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Biomedical subjects

J B Schmidt

Publications and source records attributed to J B Schmidt.

At least 19 recordsLinked to original sources
PubMed1998

Other antiandrogens.

Various substances of steroidal or nonsteroidal structure may serve as an alternative for the antiandrogenic treatment of acne. Compounds with antiandrogenic properties like cimetidine or ketoconazole are rarely administered for acne due to their weak effects. In contrast, spironolactone is an effective antiandrogen that shows good treatment effects in hirsutism and acne. Side effects occur frequently and are dose dependent. Isotretinoin--the most effective agent in acne therapy--has been under discussion for additional antiandrogenic properties for years. At present there is additional evidence for the antiandrogenic effects of isotretinoin. Regarding substances acting on both levels, androgen receptor binding and 5 alpha-reductase inhibition, the question is raised whether the term 'antiandrogen' should be amplified by including the 5 alpha-reductase inhibitors. This would pay tribute to the biological aspect of antiandrogenicity that takes into account not only the mode of action but also the effects of the substance. Under this aspect type 1 5 alpha-reductase inhibitors may gain attention in the future.

Acne Vulgaris↗
PubMed1998

A comparison of capitated and fee-for-service Medicaid reimbursement methods on pregnancy outcomes.

OBJECTIVE: To determine if the payment method influenced the likelihood of selected obstetrical process measures and pregnancy outcome indicators among Medicaid women. DATA SOURCE/STUDY SETTING: Data from the live birth certificates computer file for 1993 from the State of California. The computer files contain information about the demographic characteristics of the mother, her medical conditions prior to delivery, medical problems during labor and delivery, delivery method, newborn and maternal outcomes, and expected principal source of payment for prenatal care and for hospital delivery. STUDY DESIGN: The study sample consisted of singleton live births to women in the California Medi-Cal program residing in one of two counties in which a mixed-model managed care plan was the method of reimbursement or in one of three counties in which fee-for-service was the payment method. The study and control counties were matched in terms of geographic proximity and sociodemographics. PRINCIPAL FINDINGS: Among Medi-Cal women, the likelihood of low birth weight (LBW) was lower in the capitated payment group than in the fee-for-service payment group even when controlling for maternal and newborn characteristics and adequacy of prenatal care. There was no difference in either the adequacy of prenatal care, the cesarean birth rate, or the likelihood of adverse pregnancy outcomes other than LBW between the two payer groups. CONCLUSIONS: Results of this "natural experiment" suggest that enrollment of pregnant Medi-Cal beneficiaries in capitated healthcare services through a primary care case management system in a county-organized health system/health insuring organization can have a beneficial effect on low birth weight and provide care comparable to a fee-for-service system.

Adolescent↗
PubMed1996

Treatment of skin aging with topical estrogens.

BACKGROUND: The coincidence of climacteric symptoms and the beginning of skin aging suggests that estrogen deficiency may be a common and important factor in the perimenopausal woman. Often hormones have been considered important in endogenous aging of the skin, but their role has not been clearly defined. Therefore, we investigated, whether topical treatment of the skin with estrogen could reverse some of the changes in the aging skin. MATERIAL AND METHODS: The effects of 0.01% estradiol and 0.3% estriol compounds were compared in 59 preclimacteric women with skim aging symptoms. Monthly determinations of estrodiol (E2), follicle-stimulating hormone (FSH), and prolactin (PRL) were done and the monthly clinical monitoring was supplemented by measurements of skin hydration by corneometry and profilometry. In 10 patients, skin biopsies were taken for immunohistochemical determination of collagen types I and III. RESULTS: After treatment for 6 months, elasticity and firmness of the skin had markedly improved and the wrinkle depth and pore sizes had decreased by 61 to 100% in both groups. Furthermore, skin moisture had increased and the measurement of wrinkles using skin profilometry, revealed significant, or even highly significant, decreases of wrinkle depth in the estradiol and the estriol groups, respectively. On immunohistochemistry, significant increases of Type III collagen labeling were combined with increased numbers of collagen fibers at the end of the treatment period. As to hormone levels, only those of PRL had increased significantly and no systemic hormonal side effects were noted.

