Effects of isotretinoin on the hair cycle.

BACKGROUND/ OBJECTIVES: Isotretinoin is a synthetic vitamin A agent that affects all of the pathogenic factors that suppress sebum production and play a role in the formation of acne. It is frequently used in the treatment of moderate-severe acne vulgaris. However, there are some mucocutaneous and systemic side effects that limit the use of isotretinoin. In this study, we aimed to determine the effect of isotretinoin on hair growth parameters. MATERIAL AND METHODS: Isotretinoin treatment at 0.5 mg/kg per day dose was started to patients with moderate-severe acne vulgaris, and hair growth parameters were evaluated before treatment and after 3 months of treatment. Parameters were measured by Fotofinder dermatoscopy device using the TrichoScan Professional program. RESULTS: In the TrichoScan analysis, the total hair count, hair density, percentage of anagen and telogen hair, density, count, and ratio of vellus and terminal hairs in the 0.73 area were calculated. As a result, there were differences in some values between the first analysis and the second analysis. However, these differences were not statistically significant. CONCLUSION: Our study was based on the mucocutaneous side effects of isotretinoin which are telogen effluvium and thinning hair. Our results support that the drug does not alter hair growth parameters in the short term and when very high doses are not used.

Are 2D:4D finger-length ratios an indicator of androgenetic alopecia in males?

BACKGROUND: Although the pathogenesis of androgenetic alopecia is not completely understood, the roles of genetic susceptibility and androgens are well-known. A lower ratio of the second digit (index finger = 2D) to the fourth digit (ring finger = 4D) length has been hypothesized to reflect prenatal androgen exposure and/or higher sensitivity to androgens. OBJECTIVES: To determine the relationship between the second to fourth digit length ratio and androgenetic alopecia. METHODS: Finger length measurements were made by a digital vernier calliper. Androgenetic alopecia severity was assessed using the Hamilton-Norwood scale. Subjects with an androgenetic alopecia score of grade III or more were included in the study. RESULTS: A total of 189 males with androgenetic alopecia and 171 healthy controls were enrolled in the study. The age range of participants was 19-65 years. The 2D:4D ratios in patients with androgenetic alopecia were significantly lower than those of healthy controls for the right hand; however, no significant difference was found for the left hand. Average 2D:4D ratios in androgenetic alopecia patients were also lower than in controls. No significant relationship was observed between androgenetic alopecia severity and 2D:4D ratios. CONCLUSION: Our data support the anatomical evidence of in utero androgen exposure and/or an individual's sensitivity to androgens in patients with androgenetic alopecia. Furthermore, the right hand 2D:4D ratio might be an indicator of androgenetic alopecia development.

Relationship between acne vulgaris and attention-deficit/hyperactivity disorder symptoms in a clinical sample of women.

Acne vulgaris has recently been reported to be associated with elevated rates of attention deficit/hyperactivity disorder in epidemiological studies. This report examines childhood and current attention-deficit/hyperactivity disorder symptoms in a clinical sample of female adults. Ninety-one women with acne vulgaris and 53 controls were included in this study. The aforementioned symptoms were measured in participants. No significant differences were found between patients and controls in any of the measurements. Contrary to the findings of epidemiological studies, this study did not uncover a link between acne vulgaris and attention-deficit/hyperactivity disorder.

Autistic Trait, Empathy, and Attention-Deficit/Hyperactivity Symptoms in Women with Idiopathic Hirsutism.

AIM: Many psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), disruptive behavioral disorders, autism spectrum disorders, and some psychiatric characteristics, such as poor empathizing, are regarded to be related to elevated levels of androgens or androgen sensitivity. Thus, numerous studies have investigated the potential association between androgen-related physical diseases and these psychiatric conditions. Idiopathic hirsutism (IH) is a disease characterized by an increased sensitivity of the pilosebaceous unit to circulating androgens in women. The purpose of this study was to examine whether IH has a relationship with androgen-related psychiatric conditions. MATERIALS AND METHODS: Totally 37 females with IH and 33 healthy female controls were included in this study. Childhood and present ADHD symptoms of the participants were assessed using the Wender Utah Rating Scale (WURS) and the Adult ADHD Self-Report Scale, respectively. The Autism-spectrum quotient and the interpersonal reactivity index were used to assess autistic traits and different aspects of empathy. Hirsutism severity was measured using the Ferriman-Gallwey scoring system. RESULTS: No significant difference was found between the patients and controls on psychiatric questionnaire scores, except for a trend for subjects with IH to show higher levels of the school-associated problems than controls according to WURS. The severity of hirsutism was strongly correlated with the WURS irritability and behavioral problems/impulsivity subscores and WURS total score, and moderately correlated with the WURS attentional deficit subscore. CONCLUSIONS: This study provides preliminary evidence that common etiological factors may be involved in both the severity of IH, ADHD, and coexisting disruptive behavioral problems.

Serum homocysteine, asymmetric dimethyl arginine (ADMA) and other arginine-NO pathway metabolite levels in patients with psoriasis.

