Skin virilism in women with hrsutism

Characterization, expression, and immunohistochemical localization of 5 alpha-reductase in human skin

Human skin has been shown to contain a high level of 5 alpha-reductase activity, the enzyme that catalyses the conversion of the weak androgen testosterone into dihydrotestosterone, the most potent androgen. Because two types of 5 alpha-reductase genes have been characterized in humans, we have cloned 5 alpha-reductase cDNAs from adult human keratinocyte and skin fibroblast cDNA libraries to identify and gain better knowledge of the 5 alpha-reductase expressed in normal human skin. Nucleotide sequence analysis shows that the clones obtained correspond to the type I 5 alpha-reductase. RNase protection analysis using (poly A)+ RNA obtained from human skin and prostate also confirms that type I 5 alpha-reductase is the predominant type expressed in normal skin, whereas type II 5 alpha-reductase is the major form found in the prostate. Following polymerase chain reaction amplification of human keratinocyte and skin fibroblast cDNA, a low level of type II 5 alpha-reductase cDNA has been detected. Using antipeptide antibodies raised in rabbits against the peptide sequence covering amino acids 227 -240 to perform immunohistochemical localization of 5 alpha-reductase, we have found that 5 alpha-reductase is distributed in sweat and sebaceous glands, as well as in the epidermal cell layers, thus providing the basis for the important role of androgens in human skin and its appendages.

Characterization, expression, and immunohistochemical localization of 3 beta-hydroxysteroid dehydrogenase/delta 5-delta 4 isomerase in human skin

Three beta-hydroxysteroid dehydrogenase/delta 5-delta 4 isomerase (3 beta-HSD) catalyses an obligatory step in the biosynthesis of all classes of hormonal steroids, namely, the oxidation/isomerization of 3 beta-hydroxy-5-ene steroids into the corresponding 3-keto-4-ene steroids in gonadal as well as in peripheral tissues. Because humans are unique with some primates in having adrenals that secrete large amounts of the steroid precursors dehydropiandrosterone (DHEA) and its sulfate (DHEA-S) and its exceptionally large volume makes the skin an important site of steroid biosynthesis, we have isolated and characterized cDNA clones encoding 3 beta-hydroxysteroid dehydrogenase/delta 5-delta 4 isomerase from a human skin lambda gt11 library. The longest clone obtained contains the entire coding sequence for type I 3 beta-HSD (372 amino acids) as well as an additional 131 nucleotides in the 5'-untranslated region. The insert of 1647 bp containing the entire coding region has been inserted in a pCMV expression vector and transfected into human cervical carcinoma cells (HeLa). The expressed enzyme efficiently catalyzes the transformation of pregnenolone, DHEA, and dihydrotestosterone into progesterone, 4-androstenedione, and 5 alpha-androstane-3 beta, 17 beta-diol, respectively. Using the enzyme expressed in HeLa cells, we have shown cyproterone acetate, a progestin used in the treatment of acne and hirsutism, as well as norgestrel and norethindrone, two steroids widely used as oral contraceptives, to be relatively potent inhibitors, with Ki values of 0.38 microM, 1.3 microM, and 1.2 microM, respectively. Immunohistochemical localization of 3 beta-HSD, illustrated by using an antibody raised against human placental 3 beta-HSD, shows that the enzyme is localized in sebaceous glands.

Autonomic function in cholinergic urticaria and atopic eczema

Autonomic function in patients with cholinergic urticaria and atopic eczema was compared with that in patients with chronic idiopathic urticaria and non-atopic allergic contact dermatitis, respectively. Forty-nine patients were studied. The following specific tests of sympathetic and parasympathetic function were used to assess the integrity of autonomic control: pupillary reflex amplitude in response to pulsed light stimulation and response to topical arecoline hydrobromide (parasympathetic); the speed of pupillary dilatation following a large light reflex (sympathetic); pupillary resting diameter (sympathetic and parasympathetic); sweat gland response to forearm intradermal injection of acetylcholine chloride; and the effect of postural change and deep breathing on blood pressure and heart rate (sinus arrhythmia indicating parasympathetic function). No significant difference in autonomic function was found between the four groups of patients.

The relationship between the vitro activity of 3 beta-hydroxysteroid dehydrogenase delta 4-5-isomerase in human sebaceous glands and their secretory activity in vivo

3 beta-hydroxysteroid dehydrogenase delta 4-5-isomerase (delta 5-3 beta-HSD) catalyzes an early step in the synthesis of testosterone from dehydroepiandrosterone (DHA). We compared enzyme activity in back skin biopsies with sebum excretion rate (SER) in 14 individuals. The rate of conversion of [7 alpha-3H]DHA into [3H]-4-androstene-3,17-dione was measured in cryostat sections of skin and compared with the sebaceous gland content of the same biopsies. Reaction rate was proportional to the volume of sebaceous gland tissue in the sections. Enzyme activity was absent from sections without histologically identifiable sebaceous gland tissue. This suggests that the delta 5-3 beta-HSD is localized in sebaceous glands. SER, measured by a modified photometric technique at the biopsy site, correlated highly with sebaceous gland volume and with the rate of conversion of DHA into androstenedione in the biopsy. For each biopsy, specific activity of delta 5-3 beta-HSD in sebaceous glands was calculated by dividing the rate of formation of [3H]-4-androstene-3,17-dione by sebaceous gland volume. Specific activity of delta 5-3 beta-HSD did not correlate significantly with SER, suggesting that variations in concentration of delta 5-3 beta-HSD in sebaceous glands probably do not underlie variations in sebaceous gland activity.

