Stefano Lello

Istituto Dermopatico dell'Immacolata, Roma, Latium, Italy

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Publications (49)101.2 Total impact

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    ABSTRACT: In the menopausal transition (MT), combined oral contraceptive (COC) should be chosen accordingly to its neutrality on liver metabolism and to its ability to counter the increase of fat mass (FM) that occurs in this reproductive period of life. This prospective multi-centric observational study was conducted on 36 women in their MT at the Universities of Cagliari, Modena and Naples. The body weight (BW), the Body Mass Index (BMI), the waist to hip ratio (WHR), the measurement of body composition (BC) with the Multi-frequency Bioelectrical Impedance (MF-BIA) were performed before, at the 6th and at the 12th month of the study in which a group of women (control group; N.18) did not assume COC, whereas the other 18 women assumed the four-phasic COC containing estradiol valerate (EV) associated with dienogest (EV/DNG group). In comparison to controls in the EV/DNG group, a significant decrease (p < 0.05) of BW (58.8 ± 7.6 to 57.3 ± 7.0), BMI (24.1 ± 2.7 to 23.5 ± 2.8), WHR (0.82 ± 0.052 to 0.79 ± 0.048) and FM (17.7 ± 5.4 to 16.4 ± 5.6) was observed. In controls, FM significantly increased (17.0 ± 11 to 17.7 ± 2.7; p < 0.05). In conclusion, these results suggest that the anti-androgenic and progestinic activities of DNG associated with a weak estrogenic activity of EV, is a contraceptive method capable of counteracting the negative changes of BC occurring in the MT.
    Gynecological Endocrinology 09/2015; DOI:10.3109/09513590.2015.1079175 · 1.33 Impact Factor
  • Stefano Lello · Roberto Sorge · Nicola Surico ·
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    ABSTRACT: Osteoporosis (OP) and related fractures are well-known severe conditions affecting quality of life and life expectancy of postmenopausal women, with high economic costs in Europe. On behalf of The Italian Society of Gynecology and Obstetrics (Società Italiana di Ginecologia ed Ostetricia, SIGO), the Osteoporosis's Menopausal Epidemiological Risk Observation (O.M.E.R.O.) study, a national multicenter study on clinical risk factors of OP was organized, using FRAX® tool as a reference. Here, data from this study are presented, showing an important portion of Italian postmenopausal women affected by osteopenia/OP at high risk of fracture and the need to do prevention and/or treatment. Gynecologist can be a primary specialist in this important challenge.
    Gynecological Endocrinology 07/2015; DOI:10.3109/09513590.2015.1063605 · 1.33 Impact Factor
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    ABSTRACT: Prolactin (PRL) is a hormone, mainly secreted by lactotroph cells of the anterior pituitary gland. Recent studies have shown it may also be produced by many extrapituitary cells. Its well-recognized PRL plays an important role in lactation during pregnancy, but it is involved in other biological functions such as angiogenesis, immunoregulation and osmoregulation. Hyperprolactinemia is a typical condition producing reproductive dysfunction in both sexes, resulting in hypogonadism, infertility and galactorrhea. It may be also asymptomatic. Lactotroph adenomas (prolactinoma) is one of the most common cause of PRL excess, representing approximately 40% of all pituitary tumors. Several other conditions should be excluded before a clear diagnosis of hyperprolactinemia is made. Hyperprolactinemia may be secondary to pharmacological or pathological interruption of hypothalamic–pituitary dopaminergic pathways or idiopathic. Stress, renal failure or hypothyroidism are other frequent conditions to exclude in patients with hyperprolactinemia. We will review biochemical characteristics and physiological functions of that hormone. Clinical and pharmacological approach to hyperprolactinemia will also be discussed.
