Low dose flutamide in the treatment of acne vulgaris in women with or without oligomenorrhea or amenorrhea.

Changgeng yi xue za zhi Pub Date : 1999-09-01
H S Wang, T H Wang, Y K Soong
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Abstract

Background: In the skin, the expression of androgen action is dependent on the reduction of testosterone to dihydrotestosterone mediated by the enzyme 5 alpha-reductase. Additionally, an exaggeration of this peripheral metabolism has been associated with acne in women.

Methods: Fifty-two women with acne vulgaris but without hirsutism were recruited in this study, including 42 with oligomenorrhea or amenorrhea (Group 1) and 10 with regular menstrual cycles (Group 2). As a control, another 15 oligomenorrheic women without acne were also studied (Group 3). Flutamide combined with sequential estrogen-progestogen preparations was given to patients in Group 1. In Group 2, flutamide alone was administered. In Group 3, the women were treated with sequential estrogen-progestogen.

Results: In Groups 1 and 2, a significant decrease in the number of inflammatory lesions was found at the end of 3 and 6 months of treatment, and even after discontinuation of therapy for 6 months. Before treatment, patients in Group 1 showed signs of biochemical hyperandrogenism, including elevated levels of serum testosterone (T), androstenedione (A), and dehydroepiandrosterone sulfate (DHEA-S), as well as a decreased level of sex hormone-binding globulin (SHBG). A decrease in circulating T and A, and an elevation in serum SHBG were found 3 and 6 months after treatment in Group 1. In Group 2, clinical improvement of acne was achieved by flutamide alone without alteration in circulating androgens (including T, A, and DHEA-S). Similarly, no change in serum androgens was observed in the women of Group 3 after treatment.

Conclusion: A low dose of flutamide (250 mg/day) in association with or without estrogen-progestogen is effective for the clinical improvement of acne vulgaris in women with or without oligomenorrhea or amenorrhea. However, the effectiveness on hyperandrogenic symptoms by antiandrogens may or may not be reflected by the suppression of serum androgens.

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低剂量氟他胺治疗有或无少经或闭经的寻常性痤疮。
背景:在皮肤中,雄激素作用的表达依赖于5 α还原酶介导的睾酮还原为二氢睾酮。此外,这种外周代谢的夸大与女性痤疮有关。方法:本研究招募了52例无多毛的寻常性痤疮女性,其中少经期或闭经42例(1组),月经周期正常的10例(2组)。另外15例无痤疮的少经期女性作为对照(3组)。1组患者给予氟他胺联合序贯雌激素-孕激素制剂。第2组仅给予氟他胺。在第三组,妇女接受序贯雌激素-孕激素治疗。结果:1组和2组在治疗3个月和6个月结束时,甚至停药6个月后,炎性病灶数量均明显减少。治疗前,1组患者出现生化高雄激素症的迹象,包括血清睾酮(T)、雄烯二酮(A)、硫酸脱氢表雄酮(DHEA-S)水平升高,性激素结合球蛋白(SHBG)水平降低。治疗3个月和6个月后,1组患者循环T和A降低,血清SHBG升高。在第2组中,痤疮的临床改善是单独使用氟他胺而不改变循环雄激素(包括T, A和DHEA-S)。同样,治疗后3组妇女血清雄激素无变化。结论:低剂量氟他胺(250mg /天)联合或不联合雌激素-孕激素治疗有或无少经或闭经的寻常性痤疮均可有效改善其临床症状。然而,抗雄激素对高雄激素症状的有效性可能反映在抑制血清雄激素上,也可能不反映在抑制血清雄激素上。
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