Administration, Topical↗
PubMed1995

New treatment of atrophic acne scars by iontophoresis with estriol and tretinoin.

BACKGROUND: Common treatment of atrophic acne scars consists of invasive methods such as dermabrasion, chemopeeling, or implantation of bovine collagen. In our study a new noninvasive treatment method consisting of local iontophoresis is demonstrated. Local iontophoresis was performed with either estriol--a mainly topically active estrogen--or with tretinoin. PATIENTS AND METHODS: Eighteen women were treated with estriol iontophoresis twice weekly for a period of 3 months. In addition to photographic and clinical documentation of the skin, venous blood for determination of serum levels of prolactin and estradiol according to standard radioimmunoassay methods was obtained monthly. Tretinoin iontophoresis was performed according to the same time schedule in 28 patients (19 women and 9 men) with atrophic acne scars. RESULTS: Improvement of acne scars was observed in 93% of patients treated with tretinoin iontophoresis and in 100% of the group treated with estriol iontophoresis. No hormonal changes were noted in the estrogen group. Side effects involving the skin appeared in the tretinoin group in 4 cases and consisted of increased dryness and of retinoid dermatitis. CONCLUSION: Both treatments were shown to be clinically effective in decreasing acne scars and persistence of effects. This promising new therapeutic approach may thus replace invasive treatment methods in many patients.

Acne Vulgaris↗
PubMed1994

Monte Carlo approach in assessing damage in higher order structures of DNA.

We have developed a computer monitor of nuclear DNA in the form of chromatin fibre. The fibres are modeled as a ideal solenoid consisting of twenty helical turns with six nucleosomes per turn. The chromatin model, in combination with are Monte Carlo theory of radiation damage induces by charged particles, based on general features of tack structure and stopping power theory, has been used to evaluate the influence of DNA structure on initial damage. An interesting has emerged from our calculations. Our calculated results predict the existence of strong spatial correlations in damage sites associated with the symmetries in the solenoidal model. We have calculated spectra of short fragments of double stranded DNA produced by multiple double strand breaks induced by both high and low LET radiation. The spectra exhibit peaks at multiples of approximately 85 base pairs (the nucleosome periodicity), and approximately 1000 base pairs (solenoid periodicity). Preliminary experiments to investigate the fragment distributions from irradiated DNA, made by B. Rydberg at Lawrence Berkeley Laboratory, confirm the existence of short DNA fragments and are in substantial agreement with the predictions of our theory.

Chromatin↗
PubMed1994

[Profilometry. A method for documenting skin structure].

Profilometry is a novel procedure allowing precise analysis of skin surface structure. With the help of a synthetic material a negative image of a defined area of the skin is taken. During the subsequent analytical procedure the roughness is determined by means of a profilometer. A commercially available statistics software program is used for statistical analysis of the results. This procedure was applied to check for to evaluate positive effects of oestrogen creams on the structure of the skin surface on the face.

Administration, Topical↗
PubMed1994

Treatment of skin ageing symptoms in perimenopausal females with estrogen compounds. A pilot study.

A wide range of somatic symptoms of the perimenopausal female is due to the decrease of estrogen at that age. Minor attention has been paid hitherto to the involvement of estrogens in female skin ageing symptoms. In our study, the ageing skin of the face of perimenopausal females was treated with a 0.3% estriol cream (8 patients) or with a 0.01% estradiol cream (10 patients) for 6 months. Dermatologic follow-up was performed monthly. At each follow-up venous blood for radioimmuno assay determination of prolactin (PRL), follicle stimulating hormone (FSH) and estradiol (E2) was sampled. In addition, prior to and after 3 and 6 months of treatment, gynecological examinations for climacteric symptoms, mammary and colposcopic investigations and vaginal smears for cytology were performed. Both treatment groups showed improvement of the various skin ageing symptoms at the end of treatment. The effects of the group treated with topical estriol were slightly superior with regard to their extent and onset. No hormonal side effects were noted either clinically or by hormone monitoring. According to these preliminary results, local estrogen treatment appears to be a promising new approach for the treatment of skin ageing in perimenopausal females. However, for minimizing the risk of systemic hormonal side effects, concentrations and size of application field should be limited.