    Gynecological Endocrinology 07/2015; 31(7). DOI:10.3109/09513590.2015.1017810 · 1.33 Impact Factor
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    ABSTRACT: Objective Since its introduction 50 years ago, the contraceptive pill has continuously evolved to decrease the risk of venous thromboembolism (VTE) associated with its use. An increased risk of VTE still remains, however. Other concerns, such as effects on lipid and carbohydrate metabolism, have also been reported. In this study we compared two reference combined oral contraceptives (COCs) containing ethinylestradiol (EE)/levonorgestrel (LNG) and EE/drospirenone (DRSP) with COCs containing estradiol (E2) (estradiol valerate [E2V]/dienogest [DNG] and E2/nomegestrol acetate [NOMAC]). They were evaluated according to their influence on recognised haemostatic and metabolic markers. Methods A literature search of the MEDLINE/PubMed database was conducted for head-to-head studies. EE/LNG was chosen as the comparator pill. Results The haemostatic impact of E2 pills and EE/LNG has been extensively compared, in contrast to that of EE/DRSP and EE/LNG. Changes in haemostatic and metabolic marker levels between EE/LNG and E2V/DNG were generally not statistically significant. E2/NOMAC showed statistically significantly favourable results on haemostatic markers and had a neutral effect on carbohydrate and lipid metabolism when compared with EE/LNG. Conclusion E2/NOMAC exhibits less haemostatic and metabolic impact than EE/LNG and other COCs, suggesting that it may be a promising candidate to reduce residual VTE risk associated with COC use. Confirmation from a well-powered prospective clinical trial is, however, needed.
    The European Journal of Contraception and Reproductive Health Care 05/2015; 20(5):1-15. DOI:10.3109/13625187.2015.1050091 · 1.39 Impact Factor
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    Stefano Lello · Andrea Cavani ·
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    ABSTRACT: Estroprogestins (EPs) are combinations of estrogen and progestin with several actions on women's health. The different pharmacological composition of EPs is responsible for different clinical effects. One of the most used low-dose EP associations is ethinylestradiol 20 mcg plus levonorgestrel 100 mcg in monophasic regimen (EE20/LNG100). This review summarizes clinical pharmacology, cycle control, and effects on lipid and glucose metabolism, coagulation, body weight/body composition, acne, and sexuality of EE20/LNG100. Overall, EE20/LNG100 combination is safe and well tolerated, and in several studies the incidence of adverse events in the treated group was comparable to that of the placebo group. Cycle control was effective and body weight/body composition did not vary among treated and untreated groups in most studies. The EE20/LNG100 combination shows mild or no effect on lipid and glucose metabolism. Lastly, EE20/LNG100 is associated with a low risk of venous thromboembolism (VTE). In conclusion, in the process of decision making for the individualization of EPs choice, EE20/LNG100 should be considered for its favorable clinical profile.
    International Journal of Endocrinology 11/2014; 2014:102184. DOI:10.1155/2014/102184 · 1.95 Impact Factor
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    ABSTRACT: Estroprogestins with “natural oestrogen” has represented a new option in terms of combined hormonal contraception. So, the aim of this study is to investigate how estroprogestins with natural estrogen may modify the vaginal niche. In literature, very few studies focused on the interaction between hormonal contraception and vaginal milieu. This is a prospective comparative study. We enrolled 60 women from January 2013 to September 2013, 30 of them were administered estradiol valerate dienogest (E2V+DNG – Klaira®) in a quadriphasic regimen, while the other 30 women were administered 17-β estradiol with nomestrol acetate (EV+NOMAC – Zoely®) in a monophasic regimen. After a baseline study of vaginal milieu at recruitment of patients (Gram stain with Nugent score, vaginal pH, vaginal wet mount for the quantification of leukocytes, Lactobacilli and/or presence of Candida), we performed the same follow-up after six months of estroprogestin therapy. Our results showed that the women treated with E2V+DNG had a trend of an improvement of vaginal health in terms of increase of lactobacillar flora and reduction of vaginal pH in place of women treated with EV+NOMAC that showed a reduction of cervical mucus. Finally, our data about the effects on vaginal flora exerted by two estroprogestin pills (EPs) containing a natural estrogen suggest slight, but interesting differences in terms of vaginal ecology. These differences could be related to the type of estrogen, type of progestin, regimen of administration and, after all, to the net balance between estrogenic and progestin component of the EPs.
