Post Cycle Depression Cure.
You have sent too many requests causing Linguee to block your computerDer folgende Artikel beschreibt Geschlechterunterschiede vordergründig bei Unipolarer Depression lat.: Anders als bei unipolaren Depressionen zeigt sich bei bipolaren Störungen und Manie Affektive Störung i. Von einem steroids cure depression geschlechterspezifischen Prävalenzunterschied affektiver Störungen kann somit nicht ausgegangen werden vergleiche Grafik 1. Dennoch unterscheiden sich auch bei bipolaren Störungen Verlauf und genaue Krankheitssymptomatik zwischen den Geschlechtern. Studien bestätigen überwiegend das weibliche Steroids cure depression als einen Risikofaktor für die Entwicklung einer depressiven Episode.
Oxidative Medicine and Cellular Longevity
Chronic hand eczema is a debilitating dermatological condition with significant economic, social, and functional impacts.
To date, conventional treatments such as topical corticosteroids, phototherapy, and systemic immunosuppressants have yielded disappointing results, owing to either a lack of efficacy or significant adverse events. Oral alitretinoin 9-cis-retinoic acid is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema. Hand eczema has a multi-factorial etiology, involving both endogenous and exogenous factors.
Occupational exposure to these causative agents, primarily among dressers, cooks, healthcare workers, for example, are the most common causes of hand eczema.
When hand eczema persists for more than 6 months despite therapeutic measures, it is considered to be a chronic form. A broad variety of both pharmacological and non-pharmacological strategies exist for the management of chronic hand eczema.
These are usually delivered in a step-wise approach and begin by lifestyle modifications, including educating the patient about the avoidance of irritants and allergens, the avoidance of occupational-related irritation, and the use of emollients. However, most of these are not licensed for the treatment of chronic hand eczema, owing to the lack of clinical evidence supporting their lack of efficacy and safety.
Oral corticosteroids are also an option, but their long-term use is limited by well-studied adverse affects such as osteoporosis, hyperglycemia, cataracts, hypertension, and immunosuppression. The high prevalence of chronic hand eczema, its adverse impact on quality of life, and its failure to respond to standard therapeutic measures has ignited much recent interest in the search for an effective and tolerable medication. Given its effects on cell proliferation, alitretinoin is a potent teratogen and is therefore contraindicated in pregnant women and women who might become pregnant during the course of treatment.
The metabolic effects of alitretinoin have also been extensively studied. It was recently shown to increase sex steroid synthesis in the rat hippocampus and therefore play a role in reproductive behavior. Oral alitretinoin has only been clinically approved for its use in chronic hand eczema, but recent studies have demonstrated its potential use in other dermatologic settings.
In a small study with six patients who were treated for the hand eczema, alitretinoin was also shown to be effective in treating lesions of their extrapalmar atopic eczema. While alitretinoin potentially has profound dermatological and non-dermatological applications, this review focuses on its treatment for chronic hand eczema.
Summarized results of clinical trials of oral alitretinoin in the treatment of refractory chronic hand eczema. In a pilot open-label study in , thirty-eight patients 19 men and 19 women with chronic hand eczema unresponsive to conventional treatment were treated with 20—40 mg of oral alitretinoin for 1 to 5 months. The patients assessed their own responses subjectively using the same 4 point scale. Side effects, such as headache, chelitis, conjunctivitis, and other mucocutaneous manifestations, were similarly recorded on a 4 point scale.
Only mild side effects related to hypervitaminosis A were noted, namely transient headache, chelitis, transient flushing, and conjunctivitis. In a larger randomized, double-blind, placebo-control study in , alitretinoin was again determined to be an efficacious and well-tolerated treatment for the treatment of refractory chronic hand eczema.
Patients were randomized into four treatment groups of placebo, 10 mg, 20 mg, and 40 mg of oral alitretinoin taken once a day for 12 weeks, and assessed at the end of the study as well as at a 3 month follow-up.
The researchers suggested that the response rate in the placebo group may be related to a variety of factors such as the natural course of the disease, placebo effects, or changes in influential factors of the disease eg, climate, level of stress, occupation. Safety evaluation of the drug at a 4 week follow-up revealed adverse effects only in the 40 mg dosage group, which included headache, flushing, hyperlipidemia, decreased hemoglobin level, and decreased free thyroxin level.
Patients stopped treatment if they responded within the first 12 weeks, while the others continued for the full duration of the study. The results of the investigation were concordant with the results in the previous study in There was not a uniform response rate amongst the various morphological classifications of hand eczema.
However, these classifications were not mutually exclusive so it would not be feasible to conclude that alitretinoin is more effective in one variant over the other. Adverse events were seen in One fatal event was reported in the 10 mg group, although it was from a myocardial infarction unrelated to treatment. Typical retinoid-related laboratory abnormalities were noted, which included increases in serum cholesterol and triglyceride levels, and decreases in thyroid-stimulating hormone TSH.
