoRESUMEN
Despite systemic glucocorticoids are widely used, risk factors for most of their adverse events and patients' beliefs about the drug are poorly known. An online survey was conducted between February and July 2013 through the website www.cortisone-info.fr . Demographic (e.g., age, gender) and therapeutic (e.g., type of prescribed glucocorticoid, duration of prescription) data were collected. Patients were further asked to answer questions about glucocorticoid-induced adverse events and their beliefs about efficacy and safety of the drug. Risk factors for adverse events and efficacy/safety beliefs were assessed using multivariate logistic regression models. Eight hundred twenty questionnaires were analyzed (women 74.3 %; median age 49 [34-62] years, median equivalent prednisone dosage 20 [10-48] mg/day). The most frequently reported adverse events were insomnia (n = 477, 58.2 %), mood disturbances (n = 411, 50.1 %), hyperphagia (n = 402, 49.0 %), and lipodystrophy (n = 387, 47.2 %). The risk of some adverse events (e.g., weight gain, easy bruising) increased with the duration of exposure while other adverse events (e.g., insomnia, mood disorders, epigastric pain) were present since the first days of exposure. The risk of hirsutism, altered wound healing, mood disturbances, weight gain, lipodystrophy, hyperphagia, and epigastric pain decreased with age. Cutaneous disorders, morphological changes, and epigastric pain were more frequently reported by women. Interestingly, patients prescribed prednisolone reported less adverse events than those prescribed prednisone. No adverse event, demographical or prescribing characteristics were associated with beliefs about efficacy while factors associated with safety concerns were age (OR: 1.2 [1.1-1.3] per 10-year increase), osteoporosis (OR: 3.3 [1.4-7.9]), easy bruising (OR: 1.6 [1.1-2.3]), insomnia (OR: 1.7 [1.2-2.4]), and weight gain (OR: 1.6 [1.1-2.2]). These results may help clinicians to adapt information speech, therapeutic education, and clinical and laboratory monitoring of patients prescribed glucocorticoid therapy.
Asunto(s)
Actitud Frente a la Salud , Trastornos de la Coagulación Sanguínea/inducido químicamente , Glucocorticoides/efectos adversos , Hiperfagia/inducido químicamente , Lipodistrofia/inducido químicamente , Trastornos del Humor/inducido químicamente , Osteoporosis/inducido químicamente , Trastornos del Inicio y del Mantenimiento del Sueño/inducido químicamente , Dolor Abdominal/inducido químicamente , Adulto , Factores de Edad , Estudios Transversales , Erupciones por Medicamentos/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Hirsutismo/inducido químicamente , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Aumento de PesoRESUMEN
OBJECTIVE: Cosmetic side effects (CSEs) such as weight gain and alopecia are common, undesirable effects associated with several AEDs. The objective of the study was to compare the CSE profiles in a large specialty practice-based sample of patients taking both older and newer AEDs. METHODS: As part of the Columbia and Yale AED Database Project, we reviewed patient records including demographics, medical history, AED use, and side effects for 1903 adult patients (≥16years of age) newly started on an AED. Cosmetic side effects were determined by patient or physician report in the medical record and included acne, gingival hyperplasia, hair loss, hirsutism, and weight gain. We compared the overall rate of CSEs and intolerable CSEs (ICSEs-CSEs that led to dosage reduction or discontinuation) between different AEDs in both monotherapy and polytherapy. RESULTS: Overall, CSEs occurred in 110/1903 (5.8%) patients and led to intolerability in 70/1903 (3.7%) patients. Weight gain was the most commonly reported CSE (68/1903, 3.6%) and led to intolerability in 63 (3.3%) patients. Alopecia was the second most common patient-reported CSE (36/1903, 1.9%) and was intolerable in 33/1903 (1.7%) patients. Risk factors for CSEs included female sex (7.0% vs. 4.3% in males; p<0.05) and any prior CSE (37% vs. 2.9% in patients without prior CSE; p<0.001). Significantly more CSEs were attributed to valproic acid (59/270; 21.9%; p<0.001) and pregabalin (14/143; 9.8%; p<0.001) than to all other AEDs. Significantly less CSEs were attributed to levetiracetam (7/524; 1.3%; p=0.002). Weight gain was most frequently associated with valproic acid (35/270; 13.0%; p<0.001) and pregabalin (12/143; 8.4%; p<0.001). Hair loss was most commonly reported among patients taking valproic acid (24/270; 8.9%; p<0.001). Finally, gingival hyperplasia was most commonly reported in patients taking phenytoin (10/404; 2.5%; p<0.001). Cosmetic side effects leading to dosage change or discontinuation occurred most frequently with pregabalin and valproic acid compared with all other AEDs (13.3 and 5.6% vs. 2.3%; p<0.001). For patients who had been on an AED in monotherapy (n=677), CSEs and ICSEs were still more likely to be attributed to valproic acid (30.2% and 17.1%, respectively) than to any other AED (both p<0.001). SIGNIFICANCE: Weight gain and alopecia were the most common patient-reported CSEs in this study, and weight gain was the most likely cosmetic side effect to result in dosage adjustment or medication discontinuation. Particular attention should be paid to pregabalin, phenytoin, and valproic acid when considering cosmetic side effects. Female patients and patients who have had prior CSE(s) to AED(s) were more likely to report CSEs. Knowledge of specific CSE rates for each AED found in this study may be useful in clinical practice.