    Gynecological Endocrinology 07/2014; 30(11). DOI:10.3109/09513590.2014.936847 · 1.33 Impact Factor
  • Anna Capozzi · Stefano Lello · Alfredo Pontecorvi ·
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    ABSTRACT: Abstract There is great interest in new treatments of osteoporosis owing to general ageing of population and increased risk for fragility fractures in the elderly. Current therapies show a good efficacy in improving bone quality and bone density, but, in spite of a certain reduction in fracture rate, according to each treatment, the problem of osteoporotic fractures is yet far from to be solved. Moreover, some treatments may produce different side effects. Denosumab (Dmab), a receptor activator of nuclear factor kappa-B ligand (RANKL)-inhibitor, is an agent recently introduced in clinical practice for treatment of osteoporosis of postmenopausal women. Dmab has improved bone mineral density and prevented new vertebral and non-vertebral fractures with a similar efficacy in comparison with alendronate. Many clinical studies showed Dmab produces also significant improvement versus placebo in bone quality as indicated by decreasing markers of bone turnover. Patients using Dmab reported less risk of AFF (Atypical Femoral Fractures) and ONJ (Osteonecrosis of the Jaw) with an increased number of cellulitis. Here, we review articles using Dmab for female post-menopausal osteoporosis.
    Gynecological Endocrinology 03/2014; 30(6). DOI:10.3109/09513590.2014.892067 · 1.33 Impact Factor
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    ABSTRACT: Abstract The Pill has undergone many changes since its first appearance some 50 years ago. Key developments included the reduction of ethinylestradiol doses and the synthesis of new progestins in order to increase safety, compliance and efficiency. Low-dose combined oral contraceptives (COCs) are currently the preferred option for millions of women. Due to this widespread use, it has been argued that the safety of COCs should be even better, raising the threshold for excellence. Yet in spite of major improvements, there is still an associated risk of venous thromboembolism (VTE). The next step in COCs' evolution should take total estrogenicity and hepatic estro-androgenic balance into account. The focus on the estrogen component - which has not changed in 50 years - has yielded a new class of natural estrogen pills. Following the introduction of a first quadriphasic pill, a monophasic estradiol pill based on the concept of "natural balance" was subsequently made available. These recent achievements could represent a step forward in the evolution of COCs and pave the way for better safety.
    Gynecological Endocrinology 08/2013; 29(10). DOI:10.3109/09513590.2013.824963 · 1.33 Impact Factor
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    ABSTRACT: Decreasing levels of estrogens during menopause are associated with reduced bone density and an increased risk of osteoporosis. Many women also experience bothersome vasomotor and vaginal symptoms during the menopausal transition. Results of systematic reviews and meta-analyses of randomized controlled trials have shown that both systemic estrogen therapy or hormone therapy (estrogen combined with a progestin) are useful to prevent bone loss, and they are the most effective treatment for such climacteric symptoms as hot flushes, sweating, vaginal dryness, and dyspareunia. Unfortunately, estrogen therapy and hormone therapy increase the risk of endometrial and breast cancer, respectively. The selective estrogen receptor modulators (SERMs) result in positive estrogenic effects on bone, with no negative effects on the endometrium and breast but do not provide relief from postmenopausal symptoms. The combination of a SERM with estrogen as a tissue selective estrogen complex (TSEC) is a new strategy for the prevention of bone loss and the treatment of climacteric symptoms. This combination is particularly interesting from a clinical point of view, taking into account that estrogen alone did not increase breast cancer risk by the Women's Health Initiative. TSEC is hypothesized to provide the benefits of estrogen-alone therapy, with an improved tolerability profile because the SERM component can make possible the elimination of progestin. The objective of this review was to critically evaluate the evidence from the reports published to date on the use of bazedoxifene (a third-generation SERM) in combination with conjugated estrogens in postmenopausal women. The conclusion is that effectively, the combination of bazedoxifene and conjugated estrogens may be a promising alternative to hormone therapy for the prevention of osteoporosis and the treatment of postmenopausal symptoms in non-hysterectomized postmenopausal women.
