Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042109 (urticaria)
 6,569 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This comprehensive review of transdermal delivery systems for estrogens and progestins covers skin structure and absorption of chemical agents by diffusion and partition, permeability and use of enhancers to speed absorption, choices of drugs for transdermal contraceptives, animal and clinical work with estradiol, ethinyl estradiol and levonorgestrel, use of pro-drugs and derivatives, types of transderm delivery systems, metabolism of these drugs by skin and skin flora, and cutaneous side effects, all illustrated graphically and mathematically. Drug absorption entails diffusion through the primarily and mathematically. Drug absorption entails diffusion through the primarily lipophilic stratum corneum, and the hydrophilic epidermis: transport between these layers is often the rate-limiting step. For many drugs, permeability enhancers such as dimethyl sulfoxide, ethanol and ethyl acetate are needed. Good drug candidates for transdermal application must be potent in low doses, have short half-lives, not elicit an allergic response nor be extensively metabolized in skin. The permeability of levonorgestrel has been increased by using esters, and "pro-drugs" which are compounds that increase polarity, but are degraded to the active drug by skin tissue. The estrogens are subject to a minor degree of oxidation, and no significant degradation by skin microbes. There are 3 types of transdermal systems: the membrane, matrix and drug reservoir types. The Estraderm brand system for estradiol is a membrane-moderated design with ethanol as the chemical enhancer. Skin penetration is the rate-limiting step. Levonorgestrel as been tested with ethyl acetate and ethanol as penetration enhancers in rats, rabbits, and in a Phase I trial. The development of a transderm system for a combination of estrogen and progestin is a complex problem because 2 different enhancers must be used. Most transdermal systems are mild skin irritants, but incidence of contact allergy or urticaria are rare, with no cases yet reported from use of Estraderm. Transdermal application of contraceptive steroids is expected to be available eventually.
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PMID:Transdermal delivery of contraceptives. 227 99

Angioedema without urticaria is a clinical syndrome characterised by self-limiting local swellings involving the deeper cutaneous and mucosa tissue layers. Most occurrences of angioedema respond to treatment with a histamine H1 receptor blocker (antihistamine) because they are an allergic or parallergic reaction. A small number of cases do not respond to antihistamine treatment. Such cases tend to occur in patients with deficiency or dysfunction of the inhibitor of the first component of the complement (C1-INH), but more rarely can occur in patients with other conditions and as an adverse drug reaction. Angioedema is well documented in patients taking ACE inhibitors. Considering that 35 to 40 million patients are treated worldwide with ACE inhibitors, this drug class could account for several hundred deaths per year from laryngeal oedema. ACE inhibitors certainly do not mediate angioedema through an allergic or idiosyncratic reaction. For this reason the relationship with this drug is often missed and consequently quite underestimated. Rare instances of angioedema have also been reported with angiotensin II receptor antagonists. This adverse effect seems to occur less frequently with angiotensin II receptor antagonists than with ACE inhibitors. However, we do not know whether this adverse effect has the same mechanism with the 2 classes of medications. Some cases of severe angioedema have been recently reported after treatment with fibrinolytic agents. Scattered reports suggest the possibility of angioedema associated with the use of estrogens, antihypertensive drugs other than ACE inhibitors, and psychotropic drugs. Angioedema can also occur with nonsteroidal anti-inflammatory drugs. Prevention of angioedema relies first on the patient history. Estrogen and ACE inhibitors should be avoided in a patient with congenital or acquired C1-INH deficiency. In the case of ACE inhibitors, the appearance of angioedema following long term treatment does not lessen the probability that such an agent could be the cause. The most important action to take in a patient with suspected drug-induced angioedema is to discontinue the pharmacological agent. Epinephrine (adrenaline), diphenydramine and intravenous methylprednisolone have been proposed for the medical management of airway obstruction, but so far no controlled studies have demonstrated their efficacy. If the acute airway obstruction leads to life-threatening respiratory compromise an emergency cricothyroidotomy must be performed.
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PMID:Drug-induced angioedema without urticaria. 1148 Apr 92

