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HIV infection and the skin
Symposium SI 7. Viruses and the skin the most potent androgen dihydrotestosterone. Sa-DHT binds to the androgen receptor to regulate specific gene expression. Inhibitors of the Scr-reductase (antiandrogens) are useful on the one hand for selective treatment of neoplastic tissue changes (prostata carcinoma) but on the other are mostly used for the treatment of SAHA-symptoms such as acne, androge(net)ic alopecia and hirsutism. Those compounds which are mostly used today are cyproterone acetate and chlormadinone acetate. Others such as spironolactone have some efficacy but a lower benefit-risk ratio. Beside steroidal, non-steroidal antiandrogens are used. In the very near future inhibitors of the human type I and type II isoenzyme of Sa-reductase will become available, allowing to treat more selectively androgen dependent diseases. 516-4
Old and new antiandrogens treatment
in acne
B. D&no. Department of Dermatology, CHU 44093 Nantes Cedex 1, France The term “antiandrogen” refers to androgen receptor blokers in tissue which are of different dytpes (1). Steroidal antiandrogen inlcuding spironolactone and cyproterone acetate (2) nonsteroidal antiandrogens such as flutamide, nilutamide and casodex. These two types act by blocking androgen receptor (3). Corticosteroids with dexamethasone and prednisone which inhibit adrenal androgen secretion (4) oral contraceptives which inhibit ovaran androgen secretion (5), GrRH agonists inhibiting pilvitary gonadotropin relase and more recently (6) 5 alpha reductase inhibitors with finasteride. This molecule has a higher affinity for the type 2 isoenzyme which is less expressed in the skin than type 1 (sebaceous gland and infra-infundibulum). Other 5 alpha-reductase inhibitors that selectively bind to type 1 isoenzyme (MI < -386, LY 191 704) may be regarded as candidates for treatment of seborrhcea and acne. The interest of this different old and new antiandrogens in the treatment of acne lesions will be discussed. References [I] Chen W, Zouboulis Ch, Orfanos CE. The 5 alpha reductase system and its inhibitors. Dermatology 1996; 193: 177-184. 121 Fangfang Y. Kojo I, Noriko I. Linda R, Hideo U. Effects of topical antinndrogen and 5-alpha-reductase inhibitors on sebaceous glands in mole fuzzy rats. Skin Pharmacol 1997; 10: 288-297. [3] Shaw JC. Antiandrogen therapy in dermatology. Inter J Dermatol 1996; 35: 770-778. S16-5
Side effects of acne therapy
W.J. Cunliffe. Skin Reseaxh Centre, Leeds University, UK The purpose of this presentation is to discuss and diagnose the management and side effects due to acne therapy. Most acne therapies - oral, topical and physical therapies will be discussed. Emphasis will be placed on those side effects which are a major problem to the patient and physician such as: Minocycline induced pigmentation, benign intracranial hypertension, hepatitis and LE like syndromes. Resistance of I! acnes to commonly used oral and topical antibiotics is an increasing problem; strategies will be discussed as how to prevent and treat such problems.
s29
Systemic and mucocutaneous side effects from Isotretinoin will be highlighted as will the prevention and management of acne flare which can be quite devastating whilst on oral isotretinoin. The recent media attention to the inter-relationship between acne, its treatment and depression will also be discussed. It is hoped that the presentation will allow the dermatologist to improve the benefit-risk ratio of acne therapy. S16-6
The difficult
acne patient
A.R. Shalita. State University of New York Health Science Center at Brooklyn, Brooklyn, New York, USA Patients with difficult to treat acne may present with a wide variety of clinical manifestations. They may vary from apparently mild acne to very severe, refractory disease. Milder forms of acne may prove difficult to treat because of the location of the lesions; the chin, mandible and neck being particularly sensitive to irritating topical therapy. The lesions may also occur infrequently in which case the physician may be reluctant to treat with systemic medication for prolonged periods. There may also be considerable psychological overlay leading to poor compliance, excoriation and/or poor understainding of the treatment program and goals. Some patients with less than severe disease appear to be refractory to good conventional treatment. In some of these patients the emergence of less sensitive strains of bacteria may be contributory factors. In women, there may be either local or systemic endocrine problems which require hormonal treatment and or oral isotretionin. Finally, patients taking oral isotretinoin may have significant untoward reactions such as exacerbation of their disease, exuberant granulation tissue or significant side effects which render treatment more difficult.
s17.