    Drug Design, Development and Therapy 07/2013; 7:601-10. DOI:10.2147/DDDT.S47807 · 3.03 Impact Factor
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    ABSTRACT: Abstract We investigated whether a formulation containing vitamins and minerals (vit&min) could improve the worsening of mood changes occurring after delivery ("a.d."). The study was performed in 552 healthy non-anaemic puerperal women ("p.w") without risk factors for puerperal depression ("p.d"). They were at their first full-term pregnancy, and spontaneously delivered healthy newborns. The Edinburgh Depression Postnatal scale (EPDS) evaluates the psychological status of "p.w". EPDS was administered the 3rd (visit 1), 15th (visit 2) and 30th (visit 3) day "a.d.". An EPDS >12 indicates a major susceptibility to "p.d". At the same time intervals, haemoglobin, iron and ferritin (haematological parameters) levels were evaluated. After visit 1, the subjects were randomized to vit&min treatment (group A; N.274) or to calcium/vitamin D3 treatment (group B; N.278). In both groups haematological parameters significantly increased without differences between the groups. EPDS score improved in both groups, but in the group A, the EPDS decrease was significantly larger (p < 0.05) in comparison to the group B. This effect is mainly evident in subjects with a basal EPDS ≥12. An early examination of psychological condition could select "p.w." with a high susceptibility to neuronal changes occurring postpartum. Vit&min favourably modulates brain functions antagonizing the evolution to "p.d".
    Gynecological Endocrinology 06/2013; 29(8). DOI:10.3109/09513590.2013.801447 · 1.33 Impact Factor
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    ABSTRACT: Introduction: Bazedoxifene is a third-generation Selective Estrogen Receptor Modulator, developed on raloxifene's model, and investigated as treatment for postmenopausal osteoporosis and menopause management. Clinical trial have shown that bazedoxifene is effective as raloxifene in preventing bone loss in women at risk of osteoporosis and that in patients with osteoporosis it is effective in reducing the incidence of new vertebral fracture with a protection maintained for up 7 years. Areas covered: This drug evaluation presents the antifracture efficacy of bazedoxifine and evidence that it, unlike raloxifene, can reduce the rate of non-vertebral fractures in high-risk patients. The authors also review the effects of bazedoxifine has on reproduction tissues as well as the on lipid pattern. Additionally, the authors present the safety profile of bazedoxifine and discuss its prospects, specifically in relation to conjugated estrogen. Expert opinion: Despite its peculiar profile, bazedoxifene could be considered as a second-line therapy for women < 65 - 70 years of age, where bisphopshonates are contraindicated or not well tolerated. Furthermore, the authors believe that bazedoxifene could also have its place as a first-line therapy for younger postmenopausal patients in the management of menopause and prevention of osteoporosis; this could be prescribed either by itself or in combination with conjugated estrogen. The authors also highlight the fact that the association of bazedoxifene and conjugated estrogen could also be beneficial in the treatment of climacteric syndrome in patients with menopausal symptoms.
    Expert Opinion on Drug Metabolism &amp Toxicology 04/2013; 9(7). DOI:10.1517/17425255.2013.794221 · 2.83 Impact Factor
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    ABSTRACT: Introduction: Progesterone (P), and its receptors (PRs), play a key role in uterine leiomyoma growth. Selective progesterone receptor modulators exert mixed antagonist and agonist effects on the PRs. Mifepristone, a PR-antagonist, reduces leiomyoma volume and related symptoms. Ulipristal acetate (UPA) exerts a potent antiprogestin activity, with less antiglucocorticoid activity compared to mifepristone. This property provides potential advantages for long-term use. Areas covered: This paper focuses on the effect of UPA on leiomyoma's growth and related symptoms in women. The authors also evaluate UPA's efficacy in reducing leiomyoma's size and menorrhagia in Phase II/III trials. Expert opinion: In the authors' opinion, UPA (5 mg/day) over 3 months can be used to plan the surgery in women with symptomatic leiomyomas. The tolerability and the safety of treatment over a period longer than 3 months have to be evaluated. The results of the follow-up treatment suggest that further studies could successfully evaluate the efficacy and the tolerability of intermittent 3-month courses of treatment.
