PubMed · 15376545
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Nigel Stollery. 2004. Key developments in dermatology.. https://pubmed.ncbi.nlm.nih.gov/15376545/
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BACKGROUND: Gender aspects are important when assessing the tolerability of antiepileptic drugs (AED). Due to its broad spectrum of action and to the lack of evidence for teratogenicity in monotherapy, lamotrigine (LTG) is an AED of first choice for women with epilepsy with child-bearing potential. METHOD: In an observational study over 6 months including 832 women with epilepsy, we evaluated the efficacy and tolerability of LTG in monotherapy and add-on therapy, with a special focus on parameters of particular importance for women including changes in weight, skin, hair, and patterns of menstruation. RESULTS: Of the treated patients, 94% had seizure reduction of at least 50%. Adverse events occurred in 7.3%; 1% experienced serious adverse events, all of which were reversible. Ninety-six percent continued treatment throughout the observation period, and 83% reported improvement in quality of life by the end of the study. Cognition, functioning at work, and mood improved in 43-54% of patients. In most of them, weight remained stable. Those who were switched from valporate (VPA) or carbamazepine (CPZ) to LTG lost 3.2 kg and 3.1 kg (means), respectively. Many of the women described problems related to menstruation at the beginning of the study: variability in cycle length (31.2%), hypermenorrhea (17.3%), and pains (10%). Skin and hair problems were reported by 18.4% and 17.3%, respectively. There was improvement in all of these aspects at the end of the study, particularly for those women switched from VPA or CBZ to LTG. CONCLUSION: In summary, this observational study confirms the good tolerability of LTG with respect to issues particularly relevant to women. More complete elucidation of the correct LTG dosage, which varies widely according to the accompanying medication, will further improve treatment safety.
OBJECTIVES: To describe a family from New Zealand with the pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome, an autoinflammatory, variably expressed, erosive destructive form of arthritis. METHODS: Information was gained through medical records and interviews of the affected patients and wider family. DNA sequencing was performed at Seay Center for Musculoskeletal Research Texas Scottish Rite Hospital for Children. RESULTS: Five patients were affected over three generations with an E250Q mutation found on the CD2BP1 gene on chromosome 15. Common features included a severe, pauciarticular-onset, destructive peripheral arthritis, beginning at ages 5, 5, 2, 3 and 1(1/2) years. This combination marked cervical ankylosis (in two members), micrognathia and a more severe phenotype is unique. A third-generation family member treated early with DMARDs is following a less severe course. The skin involvement was variable, all with degrees of acne from puberty, though only one patient displayed pyoderma gangrenosum. A clear pattern of the arthritis switching off in adolescence and the triggering of skin disease was observed. CONCLUSIONS: Differing degrees of joint destruction, and cervical ankylosis in this family with the E250Q mutation demonstrate PAPA syndrome's variable expression. Further understanding of this rare condition and its pathway may allow better targeting of treatments, not just for families with this specific syndrome but also for other, more common, forms of arthritis.
Isotretinoin treatment alters the plasma lipid levels but the mechanisms and the effects on the metabolism of triglyceride-rich lipoproteins such as chylomicrons and very-low-density lipoproteins remain unclear. We investigated the effect of isotretinoin on the plasma kinetics of emulsion models of triglyceride-rich lipoproteins and the lipid profile. Ten patients with acne were treated with 0.8 mg/kg of isotretinoin over 4 weeks for comparison with non-treated acne patients. In both groups the plasma kinetic study of a triglyceride-rich emulsion double-labeled with 14C-cholesterol oleate and 3H-triolein was performed after intravenous injection of the emulsion and radioactive counting in plasma samples collected over 60 min. Patients using isotretinoin showed decreased removal from the plasma of the 3H-triglyceride (median 0.019 min-1 TG) compared with controls (median 0.044 min-1, P=0.007), and the removal of the emulsion 14C-cholesterol oleate also tended to be decreased (treatment: 0.011 min-1; controls: 0.024 min-1, P=0.06). The values of total and LDL cholesterol and triglycerides were increased post-treatment (P<0.03). In conclusion, while increasing the fasting plasma concentration of VLDL and LDL, which are traditional risk factors for atherosclerosis, isotretinoin treatment also slows down the metabolism of triglyceride-rich lipoproteins such as chylomicrons, as tested by the emulsion model, an effect that is also increasingly recognized as atherogenic.