[Cutaneous effects in hormonal contraception]. / Bilan cutane de la contraception hormonale.

PIP: Oral contraceptives (OCs) can affect the skin through their hormonal effects or through iatrogenic effects associated with their toxicity in certain individuals. They may also be beneficial in certain androgen-dependent dermatoses. Toxic effects of OCs are rare but potentially serious; they should be diagnosed early and require permanent termination of OC use. The clinical manifestations are variable and not specific to the medication. The most frequently reported manifestations are allergic vascularities which may lead to serious renal complications, fixed pigmented erythema, urticaria, which may have other etiologic factors, and lichenoid eruptions. Combined OCs, because of their estrogen content, may cause sensitivity to light in susceptible women. Other dermatoses can be initiated or aggravated by OCs without direct relation to their hormonal effects. OCs are therefore contraindicated if there is a personal or family history of porphyries or a personal history of systemic lupus erythematosus, erythema nouex, herpes gestationis, or malignant melanoma. Hormonal-related dermatological effects caused by either progestins or estrogens have become less frequent as dose levels have declined. Chloasma, either melasma or a poorly defined spotty pigmentation, accounts for 2/3 of cases of OC-related dermatoses. It is more common in women of Mediterranean background. 80% of affected OC users have a history of "mask of pregnancy", but the condition is also found in nulliparas. Exposure to sunlight is a factor. Women with a history of chloasma of pregnancy and dark coloring should not use OCs. Seborrhea is directly related to the androgen effect of OCs and is less likely to occur with 17 OH progesterone derivatives than with 19 norsteroid derivatives. The role of androgens in acne is well known, but 2 other factors are necessary: an anomaly in keratinization and proliferation of corynebacterium acnes, a saprophyte of the follicles. OCs do not necessarily need to be suspended during well-conducted acne treatment. Alopecia is rare but difficult to diagnose because of its psychological aspects. Androgenic alopecia is aggravated by progestins derived from 19 norsteroids. True hirsutism caused by an androgen-producing ovarian pathology is not related to OC use. Estrogens are incriminated in the etiology of telangiectasies, permanent dilatations of the arterioles. Once developed the condition does not regress and requires treatment with sclerosing agents, electrocoagulation, or laser. The various dermatological risk factors should be ruled out before prescription of an OC. Classic contraceptive pills are not commonly used in treatment of common acne because the strongly estrogenic climate required for therapeutic utility carries the risk of hypertriglyceridemia, thrombophlebitis, and possibly carcinogenesis. The recent development of pills containing the antiandrogen cyproterone acetate instead of a progestin in combination with ethinyl estradiol reduces androgenic effects in women. This pill may be useful in cases of severe acne, severe seborrhea, androgenic alopecia, or excessive facial hair.^ieng

[Homologous artificial insemination and male infertility. Study of prognostic factors]. / Inséminations artificielles homologues et infertilité masculine. Recherche de facteurs de pronostic.

Artificial insemination using the husband's semen (AIH) can help overcome a number of cases of sterility, particularly where these are male in origin. But the results are not always in proportion to the effort required, both from the patients and their doctor. We have compared 25 cases in which AIH resulted in pregnancy with 25 cases in which no pregnancy was achieved after a minimum of 6 cycles' insemination. No factor other than success or failure entered into the selection of cases for comparison. No significant difference was observed in age, past medical history, clinical findings and treatment used. However, study of the seminal analyses showed that the number of spermatozoa was only a secondary factor; sperm motility, and its duration, were more important. This gave two graphs defining two prognostic zones. In 72% of cases, pregnancy was achieved during the first 5 cycles of insemination using AIH. Lastly, miscarriages increased in frequency with age. The number of cases studied is obviously too few to provide any binding statistical conclusions, but these preliminary results give grounds for continuing the study; mathematical models ought to make it possible to identify prognostic factors.

[Acute pituitary failure as the presentation of a prolactin cell adenoma during a pregnancy made possible by bromocriptine (author's transl)]. / Apoplexie hypophysaire révélatrice d'un adénome à cellules prolactiniques au cours d'une grossesse permise par la bromocriptine.

A 21-year-old woman had sterility due to amenorrhoea-galactorrhoea with hyperprolactinaemia and hypoplastic ovaries. The sella turcica was asymmetrical but tomograms were suggestive of a congenital appearance. There was no suprasellar expansion. Treatment with bromocriptine and HMG resulted in pregnancy. Acute pituitary failure occurred at the 10th week, revealing an adenoma. The pregnancy proceeded to term after hypophysectomy. This complication, the first reported under the effects of bromocriptine, may serve as a reminder of the precautions to be taken during pregnancy in a hyperprolactinaemic woman.