Dosages of androgenic hormones in adolescent patients with severe acne

SUMMARY OBJECTIVE Acne vulgaris in female adolescents, when severe or accompanied by other signs of androgenization, may represent a sign of hyperandrogenemia often underdiagnosed, which will have harmful consequences for adult life. The objective of this cross-sectional and retrospective study was to demonstrate the incidence of hormonal changes in the cases of female adolescents with severe or extensive acne, with or without other signs of hyperandrogenism, and propose a hormonal research pattern which should be indicated in order to detect early hyperandrogenemia. METHODS The medical records of 38 female patients aged between 9 and 15 years old with grade II and/or III acne were analyzed. The dehydroepiandrosterone sulfate, dehydroepiandrostenedione, and androstenedione, total testosterone, and dihydrotestosterone sulfate hormones were required prior to initiation of treatment. The hormonal dosages were performed in the serum after at least 3 hours of fasting by means of radioimmunoassay tests. RESULTS Of the 38 patients included, 44.7% presented changes in androgen levels (hyperandrogenemia), and the two most frequently altered hormones were DHEA and androstenedione, with the same incidence (23.6%). CONCLUSIONS The correct and early diagnosis provides an effective and agile approach, including antiandrogen therapy, with the purpose of avoiding the reproductive and metabolic repercussions, besides controlling the inflammatory picture and avoid aesthetic complications.

RESUMO OBJETIVO A acne vulgar em adolescentes do sexo feminino, quando grave ou acompanhada de outros sinais de androgenização, pode representar um sinal de hiperandrogenemia muitas vezes subdiagnosticado, que acarretará consequências danosas para a vida adulta. O objetivo deste estudo transversal e retrospectivo foi demonstrar a incidência das alterações hormonais nos casos de adolescentes do sexo feminino com acne grave ou extensa, acompanhada ou não de outros sinais de hiperandrogenismo e propor um padrão de pesquisa hormonal que deve ser indicado com o intuito de detectar precocemente o quadro de hiperandrogenemia. MÉTODOS Foram analisados os prontuários de 38 pacientes do sexo feminino com idades entre 9 e 15 anos, portadoras de quadro de acne grau II e/ou III. Os hormônios sulfato de dehidroepiandrostenediona, dehidroepiandrostenediona, androstenediona, testosterona total e dehidrotestosterona foram solicitados antes do início do tratamento. As dosagens hormonais foram realizadas no soro após pelo menos 3 horas de jejum por meio de exames de radioimunoensaio. RESULTADOS Das 38 pacientes incluídas, 44,7% apresentaram alterações dos níveis de andrógenos (hiperandrogenemia), sendo que os dois hormônios mais frequentemente alterados foram o DHEA e androstenediona, com a mesma incidência (23,6%). CONCLUSÕES O diagnóstico correto e precoce propicia uma abordagem efetiva e ágil, incluindo a terapia antiandrogênica, com a finalidade de evitar as repercussões reprodutivas e metabólicas, além de controlar o quadro inflamatório e evitar complicações estéticas.

Testosterona falsamente elevada em uma paciente diabética tipo 1 com acne e insuficiência renal crônica em diálise / Falsely elevated testosterone in a type 1 diabetes patients with acne and chronic renal failure on dyalisis

Descrevemos uma paciente com diabetes tipo 1 com acne e insuficiência renal crônica, em diálise, que apresentou uma dosagem de testosterona total e livre elevada (612 ng/dL, normal < 90 ng/dL e 255 pMol/L, normal: 20-45 pMol/L, respectivamente). Na avaliação clínica, além da acne facial não havia qualquer outro sinal de hiperandrogenismo. Após ter esse resultado confirmado, ela foi submetida à avaliação morfológica de adrenal e ovários (tomografia computadorizada de adrenal e ultrassom pélvico), cujos resultados foram normais. Na ausência de quadro clínico de virilização, foram consideradas outras possibilidades que pudessem explicar a elevação da testosterona, entre as quais a presença de comorbidades (diabetes e insuficiência renal crônica) e falha do método de dosagem. Uma nova determinação da testosterona total, por meio da cromatografia líquida de alta performance como método preparativo e espectrometria de massa em tandem, resultou normal (21 ng/dL), compatível com uma concentração de testosterona total falsamente elevada pela presença de interferentes com o método de dosagem.