IS17
Viruses and the skin 1 HIV infection
and the skin
E. Tschachler. Department of Dermatology, University of Vienna, Vienna, Austria Diseases of skin and mucous membranes were among the first clinical manifestations reported in patients with the acquired immunodeliciency syndrome (AIDS). More than 90% of HIV-infected patients suffer from skin or mucous membrane conditions at some time and visit rates for common dermatological conditions are several times higher in HIV-infected than in non-infected individuals. Because the incidence of mucocutaneous disorders increases with deterioration of the patients’ immune function, distinct skin conditions are important guides for the clinician to monitor disease progression. In the light of emerging effective antiretroviral therapy, it is particularly important that dermatologists are able to recognize clincial signs of HIV-l disease early to initate appropriate treatment in time.
Old and new antiandrogens treatment
in acne
B. D&no. Department of Dermatology, CHU 44093 Nantes Cedex 1, France The term “antiandrogen” refers to androgen receptor blokers in tissue which are of different dytpes (1). Steroidal antiandrogen inlcuding spironolactone and cyproterone acetate (2) nonsteroidal antiandrogens such as flutamide, nilutamide and casodex. These two types act by blocking androgen receptor (3). Corticosteroids with dexamethasone and prednisone which inhibit adrenal androgen secretion (4) oral contraceptives which inhibit ovaran androgen secretion (5), GrRH agonists inhibiting pilvitary gonadotropin relase and more recently (6) 5 alpha reductase inhibitors with finasteride. This molecule has a higher affinity for the type 2 isoenzyme which is less expressed in the skin than type 1 (sebaceous gland and infra-infundibulum). Other 5 alpha-reductase inhibitors that selectively bind to type 1 isoenzyme (MI < -386, LY 191 704) may be regarded as candidates for treatment of seborrhcea and acne. The interest of this different old and new antiandrogens in the treatment of acne lesions will be discussed. References [I] Chen W, Zouboulis Ch, Orfanos CE. The 5 alpha reductase system and its inhibitors. Dermatology 1996; 193: 177-184. 121 Fangfang Y. Kojo I, Noriko I. Linda R, Hideo U. Effects of topical antinndrogen and 5-alpha-reductase inhibitors on sebaceous glands in mole fuzzy rats. Skin Pharmacol 1997; 10: 288-297. [3] Shaw JC. Antiandrogen therapy in dermatology. Inter J Dermatol 1996; 35: 770-778. S16-5
Side effects of acne therapy
W.J. Cunliffe. Skin Reseaxh Centre, Leeds University, UK The purpose of this presentation is to discuss and diagnose the management and side effects due to acne therapy. Most acne therapies - oral, topical and physical therapies will be discussed. Emphasis will be placed on those side effects which are a major problem to the patient and physician such as: Minocycline induced pigmentation, benign intracranial hypertension, hepatitis and LE like syndromes. Resistance of I! acnes to commonly used oral and topical antibiotics is an increasing problem; strategies will be discussed as how to prevent and treat such problems.
s29
Systemic and mucocutaneous side effects from Isotretinoin will be highlighted as will the prevention and management of acne flare which can be quite devastating whilst on oral isotretinoin. The recent media attention to the inter-relationship between acne, its treatment and depression will also be discussed. It is hoped that the presentation will allow the dermatologist to improve the benefit-risk ratio of acne therapy. S16-6
The difficult
acne patient
A.R. Shalita. State University of New York Health Science Center at Brooklyn, Brooklyn, New York, USA Patients with difficult to treat acne may present with a wide variety of clinical manifestations. They may vary from apparently mild acne to very severe, refractory disease. Milder forms of acne may prove difficult to treat because of the location of the lesions; the chin, mandible and neck being particularly sensitive to irritating topical therapy. The lesions may also occur infrequently in which case the physician may be reluctant to treat with systemic medication for prolonged periods. There may also be considerable psychological overlay leading to poor compliance, excoriation and/or poor understainding of the treatment program and goals. Some patients with less than severe disease appear to be refractory to good conventional treatment. In some of these patients the emergence of less sensitive strains of bacteria may be contributory factors. In women, there may be either local or systemic endocrine problems which require hormonal treatment and or oral isotretionin. Finally, patients taking oral isotretinoin may have significant untoward reactions such as exacerbation of their disease, exuberant granulation tissue or significant side effects which render treatment more difficult.
s17.
IS17
Viruses and the skin 1 HIV infection
and the skin
E. Tschachler. Department of Dermatology, University of Vienna, Vienna, Austria Diseases of skin and mucous membranes were among the first clinical manifestations reported in patients with the acquired immunodeliciency syndrome (AIDS). More than 90% of HIV-infected patients suffer from skin or mucous membrane conditions at some time and visit rates for common dermatological conditions are several times higher in HIV-infected than in non-infected individuals. Because the incidence of mucocutaneous disorders increases with deterioration of the patients’ immune function, distinct skin conditions are important guides for the clinician to monitor disease progression. In the light of emerging effective antiretroviral therapy, it is particularly important that dermatologists are able to recognize clincial signs of HIV-l disease early to initate appropriate treatment in time.