Hyperhomocysteinemia, a well-known and independent risk factor for cardiovascular disease, has been related in several studies with psoriasis patients. It has been suggested that homocysteine leads to endothelial dysfunction by causing an accumulation of asymmetrical dimethyl arginine (ADMA), a potent endogenous nitric oxide (NO) synthase inhibitor of the L-arginine-NO pathway. However, limited data is available regarding the psoriasis and ADMA relationship. In this study, we aimed to investigate the serum levels of homocysteine, ADMA and other metabolites from the L-arginine-NO pathway in psoriasis patients. Forty-two patients with chronic plaque psoriasis and 48 controls were enrolled in the study. Serum homocysteine, ADMA, L-monomethyl-L-arginine (L-NMMA), symmetric dimethylarginine (SDMA) and L-arginine levels, and L-arginine/ADMA ratios of psoriasis patients and the control group were measured. The severity of psoriasis was assessed by the psoriasis area and severity index (PASI). The mean ADMA and homocysteine values were significantly higher, and citrulline and L-arginine/ADMA values were significantly lower in psoriasis patients compared to control subjects. However, there were no significant differences among the patient and control groups with respect to mean SDMA, L-NMMA and L-arginine values. PASI scores strongly correlated with the ADMA level and moderately correlated with L-arginine/ADMA ratio. This study suggests that the L-arginine-NO pathway metabolites, especially ADMA, may play an important role in the pathogenesis of psoriasis. Additionally, serum ADMA levels of psoriasis patients may be an indicator of the disease severity.

The relationship between erythrocyte zinc levels and isotretinoin use in acne vulgaris patients.

BACKGROUND: Prior studies have demonstrated lower serum zinc levels in acne vulgaris (AV) patients compared with controls. However, no study has investigated the relationship between AV and erythrocyte zinc levels, which is a superior indicator of body zinc levels. Additionally, the potential influence of isotretinoin use on body zinc status remains to be evaluated. In this study, we aimed to determine erythrocyte zinc levels and their relationship with isotretinoin use in AV patients. METHODS: The enrolled study participants included 106 (68% female) isotretinoin-treated AV patients, 89 (65% female) untreated AV patients and 100 (59% female) healthy volunteers between 18 and 30 years of age. The acne severity of the AV patients who did not receive treatment was assessed using the classification system of the International Consensus Conference on Acne. Erythrocyte zinc levels were analysed by atomic absorption spectroscopy. RESULTS: No significant differences were observed among the three groups with respect to erythrocyte zinc levels. In addition, erythrocyte zinc levels did not vary according to the severity of AV, nor according to the duration of isotretinoin use. CONCLUSION: This study suggests that no relationships exist among zinc status, AV and isotretinoin use. However, given the relationship between vitamin A and zinc, and the fact that previous studies have indicated low serum zinc levels in AV patients, prospective studies are required to corroborate our data.

A comparison of a 5% potassium hydroxide solution with a 5-fluorouracil and salicylic acid combination in the treatment of patients with anogenital warts: a randomized, open-label clinical trial.

Anogenital warts are caused by human papillomavirus (HPV), over 30 types of which are infectious for the anogenital tract. Without treatment, warts may regress spontaneously, remain unchanged, or increase in number and size. This study compared the efficacy of a topical 5% potassium hydroxide (KOH) solution with that of a topical 0.5% 5-fluorouracil (5-FU) and 10% salicylic acid (SA) combination in the treatment of anogenital warts. Sixty patients were randomly assigned to receive topical KOH or 5-FU + SA. Both groups demonstrated a significant decrease in numbers of lesions (P < 0.05), but this difference was not significant at week 12 (P > 0.05). The mean number of lesions decreased from baseline to week 12 from 17.03 ± 12.64 to 3.73 ± 7.30 and from 16.13 ± 12.97 to 3.10 ± 4.90 in the KOH and 5-FU + SA groups, respectively (P < 0.001). Excellent clearance was achieved by 70.0 and 76.7% of patients in the KOH and 5-FU + SA groups, respectively. Marked improvement was seen in 13.3 and 20.0% of patients in the KOH and 5-FU + SA groups, respectively. At week 16, relapse was observed in two patients in the KOH group and three in the 5-FU + SA group (P > 0.05). No serious adverse events were reported. Neither treatment was more efficacious. Safety and ease of application are important goals in treatments for anogenital warts. A 5% KOH solution is a promising alternative treatment because it is effective and inexpensive and causes minimal side effects.

Structural and Functional Assessment in Patients Treated with Systemic Isotretinoin Using Optical Coherence Tomography and Frequency-Doubling Technology Perimetry.

A causal association between central nervous system neuropathy and oral isotretinoin has been reported. In this study we aimed to assess retinal nerve fibre layer (RNFL) thickness and visual field changes in patients treated with systemic isotretinoin. Thirty-nine patients treated with 1 mg/kg daily oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent complete ophthalmologic assessment before treatment, on day 60, and 3 months after completion of treatment. RNFL thickness measurements were performed with Stratus optical coherence tomography. Functional testing included frequency-doubling technology perimetry and Humphrey field analyser. Main outcome measures were average RNFL thicknesses and visual field indices (mean deviation, pattern standard deviation). Measurements of RNFL thickness showed no statistically significant change between the three measurements (p = 0.180). No statistically significant differences were observed in the frequency-doubling technology indices (mean deviation and pattern standard deviation, p = 0.066 and p = 0.103, respectively) and in the Humphrey field analyser indices (mean deviation and pattern standard deviation, p = 0.091 and p = 0.087, respectively) at day 60 of treatment or 3 months after the cessation of treatment. In this study of 39 patients, systemic use of isotretinoin (1 mg/kg daily) does not cause a statistically significant change in peripapillary RNFL thickness or visual field findings within the usage period, and within 3 months after cessation.