Administration, Cutaneous↗
PubMed1994

Hormonal basis of male and female androgenic alopecia: clinical relevance.

A broad range of hormones was determined in males and females with androgenic hair loss (AH). The androgens testosterone, androstenedione, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone and sex hormone binding globulin were evaluated in 65 male and 46 female patients. Besides estradiol (E2), cortisol (F), and the hypophyseal hormones LH, FSH, and prolactin (PRL) were investigated. Hormone levels were compared with those of 58 age-matched male and 45 female controls. In 38 of the 46 female AH patients, hypophyseal function was moreover evaluated by the 'TRH test', which detects slight, secondary hypothyroidism and/or hyperprolactinemia. Our findings showed a significant elevation of F in both male and female AH patients compared to controls, pointing to the suprarenes as a contributing factor in AH. This is confirmed by the observation of exacerbated AH in periods of increased stress. Concerning specifically male androgens, a significant elevation of androstenedione was noted. The mainly peripheral activity of this hormone and elevated E2 levels in males stress the importance of androgen metabolism especially at the peripheral level. Additional TRH tests in females demonstrated significant hypophyseal hypothyroidism. Multilayered interaction between thyroid hormones and androgens may contribute to the development of AH in hyperthyroid patients. Another significant finding was elevated PRL after TRH stimulation. Thus, the androgen-stimulating effect of PRL may also play a role in female AH. Our findings show multilayered hormonal influences in AH. Broad-range hormone determination demonstrated a differentiated hormonal situation in this disorder.

Adult↗
PubMed1993

When applied to facial skin, does estrogen ointment have systemic effects?

We examined cytological vaginal smears of 17 women before and after three months of dermal estrogen (1 g of 0.01% estradiol ointment or 0.3% estriol ointment once daily), applied to the face for dermatological indications. The mean age was 57.1 +/- 7.6 years (range from 46 to 66). Seven women had estrogenic smears (more than 10% superficial cells) before therapy. Nine women were treated with 0.01% estradiol ointment and 8 were treated with 0.3% estriol ointment. Both groups had gynecological examinations including cervical and vaginal smears before and after treatment and also monthly measurements of serum follicle-stimulating hormone, prolactin and estradiol levels. Serum hormone levels and the appearance of vaginal smears showed no significant change during treatment.

Aged↗
PubMed1991

Hormonal parameters in androgenetic hair loss in the male.

Alopecia in the male is considered as a genetically determined disorder. Increased local androgen metabolism and androgen receptor binding in the balding areas confirm the importance of the target organ hair follicle as regulative of androgen influences. In our study the hormonal parameters of 65 male patients with male pattern hair loss with a mean age of 24.31 years were compared with those of 58 age-matched controls. Determinations of the androgens, sex-hormone-binding globulin, the hypophyseal hormones luteinizing hormone, follicle-stimulating hormone and prolactin, 17 beta-estradiol and cortisol were performed by standard radioimmunoassay. Significant differences in serum levels of androstenedione, cortisol, 17 beta-estradiol and luteinizing hormone were noted between hair loss patients and control subjects. Suprarenal stimulation as well as hypophyseal feedback mechanisms therefore seem to be involved in male pattern alopecia.

17-alpha-Hydroxyprogesterone↗
PubMed1991

Hormone studies in females with androgenic hairloss.

Reports on hormone analysis in androgenic hairloss in the female show partly contradicting results. Elevated as well as normal-range androgen levels have been found. The present study aimed at the investigation of a possibly more differentiated hormonal constellation by hormone analysis and additional determination of the hypophyseal level by the thyrotropin-releasing hormone (TRH) test. In 46 female patients with androgenic hairloss blood sampling for hormone analysis was performed. Determination of the androgens testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxy-progesterone acetate (17-OHP) and free testosterone (FT), of sex-hormone-binding globulin (SHBG), estradiol (E2), cortisol (F) and the hypophyseal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) was performed by standard radioimmunoassay methods. The TRH-test is based on feedback mechanisms between the hypothalamic TRH which stimulates hypophyseal TSH and PRL release. Thus, even mild forms of hypothyroidism or hyperprolactinaemia can be detected. The control group for the TRH test consisted of 45 volunteer females without hairloss or any other hormonal or menstrual disturbances. Statistical analysis was performed according to the Wilcoxon two-sample test. The results of the study show no significant elevation of androgens in females with androgenic hairloss, but a more complex condition with involvement of the glandula suprarenalis and the hypophyseal level. Significantly elevated TSH levels prior to and after TRH stimulation in the hairloss group indicate that hypothyroidism may be an important hormonal disturbance in androgenic hairloss. Interactions between hypothyroidism and androgen metabolism are possible at various links.(ABSTRACT TRUNCATED AT 250 WORDS)