    Expert Opinion on Drug Metabolism &amp Toxicology 06/2012; 8(7):901-8. DOI:10.1517/17425255.2012.695775 · 2.83 Impact Factor
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    ABSTRACT: The risk for fragility fracture represents a problem of enormous magnitude. It is estimated that only a small fraction of women with this risk take the benefit of preventive measures. The relationship between estrogen and bone mass is well known as they are the other factors related to the risk for fracture. There are precise diagnostic methods, including a tool to diagnose the risk for fracture. Yet there continues to be an under-diagnosis, with the unrecoverable delay in instituting preventive measures. Women under the age of 70 years, being much more numerous than those older, and having risk factors, are a group in which it is essential to avoid that first fragility fracture. Today it is usual not to differentiate between the treatment and the prevention of osteoporosis since the common aim is to prevent fragility fractures. Included in this are women with osteoporosis or with low bone mass and increased risk for fracture, for whom risk factors play a primary role. There is clearly controversy over the type of treatment and its duration, especially given the possible adverse effects of long-term use. This justifies the concept of sequential treatment, even more so in women under the age of 70, since they presumably will need treatment for many years. Bone metabolism is age-dependent. In postmenopausal women under 70 years of age, the increase in bone resorption is clearly predominant, related to a sharp drop in estrogens. Thus a logical treatment is the prevention of fragility fractures by hormone replacement therapy (HRT) and, in asymptomatic women, selective estradiol receptor modulators (SERMs). Afterwards, there is a period of greater resorption, albeit less intense but continuous, when one could utilise anti-resorptive treatments such as bisphosphonates or denosumab or a dual agent like strontium ranelate. Bone formation treatment, such as parathyroid hormone (PTH), in women under 70 years will be uncommon. That is because it should be used in cases where the formation is greatly diminished and there is a high risk for fracture, something found in much older women.
    Gynecological Endocrinology 05/2012; 28(10):770-86. DOI:10.3109/09513590.2012.679062 · 1.33 Impact Factor
  • L Colonna · V Pacifico · S Lello · R Sorge · D Raskovic · G Primavera ·
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    ABSTRACT: Background Despite it is accepted that acne is mostly caused by an hyper-responsiveness of the pilo-sebaceous unit to normal circulating androgen hormones, in a few patients, especially women, acneic lesions can be associated with increased serum androgen levels (hyperandrogenism), of which polycystic ovary syndrome (PCOS) is the most common cause. In women with acne and proven PCOS therapy with estroprogestins (EPs) can be an excellent option. Objective The aim of the study was to assess the effects of two estroprogestins (EPs), ethinyl-estradiol (EE) 30 mcg/drospirenone (DRSP) 3 mg, and ethinyl-estradiol (EE) 30 mcg/chlormadinone acetate (CMA) 2 mg, both on increased serum androgen levels and on several skin parameters in women affected by mild to severe acne and polycystic ovary syndrome (PCOS). Methods Fifty-nine women were randomized to receive EE/DRSP (n = 32) or EE/CMA (n = 27) for six months. Evaluation of serum androgen levels, grading of acne and hirsutism (respectively with Pillsbury and Ferriman-Gallwey score) and non-invasive assessment of skin hydration, transepidermal water loss (TEWL) and skin homogeneity were performed at baseline, at 3 and 6 months (end of treatment). Results Both treatments were well tolerated and showed a significant improvement of skin and hormonal parameters, although EE/DRSP showed a more potent effect on acne and seborrhea. Conclusions Estroprogestins represent an effective and safe treatment in women with acne and polycystic ovary syndrome (PCOS). Nevertheless, the combination EE 30 mcg/DRSP 3 mg appears to be a more potent therapeutic option.
