Maternal serum cholesterol levels are elevated from the 1st trimester of pregnancy: a cross-sectional study.

Cholesterol is monitored in the non-pregnant adult population, where normal values are established. Although reported to be elevated in pregnancy, cholesterol is neither routinely measured nor treated. We aimed to investigate cholesterol levels throughout pregnancy and to establish reference values for cholesterol in healthy pregnant women. This was a cross-sectional analysis of serum cholesterol in healthy women with an uncomplicated singleton pregnancy. Pregnant women attending for antenatal care were recruited and cholesterol levels assayed at 12, 20, 28 and 36 weeks' gestation and on day 1-3 postpartum. A total of 222 women were recruited. The majority (95%) were white Irish, with a median age of 31 years (range 16-46). Median BMI was 25.9 kg/m2 (range 18-40) and 16% were smokers. Cholesterol levels were elevated in all trimesters of pregnancy, with median values from 1st trimester raised outside the non-pregnant adult range. High-density lipoprotein (HDL) levels ranged from 0.9 to 3.7 mmol/l and low-density lipoprotein (LDL) levels ranged from 1.3 to 6.1 mmol/l. Fasting, smoking and obesity did not have any significant effects on results. Total and LDL-cholesterol levels were raised throughout pregnancy. Levels were above non-pregnant adult ranges as early as the 1st trimester. The implications of this on fetus and mother are undetermined and deserve further investigation.

Reference standard for serum bile acids in pregnancy.

OBJECTIVE: Obstetric cholestasis (OC) is a liver disorder characterised by pruritus and elevated serum bile acids (SBA) that affects one in 200 pregnant women. It is associated with adverse perinatal outcomes such as premature delivery and stillbirth. Mild OC is defined as SBA levels of 10-39 µmol/l, and severe OC is defined by levels >40 µmol/l. SBA levels in normal pregnancy have not been investigated. We aimed to establish reference values for SBA in healthy pregnant women across different trimesters of pregnancy. DESIGN: Cross-sectional analysis of SBA levels. SETTING: A large tertiary referral university teaching maternity hospital. POPULATION: Healthy pregnant women with a singleton pregnancy and a body mass index (BMI) < 40, excluding women with significant alcohol intake, history of liver disease, prior cholecystectomy and OC. METHODS: Cross-sectional analysis of SBA levels at 12, 20, 28 and 36 weeks of gestation, and on days 1-3 postpartum. MAIN OUTCOME MEASURES: SBA levels in µmol/l. RESULTS: A total of 219 women attending for antenatal care were recruited, and SBA levels were assayed at 12, 20, 28 and 36 weeks of gestation, and up to 72 hours postpartum (n = 44-49 cases at each stage). The majority were white European women, with a median age of 30 years (range 17-46 years) and median BMI of 25 (range 18-38). Values of SBA ranged from 0.3 to 9.8 µmol/l in 216 women, with only three measurements outside this range. There were no significant changes throughout pregnancy. CONCLUSIONS: SBA values in uncomplicated pregnancies are consistent, regardless of gestation, and are not elevated in pregnancy. The current reference values for the diagnosis of OC appear to be appropriate.

Randomized, controlled, bilateral (split-face) comparison trial of the tolerability and patient preference of adapalene gel 0.1% and tretinoin microsphere gel 0.1% for the treatment of acne vulgaris.

Poor patient compliance is one of the main reasons for treatment failure in acne. Our objective was to evaluate the tolerability and patient preference of adapalene gel 0.1% compared with tretinoin microsphere gel 0.1% using a randomized, controlled, investigator-masked, bilateral (split-face), 4-week comparative study of the 2 products when applied once daily in 40 patients. We found that adapalene produced less stinging/burning than tretinoin at weeks 1 and 4 and, overall, more patients felt more skin irritation on the side of the face treated with tretinoin than on the side treated with adapalene (P<.05). At week 4, a significantly greater number of patients preferred adapalene gel 0.1% to tretinoin microsphere gel 0.1% (72.5% vs 27.5%, respectively, P<.01).