17-alpha-Hydroxyprogesterone↗
PubMed1991

[Hyperprolactinemia and hypophyseal hypothyroidism as cofactors in hirsutism and androgen-induced alopecia in women].

A more comprehensive hormonal diagnosis than has previously been performed shows that androgen-dependent diseases of hair growth are due to more varied hormonal disturbances than elevated androgen serum levels alone. In 46 female patients with androgenic hair loss and 27 patients with hirsutism, the levels of the androgens testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulphate and 17-hydroxyprogesterone and of sex hormone-binding globulin, cortisol, oestradiol and the hypophyseal hormones follicle-stimulating hormone and luteinizing hormone were determined and compared with the hormone levels of 27 female patients without endocrine disorders. Of the androgens, only androstenedione showed a slightly significant elevation in hirsutism. Cortisol was elevated significantly in androgenic hair loss, and with a low degree of significance in hirsutism. In view of the complex hormonal interactions of thyroxin, prolactin and androgens and thyroid hormones the thyrotropin-releasing hormone (TRH)-stimulation test was performed in 38 female patients with androgenic hair loss and 27 with hirsutism, and the results were compared with those recorded in 45 female control persons. The test is based on feedback mechanisms between hypothalamic TRH and hypophyseal TSH and prolactin and peripheral thyroid hormones. Baseline concentrations of TSH prior to stimulation were significantly elevated in hirsutism, while in androgenic hair loss both baseline and stimulated TSH levels were significantly elevated; thus, hypothyroidism is a significant finding in both clinical pictures. In the case of prolactin, both baseline and stimulated levels were highly significantly elevated in hirsutism, while in androgenic hair loss the stimulated levels were significantly elevated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Hormone receptors in pubic skin of premenopausal and postmenopausal females.

Various functions of the skin are hormone-dependent. Recently hormonal involvement in aging processes of the skin has attracted increasing interest. The rapid onset of aging of the skin from the climacterium on seems to be correlated with the decrease of estrogens. In order to evaluate hormonal stimulability of the skin a study of hormone receptors was performed in pre- and postclimacteric women. Pubic skin of a total of 106 females was obtained during gynecologic operations for determination of estrogen receptors (ER), androgen receptors (AR) and gestagen receptors (PgR) by saturation analysis. In the preclimacteric group consisting of 62 females with a mean age of 39.6 +/- (SD) 6.5 years the operations were performed in the luteal phase of the menstrual cycle. The results were compared with those of 44 postmenopausal females with a mean age of 63.2 +/- 9.4 years. AR concentrations were significantly lower in the skin of postmenopausal women. 47.4% positive findings with a mean receptor level of 15.3 +/- 33.3 fmol/mg protein were to be found against 85.2% positive AR with a mean level of 31.4 +/- 20.3 fmol/mg protein in the ovulatory cycling females. These findings were of high significance. In addition, diminished PgR in the postmenopausal group were noted for incidence and mean receptor levels. PgR were positive in 18.4% with a mean level of 34.2 +/- 72.8 fmol/mg protein versus 36.3% with a mean receptor level of 34.2 +/- 72.8 in the ovulatory group. In contrast, no significant differences between ER of premenopausal and postmenopausal skin became evident. Results of hormone receptor determinations in the premenopausal and postmenopausal group with regard to the aging process are interpreted.

Adult↗
PubMed1990

Endocrine parameters in acne vulgaris.

