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Biomedical subjects

J H Barth

Publications and source records attributed to J H Barth.

At least 19 recordsLinked to original sources
PubMed1992

ACP Broadsheet 131: March 1992. Hirsute women: should they be investigated?

Should hirsute women be investigated? Most only need careful clinical evaluation. First, they need to be examined to determine whether they are hirsute or hypertrichotic, and for the degree of hair growth to assess the most appropriate form of treatment. Second, they need to be clinically evaluated for signs and symptoms of virilism to determine the extent of investigation needed. If virilism is absent laboratory investigation need only be minimal. As most hirsute women will have mild ovarian hyperandrogenism they will only require the appropriate tests for polycystic ovaries, and only those women who are virilised will need intensive investigation. The approach described is considered minimalist by some; but unless a tumour is diagnosed, anti-androgen treatment will only be offered to those with severe hirsutism who want treatment. Anti-androgens will be prescribed because (i) current medical treatment is insufficiently specific to require accurate localisation of the source of excess androgen and (ii) because anti-androgens are more effective at reducing hair growth than hydrocortisone, even in late onset congenital adrenal hyperplasia.

Female↗
PubMed1991

Androgen metabolism by isolated human axillary apocrine glands in hidradenitis suppurativa.

Androgen metabolism was investigated in normal human apocrine glands and in those isolated from age-matched patients with hidradenitis suppurativa. Axillary glands were isolated by shearing and androgen interconverting enzyme activities were measured in cell-free homogenates by incubation with [3H] dehydroepiandrosterone, [3H] androstenedione and [3H] testosterone. The activities (pmol/mg protein/min: mean + SEM) of 3 beta-hydroxysteroid dehydrogenase delta 4-5-isomerase (10.0 +/- 1.2 vs. 5.3 +/- 0.5: n = 5) and 17 beta-hydroxysteroid dehydrogenase (58.1 +/- 4.5 vs. 35.7 +/- 5.2: n = 5) were significantly lower (P less than 0.005) in hidradenitis suppurativa, whereas 5 alpha-reductase activity (12.5 +/- 2.3 vs. 12.5 +/- 2.0: n = 5) was similar. This report suggests that hidradenitis suppurativa cannot be attributed to exaggerated activities of end-organ androgen interconverting enzymes.

3-Hydroxysteroid Dehydrogenases↗
PubMed1991

Cyproterone acetate for severe hirsutism: results of a double-blind dose-ranging study.

OBJECTIVE: The objective was to determine if cyproterone acetate (CPA) therapy for hirsute women demonstrated a dose response. DESIGN: A double-blind dose-ranging study of the effect of 3 doses of cyproterone acetate for a period of 12 months. PATIENTS: Twenty-one hirsute women received the Dianette contraceptive pill (35 micrograms ethinyl oestradiol + 2 mg CPA, Schering Healthcare, UK), 20 received Dianette plus 20 mg CPA and 19 received Dianette plus 100 mg CPA: supplementary CPA was administered on days 1-10 of the birth control pill cycle as described by Hammerstein. MEASUREMENTS: Hair growth was measured using the clinical scale of Ferriman and Gallwey and by direct measurement of hair shaft diameter and linear growth of hair on the face, forearm, abdomen and thigh. RESULTS: Thirty-eight women completed 12 months therapy, eight withdrew due to side-effects and 14 were lost to follow-up. All three dose schedules produced significant reductions in clinical hair growth scores. This reduction was seen after 6 months with Dianette alone (P less than 0.005) and after 3 months with both the higher doses (P less than 0.01). There were no significant differences between the effect of different doses at any of the three-monthly time points. Hair diameter measurements were reduced by all doses after 12 months: face by 27*, 37, 37%*, forearm 5, 10, 8%*, abdomen 22*, 39*, 33%*, thigh 12, 24*, 30%* (median reductions (*P less than 0.01) for Dianette, D + 20 mg CPA and D + 100 mg CPA respectively). There were no significant reductions in daily linear growth rates. A comparison of the percentage reduction in hair shaft diameter at each site demonstrated no significant difference between doses, although the reductions by the three doses on the forearm, abdomen and thigh suggested a trend towards a dose response. CONCLUSIONS: We conclude that cyproterone acetate 2 mg daily appears to be as effective as higher doses in the therapy of hirsute women.

Adolescent↗
PubMed1989

Lipogenesis by isolated human apocrine sweat glands: testosterone has no effect during long-term organ maintenance.

Lipid synthesis by freshly isolated human apocrine glands has been measured by the incorporation of [U-14C] acetate. Incorporation is linear over 6 h at 1010 +/- 282 pmol/mg wet weight/h (n = 11; mean +/- sem). The lipid classes, as percentages of the total lipid synthesized, were found by TLC to be cholesterol 12.3 +/- 2.0, mono-glycerides 7.5 +/- 1.5, 1,2 di-glycerides 3.0 +/- 0.9, 1,3 di-glycerides 3.5 +/- 0.5, tri-glycerides 28.4 +/- 1.8, free fatty acids 2.0 +/- 0.4, lysolecithin 15.4 +/- 3.9, sphingomyelin 9.9 +/- 4.3, phosphatidyl-choline 8.4 +/- 0.4, phosphatidyl-ethanolamine -inositol and -serine 1.8 +/- 0.1, phosphatidic acid and cardiolipin 3.3 +/- 0.5, and unidentified 3.3 +/- 0.5 (mean +/- sem, n = 5). Glands were maintained on permeable supports. After 10 d maintenance, electron microscopy showed that the cellular architecture had been preserved, that the ATP contents were the same as in freshly isolated glands, and that [U-14C] acetate incorporation was not significantly altered at 851 +/- 237 pmol/mg/h (n = 18). The addition of 3 microM testosterone had no effect on acetate incorporation at 844 +/- 231 pmol/mg/h (n = 18). The lipid classes and their proportions were similar to the values for fresh glands after 10 d maintenance both with and without testosterone.