As the largest clinical investigation on chronic hand eczema to date, this study demonstrated promising results of dose-dependent efficacy of oral alitretinoin that were consistent with previous studies.
In , the results of an extension of the BACH study were published. The remaining participants in the study were 13 responders to previous treatment with placebo. Patients were treated for 24 weeks, but they stopped treatment if they responded within the first 12 weeks. Adverse events were similar in frequency to the previous studies, with headache being the most common.
Six patients in total 2 from each treatment group withdrew from the study due to adverse events. Laboratory abnormalities were comparable to those reported in previous studies, namely hypercholesterolemia, increased triglyceride levels, and reduced TSH levels.
This investigation was the first to show the long-term management of chronic hand eczema with intermittent systemic treatment, as it demonstrated the efficacy of retreatment with oral alitretinoin in patients who had previously relapsed. Chronic hand eczema has a significant detrimental effect on quality of life, work productivity, activity impairment, and heath care costs. Blome et al recently presented a method whereby patients answered two sets of questionnaires to weigh the importance of their treatment needs Patient Needs Questionnaire against their achieved benefits Patient Benefit Questionnaire.
The instrument was utilized in an open label study in the safety and efficacy of oral alitretinoin in patients with severe refractory hand eczema, in which the patients received 24 weeks of treatment with 30 mg of oral alitretinoin daily. Based on the PBI, an overwhelming The most common needs the patients wanted were to have their skin lesions improved, have confidence in therapy, get rid of itching, and to find a clear diagnosis and therapy.
Likewise, the most common treatment benefits included having confidence in the therapy, having confidence in the therapy, and being free of itching, as well as to lead a normal daily life.
Chronic hand eczema is a debilitating disease with profound social, functional, psychological, and economical impacts. Standard management to date has failed to provide an efficacious and convenient form of therapy without dangerous adverse reactions. In view of several controlled clinical studies, oral alitretinoin has been proven to be an effective and safe treatment modality in refractory patients with a high disease burden.
The current approved drug dosing is 30 mg daily for 12 to 24 weeks, depending on the response, with a dose decrease to 10 mg if any serious adverse reactions are experienced. A recent appraisal by the National Institute for Health and Clinical Excellence NICE supported this protocol and made recommendations as to when treatment should be stopped.
They advocated that the prescribing physician stop treatment once the patient has an adequate response, if the degree of hand eczema continued to be severe after 12 weeks of treatment, or if there was an inadequate response at 24 weeks.
Oral alitretinoin has recently been approved in several European countries, but despite positive results, it still faces several challenges for US approval.
This impedance can be attributed to revolving teratogenic concerns, its dose-dependent side effects, and a lack of long-term data on its effects on bone density. Furthermore, the pharmacoeconomics of the drug must be further explored prior to US approval. Nonetheless, oral alitretinoin has emerged as a promising treatment for patients with chronic hand eczema refractory to conventional medications.
National Center for Biotechnology Information , U. Clin Cosmet Investig Dermatol. Pedram Ghasri 1 and Noah Scheinfeld 2. Received Apr This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Chronic hand eczema is a debilitating dermatological condition with significant economic, social, and functional impacts.
Management A broad variety of both pharmacological and non-pharmacological strategies exist for the management of chronic hand eczema. Clinical studies Table 1 Table 1 Summarized results of clinical trials of oral alitretinoin in the treatment of refractory chronic hand eczema.
Investigators Date of study Patients Type of study Alitretinoin doses Duration of treatment Responders Bollag and Ott 24 38 patients Exploratory open-label 20 mg, 40 mg once daily 1—5 months mean 2. Open in a separate window. Conclusion Chronic hand eczema is a debilitating disease with profound social, functional, psychological, and economical impacts. Footnotes Disclosures The authors declare no conflicts of interest.
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Vitamin effects on the immune system: Retinoid, treatment of chromic hand dermatitis. International Union of Pharmacology. Expert Opin Investig Drugs. Bollag W, Ott F. Successful treatment of chronic hand eczema with oral 9-cis-retinoic acid. Effect of co-administration of retinoids on rat embryo development in vitro. Xu J, Drew PD. Retinoic acid stimulates 17betaestradiol and testosterone synthesis in rat hippocampal slice cultures.
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Steroids ; – Hermus AR, Smals AG, Swinkels LM, et al. Bone mineral density and bone turnover before and after surgical cure of A group of 21 to year old women with major depression exhibits greater plasma. Interview sleepingperiod time steroid receptor coactivator steroid-responsive Sequenced Treatment Alternatives to Relieve Depression signaltransducers. In der Behandlung einer Depression wird ein Nichtansprechen auf zwei adäquate Antidepressivatherapien Key words: treatment resistance, depression, antidepressants, lithium, thyroid hormone, atypical neuroleptics . Ovarielles Steroid-.