The purpose of this report is to present the case of a patient with type 1 diabetes with acne and chronic renal failure on dialysis admitted to the hospital with high total total and free testosterone (612 ng/dL, normal < 90 ng/dL; 255 pMol/L, normal: 20-45 pMol/L). On clinical evalua­tion, she presented facial acne, and no other signs of hyperandrogenism. As this result was confirmed, she underwent adrenal and ovary morphological assessment (adrenal CT and pelvic ultrasound), which yielded normal results. Due to divergence between clinical and laboratory findings, we considered other possibilities that could explain the elevation of testosterone, including the presence of comorbidities (diabetes and chronic renal failure) and failure of the testosterone assay. Testosterone levels were determined again by high performance liquid chromatography, as a preparative method, and tandem mass spectrometry, yielding normal results (21 ng/dL), which were compatible with a falsely elevated total testosterone level caused by the presence of factors that intereferred with the assay.

The effect of isotretinoin on triglycerides and liver aminotransferases / Influência da isotretinoína nas transaminases hepáticas e triglicerídeos

BACKGROUND: Isotretinoin has been used to treat the most severe cases of acne; however, it may provoke adverse events in mucocutaneous and hepatic tissues, lead to alterations in lipid levels and cause teratogenicity. OBJECTIVE: The objective of this study was to evaluate the profile of changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and triglyceride levels in patients who had been treated with oral isotretinoin dispensed by the São Mateus/ES pharmacy for special drugs. METHODS: A retrospective, observational, longitudinal study was conducted by carrying out a secondary analysis of each patient's data. RESULTS: Of the 130 patients who received isotretinoin between January and December 2009, only 70 were actually treated for 3 months or more and handed in the results of their laboratory tests. Of these 70 patients, 39 (55.7%) were female. The mean age of the women (23.9 years) was higher than the mean age of the men (20.1 years). There was a statistically significant increase in the levels of triglycerides (87.01 ± 48.25 versus 105.32 ± 48.76 mg/dL), AST (20.44 ± 6.26 versus 24.38 ± 11.92 U/L) and ALT (18.24 ± 8.31 versus 23.34 ± 20.03 U/L) performed prior to and 3 months or more after oral isotretinoin treatment. After treatment with oral isotretinoin, triglyceride levels had increased beyond the normal range in 11% of the patients, while 8.6% had elevated AST levels and 7.3% had increased ALT levels. CONCLUSION: The results in this population show that the use of oral isotretinoin for the treatment of acne may result in altered triglyceride, AST and ALT levels. These findings are in accordance with data published previously in the scientific literature, confirming the need to monitor these patients.