    Journal of the European Academy of Dermatology and Venereology 10/2011; 26(11):1364-71. DOI:10.1111/j.1468-3083.2011.04292.x · 2.83 Impact Factor
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    ABSTRACT: A Multidisciplinary National Panel of Experts in the management of Menopause and Postmenopausal Osteoporosis was created to determine the specific positioning of Bazedoxifene acetate (BZA), a third-generation selective estrogen receptor modulator (SERM), in the field of available therapeutic options in prevention and treatment of postmenopausal osteoporosis.There are various therapeutic options in prevention and treatment for postmenopausal osteoporosis, but nevertheless the problem of osteoporosis and osteoporosis-related fractures is not yet resolved today.In view of this unmet medical need, to have new treatments with efficacy and safety profile so good to therapeutically manage even larger groups of population is the conceptual basis to reduce the devastating impact of this disease on individual's morbidity and mortality, and on public health expense.The Panel has, moreover, pointed up the need to increase the awareness about the issue "osteopenia" as a risk factor for fracture to consider in daily clinical practice and the opportunity to evaluate fracture risk using an adequate algorithm (for example, FRAX®, deFRA®), which integrates the result obtained by densitometry (Bone Mineral Density, BMD) (1, 2) and clinical risk factors, in order to consider threshold values for pharmacological intervention.As for prevention and treatment and different groups of age in women's life, it is evident as in the group ranging in age 50 to 65 years the reference Specialist may be the Gynecologist, as the Woman's doctor, even if other Specialists could be interested (Endocrinologist, Rheumatologist, Internist, General Practitioner, or other Specialist who is seeing a patient with osteopenia/osteoporosis). The involved Specialist, necessarily, has to make preventative and/or therapeutic strategies for osteopenia/osteoporosis.After the publication of the study Women's Health Initiative (WHI) in 2002 (3), there was a decrease in applying Hormonal Replacement Therapy (HRT) or Hormone Therapy (HT), that even if is prescribed for climacteric symptoms (hot flushes, night sweats, etc.) can prevent bone loss and reduce osteoporosis-related fracture risk. The lower use of HRT (HT) has increased and still increases the risk of developing, in postmenopausal women, osteopenia and osteoporosis, with increased fracture risk, as it is demonstrated by N.O.R.A. Study (National Osteoporosis Risk Assessment) published in 2004 (4).On the other hand, the different treatments available for osteoporosis therapy, significantly decrease the relative risk of osteoporosis, but the percentage of non-treated or under-treated patients remains high. Thus, it is still fundamental to have at disposal further treatments with proven efficacy in preventing and treating osteopenia and osteoporosis in everyday clinical practice.
    09/2011; 8(3):29-32.
  • S Lello ·
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    ABSTRACT: Prevention of osteopenia/osteoporosis in postmenopausal patients can reduce fracture risk. In this view, the use of Selective Estrogen Receptor Modulators (SERMs) appear to be important in managing this condition. Bazedoxifene Acetate (BZA) is a third-generation SERM that showed to protect bone mass in postmenopausal women with osteopenia, and to reduce vertebral fracture risk in osteoporotic postmenopausal women; moreover, BZA decreased the non-vertebral fracture risk in a subgroup of patients at high-risk for fracture in comparison to placebo. BZA showed no stimulating effects on endometrium and breast. BZA can be a valid option in management of osteopenia/osteoporosis in postmenopause.
    Minerva ginecologica 06/2011; 63(3):305-14.
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    ABSTRACT: The effects of tibolone on cardiovascular risk is not yet fully understood today. We designed this study to assess the effect of the menopausal status and tibolone treatment (2.5 mg/day for 3 months) on different biomarkers of cardiovascular risk in healthy women. Blood arterial pressure were measured, and blood samples collected for glucose, lipid profile (total cholesterol, high density lipoproteins, HDL, low density lipoproteins, and triglycerides), inflammatory (C-reactive protein, Interleukin-6, IL-6, tumor necrosis factor alpha, TNF alpha) and oxidative stress (hydroperoxides and antioxidant capacity) evaluation in 15 premenopausal (mean age: 30 +/- 4 years) and 15 postmenopausal (mean age: 52 +/- 3, mean time from menopause 1.4 +/- 0.4 years) women before and after tibolone treatment. The menopausal status is associated with increased systolic and diastolic pressure (p<0.05), higher IL-6 (p<0.05) and TNF alpha (p<0.01), and lower antioxidants (p<0.01). However, blood pressure (p<0.05), glucose (p<0.05), TNF alpha (p<0.05) and HDL (p<0.05) fell after tibolone, which did not significantly affect levels of the other biochemical parameters. As menopause is associated with increased blood pressure, inflammation and oxidative stress, tibolone restores blood pressure and has beneficial effect on inflammation and glycemia without worsening oxidative stress, although it also reduces HDL levels. Such modifications should be taken into account when tailoring menopausal therapies to specific requirements of each woman.
