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Br J Dermatol. 2000 Nov;143(5):983-91.
Psychiatric morbidity in dermatological outpatients: an issue to be recognized.

Picardi A, Abeni D, Melchi CF, Puddu P, Pasquini P.

Clinical Epidemiology Unit, 2nd Division of Clinical Dermatology and Dermatoimmunology Department, Dermatological Institute IDI-IRCCS, Via dei Monti di Creta 104, 00167 Rome, Italy. angelo.picardlashnet.it

BACKGROUND: There is a high prevalence of psychiatric disorders in dermatological outpatients. OBJECTIVES: To estimate the magnitude of this problem and to identify a set of variables associated with the presence of psychiatric disorder. METHODS: All adults attending the outpatient clinics of a dermatological hospital on predetermined days were given a questionnaire comprising the Skindex-29 and the 12-item General Health Questionnaire (GHQ-12). RESULTS: In total, 4268 questionnaires were given at admission, and 3125 were returned. Of these, 546 were blank or incomplete, leaving 2579 respondents (response rate 60.4%). Using a stringent cut-off threshold (> or = 5) for psychiatric case identification with the GHQ-12, scored in the conventional way, the overall prevalence of psychiatric morbidity was 25.2% (95% confidence interval 23.6-27.0%). We found a higher prevalence of psychiatric disorders in women and in widows/widowers, controlling for age. Health-related quality of life was a much stronger predictor of psychiatric morbidity than physician-rated clinical severity. High prevalence rates (> 30%) were observed among patients with acne, pruritus, urticaria, alopecia and herpesvirus infections, and in subjects without objective signs of dermatological disease. CONCLUSIONS: Our study has depicted the situation that is actually faced by dermatologists in their everyday practice, where they are in a unique position to recognize psychiatric morbidity and to take appropriate measures. The GHQ-12, being easy for patients to compile and for physicians or nurses to score, may be a practical tool to increase identification of patients with substantial psychological distress or formal psychiatric disorder in order to provide more comprehensive and appropriate intervention.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11069507&dopt=Abstract

Gynecol Endocrinol. 2000 Aug;14(4):223-30.
Inhibition of skin 5 alpha-reductase by oral contraceptive progestins in vitro.

Rabe T, Kowald A, Ortmann J, Rehberger-Schneider S.

Department of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Heidelberg, Germany.

Androgenic disorders of female skin such as hirsutism, acne and alopecia are etiologically caused by androgen excess. Skin 5 alpha-reductase activity is a major factor influencing the manifestation of endogenous androgen excess in women. Oral contraceptives have proven useful for the treatment of androgen disorders of the skin. The mechanisms of action by which oral contraceptives correct skin androgen levels may include inhibition of 5 alpha-reductase and androgen receptor activity. We investigated the inhibitory effect of oral contraceptive progestins and ethinyl estradiol on skin 5 alpha-reductase and their influence on androgen receptor activity and affinity, using three different in vitro assay systems. It was shown that norgestimate blocked 5 alpha-reductase activity with an IC50 value of 10 microM, followed by levonorgestrel (IC50 52 microM), dienogest (IC50 55 microM), cyproterone acetate (IC50 87 microM) and gestodene (IC50 98 microM). To determine the full androgenic potential of the progestins, androgen receptor binding affinities and activation potentials were determined. The progestins norgestimate and dienogest in particular combined 5 alpha-reductase inhibition with minimal androgenic potential. These data demonstrate that the progestins norgestimate and dienogest might help in the treatment of clinical hyperandrogeny in women.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11075290&dopt=Abstract

J Med Assoc Thai. 2000 Sep;83(9):999-1004.
Analysis of skin diseases in a referral pediatric dermatology clinic in Thailand.

Wisuthsarewong W, Viravan S.

Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

The retrospective study of skin diseases in children less than 13 years old was performed at the referral Pediatric Dermatology Clinic, Siriraj Hospital, Thailand. It included 4,265 visits made by 2,361 patients. The prevalence and demographic data of all diagnoses were analysed. In children, eczematous dermatitis was the most common (41.2%), followed by skin infections (21.9%), pigmentary disorder (7.0%), hypersensitivity skin diseases (4.1%), and others. Atopic dermatitis was the most common type of eczema in children (6.0%). The entity of contact dermatitis, scabies, vitiligo, tinea capitis, alopecia areata, papular urticaria, impetigo and urticaria represented 4.9, 4.1, 4.1, 3.3, 2.4, 2.3, 2.3 and 2.2 per cent, respectively. These data may be useful in planning the dermatologic education and health care program for Thai children in the future.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11075964&dopt=Abstract

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