FUNDAMENTOS: A isotretinoína tem sido usada no tratamento dos casos mais graves de acne, embora possa induzir reações adversas nos tecidos mucocutâneos e hepáticos, alterações nos níveis lipídicos e teratogenicidade. OBJETIVOS: Este estudo avaliou o perfil de alterações nas concentrações de Alanina Aminotransferrase, Aspartato Aminotransferrase e triglicerídeos em pacientes que fizeram uso de isotretinoína oral fornecida pelo serviço Farmácia de Medicamentos Excepcionais de São Mateus/ES. MÉTODOS: Foi realizado estudo observacional longitudinal exploratório retrospectivo, utilizando coleta de dados secundários de cada paciente. RESULTADOS: Dos 130 pacientes que receberam isotretinoína no período de janeiro a dezembro de 2009, somente 70 realizaram o tratamento por 3 meses ou mais e apresentaram os resultados dos exames. Desses 70 pacientes, 39 (55,7%) eram do sexo feminino. A média de idade das mulheres (23,9 anos) foi maior do que a média de idade dos homens (20,1 anos). Houve aumento estatisticamente significante nas dosagens de triglicerídeos (87,01±48,25 versus 105,32 ± 48,76), Aspartato Aminotransferrase (20,44 ± 6,26 versus 24,38 ± 11,92) e Alanina Aminotransferrase (18,24 ± 8,31 versus 23,34 ± 20,03), realizadas antes e após 3 meses ou mais de tratamento com isotretinoína oral. Após o tratamento com isotretinoína oral, 11% dos pacientes apresentaram elevação de triglicerídeos acima dos valores normais, 8,6% apresentaram elevação da Aspartato Aminotransferrase e 7,3% tiveram elevação da Alanina Aminotransferrase. CONCLUSÃO: Os resultados mostraram que o uso de isotretinoína oral para o tratamento da acne, na população estudada, pode levar a alterações nas dosagens de triglicerídeos, Alanina Aminotransferrase e Aspartato Aminotransferrase, como mostrado pela literatura científica, confirmando a necessidade de monitoramento.

Mulheres adultas com acne apresentam maior risco de elevação de triglicerídeos ao uso de isotretinoína oral / Adult women with acne have a higher risk of elevated triglyceride levels with the use of oral isotretinoin

A isotretinoína apresenta restrições relacionadas a efeitos no perfil lipídico. Revisaram-se 90 pacientes tratados, em busca de fatores predisponentes a essas alterações. Houve elevação significativa do colesterol e triglicerídeos. Os pacientes em que estes últimos mostraram essa alteração foram, em sua maioria, do sexo feminino, predileção que não ocorria com as alterações iniciais. Mulheres com acne persistente talvez representem população de risco para tais efeitos colaterais.

There are restrictions associated with the use of isotretinoin because of its effects on the lipid profile. The records of ninety patients treated with this medication were reviewed to identify factors that would predispose patients to these abnormalities. A significant increase in cholesterol and triglyceride levels occurred. Patients in whom triglyceride levels increased were more likely to be female, although this difference was not present at baseline. Women with persistent acne may constitute a risk population for these side effects.

Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris

Acne vulgaris is a multifactorial disease affecting a majority of the adolescent population. The objective of this study was to test for a correlation between fasting serum lipid profiles and levels of testosterone, insulin, leptin, and interleukin 1-β (IL-1β) and the incidence of severe acne vulgaris in obese adolescent females. Four groups of adolescent females were studied: obese with acne, obese without acne, non-obese with acne, and non-obese without acne. Obese females with acne, compared to obese females without acne and non-obese subjects, had significantly higher serum triglycerides, low-density lipoprotein cholesterol and apolipoprotein-B (apo-B) (mean ± SD: 197 ± 13.7 vs 171 ± 11.5, 128 ± 8.3 vs 116 ± 7.7, 96 ± 13.7 vs 85 ± 10.3 mg/dL, respectively) but significantly lower high-density lipoprotein cholesterol and apo-A1 levels (40 ± 3.3 vs 33 ± 3.5 and 126 ± 12 vs 147 ± 13 mg/dL). Serum testosterone, insulin and leptin levels were significantly higher in obese subjects with or without acne compared to non-obese females with or without acne (3 ± 0.5 vs 2.1 ± 0.47, 15.5 ± 3.3 vs 11.6 ± 3, 0.9 ± 0.2 vs 0.6 ± 0.15 nmol/mL, respectively). Serum IL-1b was significantly elevated in obese and non-obese subjects with acne compared to subjects without acne; in those without acne, these levels were higher in obese than non-obese subjects (2.4 ± 0.2, 1.4 ± 0.1 vs 1.8 ± 0.12 and 1.3 ± 0.11 pg/mL, respectively). Our results indicate that there is a relationship between obesity (BMI >27) and acne. By early recognition, the etiology and treatment protocol of acne may prevent unwanted conditions.