Correlation of serum 3 alpha-androstanediol glucuronide with acne and chest hair density in men.

Serum 3 alpha-androstanediol glucuronide (3 alpha-Adiol-G) is considered to be an indicator of peripheral tissue androgen metabolism. Precursor circulating androgens are converted in peripheral tissue to dihydrotestosterone (DHT), which is ultimately metabolized to 3 alpha-Adiol-G and secreted from the cell. Elevated serum 3 alpha-Adiol-G concentrations have been reported in women in hyperandrogenic states. We studied 44 consecutive male medical students for chest hair density, acne, and serum dehydroepiandrosterone sulfate (DHEA-S), total testosterone (total T), free and albumin-bound (bioavailable) T (bio T), and 3 alpha-Adiol-G concentrations. Although there was considerable overlap of serum 3 alpha-Adiol-G values among the groups defined by hair density or acne scores, we found statistically significant correlations between serum 3 alpha-Adiol-G and chest hairiness (P = 0.0034), acne (P = 0.0005), and a combined chest hairiness and acne score (P = 0.0018). There was no significant correlation between these clinical parameters and the levels of precursor androgens. There was, however, a strong correlation between serum 3 alpha-Adiol-G and bio T (P = 0.0005), suggesting that in men serum 3 alpha-Adiol-G levels may be dependent upon available free and albumin-bound T. The correlations in men of serum 3 alpha-Adiol-G with chest hair density, acne, and the hairiness and acne index supports the hypothesis that the serum levels of 3 alpha-Adiol-G reflect the extent of androgen action in peripheral tissues.

Skin lesions caused by Mycobacterium scrofulaceum.

A 32-year-old man with systemic lupus erythematosus controlled by steroid therapy developed multifocal cutaneous abscesses caused by Mycobacterium scrofulaceum. The distribution and evolution of the lesions suggested hematogenous dissemination, but he exhibited no pulmonary or other visceral manifestations of systemic mycobacterial disease. The patient completed nine months of therapy with isoniazid and rifampin, and the lesions resolved within five months of presentation.

Elimination of lymphangioma circumscriptum by suction-assisted lipectomy.

Lymphangioma circumscriptum presents as cutaneous vesicles or skin tags that drain lymphatic fluid. Deep, sequestered lymphatic cisterns encircled by smooth muscle are thought to be the cause of the skin manifestations, and selective resection of the deep cisterns, not the involved overlying skin, has been suggested as the treatment of choice. We report a successful treatment of lymphangioma circumscriptum using suction-assisted lipectomy to obliterate the deep lymphatic cisterns and their vertical channels communicating to the skin.

Junctional epidermolysis bullosa and pyloric atresia in two siblings.

Pyloric atresia is a rare disorder that has been seen in association with epidermolysis bullosa. Two male siblings with pyloric atresia and the junctional form of epidermolysis bullosa, confirmed by electron microscopy, are described herein. These cases strengthen the relationship between junctional epidermolysis bullosa and pyloric atresia, which are probably transmitted together in an autosomal-recessive pattern.

Tissue production of androgens in women with acne.

Precursor and target tissue-produced androgens were measured in the plasma of eighteen women with mild to moderate acne. Mean plasma levels of the precursor androgens (total testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulfate) wer similar to levels in a group of carefully selected acne-free and hirsute-free, age-matched female controls. In contrast, plasma 3 alpha-androstanediol glucuronide (3 alpha-diol G) values were elevated in 13 of the patients, with a mean value for the entire group nearly threefold that of the normal controls (117 vs 43 ng/dl; p less than 0.001). These results support the concept that target tissue androgen production plays an important hormonal role in the pathogenesis of acne in women and that plasma 3 alpha-diol G may be the most sensitive marker of this process.