Asunto(s)
Alopecia/inducido químicamente , Anticonvulsivantes/efectos adversos , Epilepsia/tratamiento farmacológico , Fenitoína/efectos adversos , Ácido Valproico/efectos adversos , Aumento de Peso/efectos de los fármacos , Ácido gamma-Aminobutírico/análogos & derivados , Acné Vulgar/inducido químicamente , Adulto , Femenino , Enfermedades de las Encías/inducido químicamente , Hirsutismo/inducido químicamente , Humanos , Levetiracetam , Masculino , Persona de Mediana Edad , Piracetam/efectos adversos , Piracetam/análogos & derivados , Pregabalina , Factores de Riesgo , Factores Sexuales , Ácido gamma-Aminobutírico/efectos adversosRESUMEN
OBJECTIVES: To assess the side effects unrelated to disease activity and the acceptability of combined oral contraceptives (COCs), progestin-only pills (POPs) and copper-releasing intrauterine devices (IUDs) in women with systemic lupus erythematosus (SLE). STUDY DESIGN: A randomized clinical trial including 162 women with SLE, assigned to COC (n=54), POP (n=54) or IUD (n=54). Follow-up visits were conducted after 1, 2, 3, 6, 9 and 12 months of treatment to monitor the presence of symptoms, changes in body weight and blood pressure as well as the development of health problems other than those relating to lupus. Reasons for discontinuation and satisfaction with the use of the assigned method were recorded at the end of treatment. Statistical analysis included descriptive statistics, repeated measure analyses and Kaplan-Meier curves. RESULTS: Significantly different discontinuation rates due to any reason [35%, 55%, 29% (p<0.01)] or nonmedical reasons [(11%, 31%, 4% (p<0.05)] were observed among the COC, POP and IUD groups. Nausea was most frequent among COC users, dysmenorrhea among IUD users and acne and hirsutism among POP users. Mean blood pressures remained unchanged. Mild increases in body weight were observed over time in all treatment groups. Most women were satisfied with the use of the assigned contraceptive method. CONCLUSIONS: Oral contraceptives and IUD are acceptable birth control methods for patients with lupus, when counseling and specialized health attention are provided; however, the acceptability of POP appears to be inferior. Side effects unrelated to lupus disease activity are not frequent reasons to discontinue the contraceptive methods. IMPLICATIONS: This study delves into an area that has not been explored among patients with lupus. Our findings on the associated side effects and reasons for discontinuing COCs, POPs or copper-bearing IUDs may be useful in improving contraceptive counseling for women with lupus. Furthermore, they also heighten our knowledge on the reasons that may preclude the widespread use of effective contraceptives among lupus patients.
Asunto(s)
Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Dispositivos Intrauterinos de Cobre/efectos adversos , Lupus Eritematoso Sistémico/fisiopatología , Aceptación de la Atención de Salud , Medicina de Precisión , Progestinas/efectos adversos , Acné Vulgar/inducido químicamente , Adulto , Dismenorrea/etiología , Femenino , Estudios de Seguimiento , Hirsutismo/inducido químicamente , Humanos , Estimación de Kaplan-Meier , Náusea/inducido químicamente , Pacientes Desistentes del Tratamiento , Satisfacción del Paciente , Índice de Severidad de la Enfermedad , Aumento de Peso/efectos de los fármacos , Adulto JovenRESUMEN
Anabolic-androgenic steroids (AAS) are increasingly being used by athletes and youngsters to become masculine and to loose body fat. Long-term consumption of AAS causes multiple physical and psychological morbidities. Research has also concluded that AAS have addictive potential and AAS abuse is commonly found with other substance abuse. Abuse of AAS is rare in eastern countries. Abuse among women is even rarer. Here is a case report of an Indian woman, who was prescribed nandrolone decanoate injections by an unqualified medical practitioner to treat multiple non-specific somatic pains and reported weakness, leading to dependence for nandrolonedecanoate. This case report supports the research finding of abuse potential of AAS, raises concern about the need for spreading the awareness about AAS abuse among medical professionals, regulating medical practice by unqualified practitioners, and strict legal check against AAS availability in developing countries.