[ effect of isotretinoin on plasma homocysteine concentration of patients with acne vulgaris]

Isotretinoin [ISO] revolutionized the treatment of acne since 1980s and there after, severe forms of acne have been treated more effectively, with less residual cosmetic or psychological damage. The use of Isotretinoin is associated with significant side-effects such as mucocutaneous involvement, dyslipidemia and increased liver enzymes. The aim of study was the evaluation of homocysteine [Hey] levels and the responsible vitamins for its metabolism in patients with moderate to severe acne vulgaris undergone ISO treatment. Forty-seven [n=47] patients with acne, prepared with liver function tests, folate, vitamin B12, homocysteine and serum lipids evaluations. Hey was evaluated before [Value 1] and on the 2[nd] month [value 2] of treatment with Isotretinoin [0.5 mg/kg/day], by HPLC methods. Hey levels [value 1: 11.8 +/- 5.3 micro mol/L vs. value 2: 13.6 +/- 7.4 micro mol/L; P<0.001] were statically significantly increased in patients treated with ISO. In addition, lipids and liver enzymes increased in mentioned group. However, there was no significant correlation between Hey levels, vitamins and liver enzymes. Elevated Hey levels in patients after 2 months on ISO treatment might be resulted from liver function disturbances. Folate supplementation along with frequent evaluations of Hey serum levels are strongly reconnnened for the prevention of a premature occlusive disease

[Serum zinc levels in patients with acne vulgaris]

Acne vulgaris is the most common disorder of pilosebaceous units which can develop serious psychological disabilities. It is clear that nutritional minerals [such as zinc] can intricately be involved in pathogenesis of inflammatory disorders such as acne vulgaris. This study was conducted to measure the serum zinc level in patients with acne vulgaris and compare it with healthy controls. We studied 30 patients with acne whom were matched in their age, sex and place of residence with healthy controls. Their serum zinc levels were measured using atomic absorption spectrophotometric method. Mean serum level of zinc in acne patients and controls were 92.42 +/- 37.6 micro g/dl and 101.3 +/- 43.41 micro g/dl, respectively. Although, the mean serum zinc level was lower in acne group, it was not statistically significant [P=0.32]. It seems that relative decrease of serum zinc level in acne patients can further highlight the role of this trace element in the pathogenesis of acne vulgaris

Hormone profile & polycystic ovaries in acne vulgaris.

Thirty women with acne vulgaris, 20 of whom had moderate/severe acne and ten mild acne, and ten controls matched for age were studied. Grade of hirsutism and menstrual irregularities, if any, were recorded. Hormonal measurements included gonadotropins, LH/FSH, prolactin, testosterone and androstenedione in the early follicular phase and progesterone in the luteal phase to assess ovulation. Pelvic ultrasound examination for polycystic ovaries (PCO) was done in all subjects. Sixteen patients with moderate/severe acne and one with mild acne had polycystic ovaries on ultrasound. Patients with moderate/severe acne with polycystic ovaries had high luteinizing hormone, prolactin, testosterone and androstenedione and LH/FSH ratio of more than three. Patients with polycystic ovaries were detected to have at least one hormonal abnormality.

Resultados de un estudio hormonal en mujeres con acné / Results of a hormonal study in women with acne

A 109 mujeres con acné clasificadas en grupos según la severidad de la enfermedad y 31 mujeres sanas, se les dosó en plasma LH, FSH, Prolactina, DHEA-S, delta4 androstenediona y testosterona libre estuvieron significativamente más elevados en las pacientes que en los controles, (2908 vs 1588; P<0.05), (3,23 vs 1,81; p<0.05) y (2,08 vs 1,33; p<0.5) respectivamente. El 57,79 por ciento de las pacientes tuvieron niveles de LH y FSH compatibles con ovario poliquístico. Otras alteraciones encontradas fueron la hiperprolactinemia y el hipotiroidismo primario. Estas alteraciones pudieron ser factor causal de acné y su detección orientaría mejor la terapétuca del mismo