Male-pattern alopecia and masculinity

Cutaneous processes which are thought to be influenced by androgenic stimulation include the development of male-pattern alopecia, terminal hair distribution, sebum excretion rate, maximal sweat secretion rate and skin thickness. We measured these indices in forty-eight normal men, together with muscle, fat and bone thickness and plasma testosterone. There was a significant correlation between hair density on the forearm, leg and chest, but no other significant correlations were found. We conclude that bald men are no more 'masculine' than those with good scalp hair growth, if masculinity is defined in terms of end-organ response to androgenic stimulation.

Increased sebaceous gland activity in the adult rat after alpha-melanocyte-stimulating hormone treatment during early life

Sebum secretion was measured in adult female and male rats given alpha-melanocyte stimulating hormone (alpha-MSH) during early life. Daily treatment with 40 microgram alpha-MSH/100 gm body weight for the first 5 weeks of life increased sebum secretion in female and male rats at 8, 11, and 15 weeks of age. A lower dose of alpha-MSH (10 microgram/100 gm body weight) produced similar changes in male but not in female rats. No effect on sebum secretion was found in female and male rats aged between 8-28 weeks when alpha-MSH was given (1) from the day of birth to 3 weeks; (2) 3--5 weeks; (3) 1st and 5th weeks and (4) 7--12 weeks. Apparently alpha-MSH must be given throughout the first 5 weeks of life in order to produce a sustained effect on the sebaceous glands. The fact that males appear to be more sensitive than females, in that they responded to a lower dose of alpha-MSH, may indicate that MSH acts by enhancing the response to androgen. Early alpha-MSH treatment failed to alter the sebaceous gland response to testosterone in adult female and male rats but the possibility that alpha-MSH enhances the action of androgen in early life cannot be ruled out.

Myocardial infarction, androgen and the skin

Various indices of masculinity were compared in 48 men who had recovered from myocardial infarction and in their age-matched controls. We found little evidence to support the idea that myocardial infarction is related to increased androgenic stimulation. The patients with myocardial infarction had no increase in plasma testosterone, muscle thickness, sebum excretion rate, maximal sweat secretion rate, male pattern alopecia or density of terminal body hair, but as a group they had a slight increase in skin and bone thickness compared with the controls.

A study of the in vitro metabolism of androgens by human scalp and pubic skin

The metabolism of dehydroepiandrosterone, androstenedione and testosterone was compared in vitro in human scalp, forehead, pubic and axillary skin biopsies. Conversion of testosterone to the metabolite 5alpha-dihydrotestosterone, believed to be the active form of androgen, occurred in all tissues; however 17-oxosteroids such as androstenedione, 5alpha-androstanedione and androsterone were also formed from testosterone and were the major metabolites of scalp and forehead skin. While 17beta-hydroxy steroid dehydrogenase activity was present in every skin sample, it was evident there were differences in the direction of operation of this enzyme in skin from different body sites. Axillary skin readily metabolised androstenedione and dehydroepiandrosterone to active 17beta-hydroxy steroids such as testosterone and 5alpha-dihydrotestosterone, but these compounds were minor metabolites of androstenedione and dehydroepiandrosterone in forehead and scalp skin despite their activity in 17beta-oxidation of testosterone. Pubic skin was intermediate between axillary and scalp skin in its ability to form 17beta-hydroxy products from androstenedione and dehydroepiandrosterone. It is suggested these patterns of metabolism may reflect differences in androgen sensitivity.

Biological purpose of acne

It is argued that the close endocrine control of human sebaceous glands and the likely effects of acne on selection indicate that both gland and disease have persisted because they are biologically useful. Two possibilities are proposed: sebum may provide precursor substrates for metabolism and synthesis by the epidermis of compounds of both local and systemic importance; and the adjuvent properties of corynebacteria which colonise the active sebaceous glands of acne may facilitate certain general immunological membrane.

The influence of age and sex on skin thickness, skin collagen and density

Forearm skin collagen, dermal thickness and collagen density were measured in a large number of normal subjects as a standard reference for future studies. Skin collagen decreased with age and was less in the females at all ages. There is a direct relationship between skin collagen and dermal thickness but variations in collagen density in disease limit the use of dermal thickness as a guide to changes in its collagen content.