Fertility control by cyclic norethindrone (Norlutin), 17 alpha-ethinyl 19-nortestosterone, plus .06 mg 3-methoxy ethinyl estradiol (Ortho-Novum) was studied in 364 women over a period of 32 months for a total of 6062 cycles. No patient who followed the instructions became pregnant. 37 patients stopped the medication for various reasons. The interval between stopping medication and becoming pregnant averaged 1.6 months. 13 of these pregnancies occurred after 11-15 cycles of treatment. Children born to these mothers were normal with no virilization observed. Findings from all Papanicolaou smears and cervical biopsies were normal. The desirable effects of diminishing the menstrual flow, reducing dysmenorrhea and regulating the menstrual cycle, plus the all-important one of contraception, far outweighed minimal and infrequent undesirable side effects (in order of frequence: chloasma, hot flashes, headache, nausea, acne, abdominal pain, dizziness and urticaria). In only 4.8% of the total 6062 cycles was some complaint made.
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PMID:Long-term administration of norethindrone in fertility control. 1227 4

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.
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PMID:[Cutaneous effects in hormonal contraception]. 1228 Dec 76

Autoimmune progesterone dermatitis is a rare clinical condition in which patients display hypersensitivity to endogenous progesterone. It manifests as a cyclical cutaneous eruption that flares during the luteal phase of the menstrual cycle, when progesterone levels peak, and resolves partially or completely a few days after menses. Its cutaneous manifestations are variable and include urticaria, eczematous eruptions, vesiculopustular eruptions, fixed drug eruptions, stomatitis, erythema multiforme, and anaphylaxis. Autoimmune progesterone dermatitis has been diagnosed previously with intradermal skin testing or intramuscular progesterone challenge. Treatment of progesterone hypersensitivity generally consists of ovulation inhibition with pharmaceutical agents or oophorectomy; other therapies (eg, thalidomide) have also been used with success. We report a case of cyclical erythema multiforme (EM) induced by hypersensitivity to endogenous progesterone in a patient with a history of past oral contraceptive use. After herpes simplex virus was ruled out as an etiologic factor, a diagnosis of progesterone hypersensitivity was confirmed with intradermal skin testing. Results of subsequent patch testing with various progesterone derivatives were negative. The EM outbreaks were suppressed temporarily by continuous administration of Loestrin (ethinyl estradiol plus norethindrone), which also increased the responsiveness of the outbreaks to prednisone tapers.
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PMID:The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis. 1680 Feb 78

The cutaneous diseases associated with progesterone are autoimmune progesterone dermatitis, erythema multiforme-like eruption, drug-induced progesterone dermatitis and solar urticaria. Estrogen and progesterone are widely used in oral contraceptives and hormone replacement therapies, and they are rarely known to cause a photosensitive reaction. The mechanism of contraceptive-induced photosensitivity is uncertain. Estrogen, rather than progesterone, in the combined oral contraceptive pill has been most frequently implicated in the induction of photosensitivity. A 32-year-old woman presented with an erythematous patch with an itching sensation on the centrofacial area of a residual vitiligious lesion. She had a history of being previously treated with narrow band UVB for 1 year. Her skin lesions had mostly subsided, but some lesions continued. She underwent an in vitro fertilization-embryo transfer 3 months previously, and she then took synthetic progesterone for 3 weeks starting at the 4th week of pregnancy. She was in good health with neither a family history of photosensitivity nor a personal history of any other drug ingestion or topical agent such as sunscreen in association with the beginning of her lesions. Phototesting revealed her to be markedly photosensitive in the UVB and UVA ranges. The intradermal skin reactions to progesterone combined with irradiation with UVA or UVB were positive. We report here on an unusual case of photosensitivity that was localized in a vitiliginous lesion, and this was associated with the intramuscular injections of synthetic progesterone that she had received during an in vitro fertilization-embryo transfer.
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PMID:The Photosensitivity Localized in a Vitiliginous Lesion Was Associated with the Intramuscular Injections of Synthetic Progesterone during an In Vitro Fertilization-embryo Transfer. 2054 67