Hormonal parameters (see below) were determined in 78 male acne patients of both sexes (mean age 21.2 +/- 3.8 years; (mean +/- S.D.) and compared with 63 controls (25.0 +/- 4.2 years). In a female group consisting of 60 patients acne (23.2 +/- 5.0 years) and 28 controls (26.1 +/- 5.7 years) of age, blood sampling was performed in the luteal phase of the menstrual cycle. Testosterone (T), dehydroepiandrosterone-sulfate (DHEAS), androstenedione (A), free testosterone (FT) and 17-hydroxy-progesterone (17-OHP) were determined by standard radioimmunoassay methods. In addition, sex hormone binding globulin (SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), 17 beta-estradiol (E2) and cortisol (F) were evaluated. Moreover, the counts of acne lesions in the face were performed in 34 males and females patients in order to investigate possible correlations between hormones and acne lesions. The results in the male group revealed a significant elevation only for F but not for the other hormones. However, the female acne group significantly elevated levels of T, DHEA and F and a decrease of E became apparent. In addition, the correlation between both free and total T and acne lesions were found in the total of males and females. In the female group, free T and total A were found to correlate with acne lesions. The evaluation of these results indicates that androgens play a more important role in female than in male acne at the hormonal and at the peripheral level in skin. Another interesting finding was the significant increase of F in both male and female acne subjects, thus stressing the role of suprarenal involvement.

17-alpha-Hydroxyprogesterone↗
PubMed1989

[Hypothyroidism and hyperprolactinemia as a possible cause of androgenetic alopecia in the female].

31 female patients suffering from androgentic alopecia were examined by means of the TRH test with regard to hypothyroidism and hyperprolactinemia. Before, as well as 20 and 40 minutes after, application of thyroxine releasing hormone (TRH), the serum concentrations of the hypohyseal thyroxine stimulating hormone (TSH) and prolactin (PRL) were measured by radioimmunoassay (RIA). In 7 of the patients (23%), we found increased TSH levels after stimulation with TRH--indicative of hypothyroidism. In 9 of the patients (29%), we observed increased PRL levels after TRH stimulation, indicating prolactinemia. TSH and PRL can interact with androgen metabolism at various levels. Thyroxine may influence the unbound, metabolically active testosterone via the sex hormone binding globulin (SHBG). Prolactine, which is stimulated by TRH, promotes the suprarenal cortisol and androgen production. In 48% of the patients, we found either hypothyroidism or hyperprolactinemia. This suggests that both conditions may contribute to the clinical picture of female androgenetic alopecia, as they interfere with the androgen metabolism.

Adult↗
PubMed1988

[1 percent clindamycin phosphate solution versus 5 percent benzoyl peroxide gel in papulopustular acne].

In a multicenter study, 60 patients suffering from mainly moderate papulopustular acne were treated to pically either with 1% clindamycin phosphate in alcoholic solution or with 5% benzoyl peroxide gel, 30 patients each. During the treatment period of 9 weeks, clinical controls with lesion counts were performed every 3 weeks and after a 3 weeks follow-up. The therapeutic efficacy according to the reduction of papules and pustules was 72% in the benzoyl peroxide group and 73% in the clindamycin group, the latter showing significantly less side effects. On account of its good therapeutic results, we consider topical treatment with clindamycin phosphate an important alternative to systemic antibiotic or topical benzoyl peroxide therapy in acne.

Acne Vulgaris↗
PubMed1988

[Effect of topical glucocorticoids on endogenous cortisol production].

In a randomized double blind study, we investigated the systemic effects of 3 different ointments containing corticoids. Every 7 patients out of a total of 21 patients suffering from various skin diseases were daily treated with 40 g of one of the 3 corticoid preparations over 8 days (group A: 0.05% clobetasol-17-propionate; group B: 0.25% fluocortolone trimethyl acetate; group C: 0.25% fluocortolone trimethyl acetate + 0.25% fluocortolone capronate). The plasma cortisol levels were determined by radioimmune assay. In group B and C, we did not observe any effect on the pituitary-adrenal axis, whereas in group A the plasma cortisol levels were extremely low already after 1 day of corticoid application. This adrenal suppression did not return to normal within 4 days after discontinuation of the corticoid. Our results suggest that highly potent topical corticoids are capable of adrenal suppression even without occlusive dressing and even in healthy persons.

Administration, Topical↗