Acetates↗
PubMed1989

Spironolactone is an effective and well tolerated systemic antiandrogen therapy for Hirsute women.

We treated 22 hirsute women with spironolactone in an open trial to determine whether it caused objective changes in hair growth. Among them, 18 women completed 12 months therapy with 200 mg spironolactone daily. During this period, the mean daily linear growth rates of hair on the face, abdomen, and thigh were reduced to 66% (P less than 0.001), 75% (P less than 0.01), and 72% (P less than 0.001) of their pretreatment values. The mean hair shaft diameters were reduced to 83% (P less than 0.01) on the face, 88% (P less than 0.001) on the arm, 74% (P less than 0.01) on the abdomen, and 80% (P less than 0.001) on the thigh. Daily hair volume production was calculated from the diameter and daily growth rate; it was reduced to 60% (P less than 0.01) on the face, 52% (P less than 0.01) on the arm, 34% (P less than 0.001) on the abdomen, and 48% (P less than 0.001) on the thigh. Six of the 18 women who completed the study developed midcycle vaginal bleeding, and 3 women had previously irregular menstrual cycles regulated. We conclude that spironolactone is effective and well tolerated for hirsute women.

Adult↗
PubMed1988

Nail abnormalities and autoimmunity.

Eight patients are described with both vitiligo and nail abnormalities. Two had additional autoimmune disorders but these did not develop at the same time as the nail abnormality. Both had thyrotoxicosis. The proposed association with certain autoimmune disorders is discussed.

Adolescent↗
PubMed1988

Pemphigoid and ulcerative colitis.

We report eight patients with ulcerative colitis who have subsequently developed pemphigoid. Four patients were investigated to determine the pattern of pemphigoid antibody staining on whole and chemically split skin and oral mucosa to distinguish between pemphigoid and epidermolysis bullosa acquisita. The findings were suggestive of pemphigoid with a predominantly epidermal pattern. Three patients were studied for the presence of antibodies against the colon (which were absent). The relationship between pemphigoid and ulcerative colitis is discussed in relation to a case-control study.

Adult↗
PubMed1988

Acanthosis nigricans, insulin resistance and cutaneous virilism.

Thirteen patients with the syndrome of acanthosis nigricans and insulin resistance are described. They all had a combination of dermatoses related to hyperandrogenism (cutaneous virilism): hirsuties (II), acne vulgaris (6), hidradenitis suppurativa (5) and androgenic alopecia (4). In addition, 9 out of 13 had keratosis pilaris. The patients had raised fasting plasma insulin levels compared with matched normal controls (P less than 0.01) and increased insulin resistance (P less than 0.02). Insulin resistance correlated with total serum testosterone (rs = 0.65; P less than 0.02).

Acanthosis Nigricans↗
PubMed1988

Prepubertal hypertrichosis: normal or abnormal?

The pattern of hair growth, morphology of the hair shafts, and the hair root state are described in four girls and two boys with prepubertal hypertrichosis. The exact nosology of this form of excessive hair growth is discussed in relation to hirsuties and the possibility of it representing an 'atavistic' trait.

Child↗
PubMed1988

Alopecia and hirsuties. Current concepts in pathogenesis and management.

Hirsuties and androgenic alopecia are the patterns of hair growth in women which develop in a similar manner to that normally seen in men. This process is mediated by androgens. It may be due to increased hormone production or increased target organ sensitivity. The majority of patients with hirsuties may be adequately managed with a careful explanation of their condition and advice about depilatory techniques. Some will benefit from a course of systemic antiandrogen therapy, but hair growth will resume on cessation of therapy. There have been few objective studies to evaluate the benefits of antiandrogen therapy in female baldness and none with minoxidil.

Alopecia↗
PubMed1988

Body fat topography in women with androgen excess.

The relationship between body fat distribution and androgen excess was determined in 168 premenopausal women of varying degrees of androgen excess. In 84 women with the polycystic ovary syndrome or idiopathic hirsutism, the waist:hips girth ratio (WHR) was 0.81 +/- 0.01 (mean +/- s.e.m.) and was significantly greater (P less than 0.001) than in an age- and weight-matched group of 84 non-hirsute women (0.77 +/- 0.01), indicating upper body fat predominance in the hirsute subjects. Plasma testosterone was directly correlated with the WHR (r = 0.55, P less than 0.001) and this relationship was independent of obesity level, supporting the hypothesis that plasma androgens are an important determinant of body fat topography in premenopausal women.

Adipose Tissue↗