The effect of eflornithine 13.9% cream on the bother and discomfort due to hirsutism

Although unwanted facial hair often leads to anxiety and avoidance of social situations, evaluation of treatment outcomes in clinical trials has relied largely on measures external to the patient such as the extent of hair growth or an expert physician's assessment, neglecting to include patient reported outcomes (PRO). To assess the level of bother caused by a dermatological condition (hirsutism) and changes brought on by treatment, the instrument ESTEEM was developed by expanding the Bother Assessment in Skin Conditions (BASC) scale to six questions to cover the discomfort felt in four social situations and bother due to removing facial hair. Each question elicits responses on a visual analog scale. Women participating in two randomized clinical trials evaluated a new treatment (eflornithine 13.9% cream). Analyses examined the level of bother at each visit, the changes with treatment, the correlations with the Physician's Global Assessment, and the effect size. Hirsutism bothers patients considerably. The mean for overall bother was 89% and the mean discomfort in social situations exceeded 80% in nearly all cases. Treatment led to significant reductions in bother on all six items with effect sizes ranging from 0.46 to 1.62. Eflornithine is an effective treatment for unwanted facial hair in women, as reported by the patients. ESTEEM addresses the specific concerns of women with hirsutism.

Spironolactone metabolism: steady-state serum levels of the sulfur-containing metabolites

Metabolism of spironolactone in man is extensive and complex. For many years the dethioacetylated metabolite, canrenone, was assumed to be the major metabolite. However, recent studies using specific high performance liquid chromatography (HPLC) have demonstrated the presence of spironolactone and the sulfur-containing metabolites 7 alpha-thiomethylspirolactone (IV) and 6 beta-hydroxy-7 alpha-thiomethylspirolactone (V), in addition to canrenone, in the serum after a single oral dose of spironolactone. The importance of spironolactone and metabolites IV and V relative to canrenone at steady state remains unknown and was the subject of the present investigation. Twelve healthy males received 100 mg spironolactone, once daily, for 15 days. Repeated blood samples were taken on days 1, 8 and 15 for estimation of spironolactone and its metabolites. Peak serum levels [mean (SD)] of spironolactone, canrenone, and sulfur-containing metabolites IV and V were 72 (45), 155 (43), 359 (106) and 101 (26) ng/ml, respectively on day 1 and 80 (20), 181 (39), 391 (118) and 125 (24) ng/ml, respectively on day 15. The AUC (0-24) values of these compounds on day 15 were 231 (50), 2173 (312), 2804 (777) and 1727 (367) ng.hr/ml, respectively and the post-steady state elimination half-life (t1/2) values were 1.4 (0.5), 16.5 (6.3), 13.8 (6.4), and 15.0 (4.0) hours, respectively. It was concluded that unmetabolized spironolactone is present in the serum and that the sulfur-containing metabolite IV rather than canrenone is the major metabolite in serum following single or repeated doses of spironolactone.

Histochemical studies of keratoconus

We quantitated the amount of collagen in corneas obtained from patients with keratoconus. Following a previously described procedure, we deparaffinized tissue sections and stained them with the collagen-specific dye Sirius red. Twenty-two (group I) of 31 keratoconus corneas examined were normal, whereas the remaining 9 (group II) showed reduced collagen staining per mm2 of surface area compared with the controls. These results agreed with our previous data demonstrating heterogeneity in keratoconus in terms of collagen content analyzed biochemically. In addition, we adapted another histochemical method, using safranin O, to measure the polyanion (mainly glycosaminoglycan) content in paraffin sections of the same specimens. All except two keratoconus corneas showed markedly higher polyanion staining per mm2 of surface area than the controls. This suggests that keratoconus corneas may contain an increased amount of glycosaminoglycans and other polyanions. Such an abnormality may be related to some of the pathologic changes seen in these corneas.

Collagen staining in corneal tissues

We adapted a previously described procedure to quantitate collagen in corneal tissue sections prepared from paraffin-embedded samples. The method entailed staining the deparaffinized tissue sections with Sirius red, eluting the bound dye with NaOH-methanol, and estimating the color in a spectrophotometer as an indication of the collagen content. This simple, rapid and reproducible method is comparable to biochemical assays and can be applied to study various corneal specimens readily available from eye pathology laboratories. We examined corneal sections from patients with aphakic bullous keratopathy, pseudophakic bullous keratopathy, Fuchs' dystrophy and lattice corneal dystrophy with this method. No significant difference in collagen staining was found between these pathologic specimens and normal control tissues. Biochemical assays also confirmed these findings. Sections from patients with macular and granular corneal dystrophies showed reduced staining suggesting a possible alteration in collagen content. This possibility, however, was not supported by data from biochemical analysis.