    Gynecological Endocrinology 03/2011; 27(3):163-9. DOI:10.3109/09513590.2010.488770 · 1.33 Impact Factor
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    ABSTRACT: The pathogenesis of acne (the most common disorder involving the sebaceous gland) originates from increased sebum production by the sebaceous gland followed by colonization of the hair follicle with Propionibacterium acnes, hyperkeratinization of the upper follicle, and release of inflammatory mediators into the skin. Androgens are the main stimulators of sebum production. Androgens originate from the gonads and adrenal glands, but can also be locally produced within the sebaceous gland from dehydroepiandrosterone sulfate. In the presence of high androgen levels, which can be either a normal pattern of adolescence or a consequence of gonadal or adrenal disease, overproduction of sebum triggers the pathogenesis of acne which, mainly in adolescent women, has deleterious psychological consequences. Estrogens exert the opposite action on sebum production, probably due to the reduction of androgen availability, a direct consequence of estrogen-related increased production of hepatic sex hormone-binding globulin (SHBG). The inhibition of the hypothalamus-pituitary axis induced by oral contra-ceptives is followed by reduced androgen production. Oral contraceptives containing ethinyl estradiol, which has strong estrogenic activity, amplify the hypoandrogenic effect via estrogen-related stimulation of SHBG. The hypoandrogenic effect of oral contraceptives is modulated by the progestin compound. Progestins derived from 19-nortestosterone bind androgenic receptors, whereas others exert antiandrogenic properties by antagonizing the binding of androgens to their receptors, reduce 5α-reductase, and do not bind SHBG. Through this last effect, SHBG is freely available to bind androgens, and the same progestin is totally free to exert its antian-drogenic properties. After correct evaluation of the cause of acne, appropriate management can be undertaken using oral contraceptives containing low daily doses of ethinyl estradiol (20 or 30 µg) associated with a progestin compound, such as cyproterone acetate, drospirenone, or chlormadinone acetate, the antiandrogenic activity of which has been demonstrated by many studies in animals and in humans.
    Open Access Journal of Contraception 01/2011; DOI:10.2147/OAJC.S17407
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    ABSTRACT: evaluate the efficacy of an estroprogestin EP containing 20 mcg ethinilestradiol (EE) and 3 mg drospirenone (DRSP) in the treatment of hyperandrogenism. In this study, twenty hyperandrogenic patients were treated with an EP containing EE 20 mcg and DRSP 3 mg in 24+4 regimen for three months. Skin evaluation was performed both quantitatively and qualitatively. This EP combination showed, after a short-term treatment (three months) to decrease significantly seborrhea, acne, and circulating androgens (testosterone, deidroepiandrosterone sulphate, and androstenedione), while increased sex hormone binding globulin levels. Moreover, this EE 20 mcg/DRSP 3mg EP combination changed some parameters of skin quality, increasing corneometry (a parameter related to skin hydration), and reduced trans epidermal water loss (TEWL, a parameter related to skin evaporation), and erythema (a parameter related to skin inflammation). These results could be taken into account in individualizing the treatment of hyperandrogenic patients.
    Minerva ginecologica 12/2010; 62(6):509-13.
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    Nicoletta Biglia · Silvia Maffei · Stefano Lello · Rossella E Nappi ·
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    ABSTRACT: To critically discuss the use of tibolone (T), in light of a series of very recent double-blind placebo (PL) controlled trials (LISA, LIFT, OPAL, THEBES, LIBERATE) conducted worldwide in a large number of postmenopausal women (PMW). The most relevant publications on T therapy in PMW were considered with emphasis on menopausal symptoms, quality of life, sexuality, bone, cardiovascular system (CVS) and oncologic risk. T significantly relieves climacteric symptoms and improves mood and sexual well-being (LISA). T is as effective as estrogen-progestin therapy in preventing bone loss and reducing the relative risk of vertebral and non-vertebral fractures (LIFT). By using surrogate endpoints of the individual risks for the CVS, studies show mixed results, but a favourable effect on acute miocardial infarction and thromboembolism has been documented (THEBES, LIFT, OPAL). Although findings about endometrial and colon cancer are reassuring, conclusive data on breast cancer risk with T are not available and an increased risk of recurrence in women with previous breast cancer emerged (LIBERATE). T is effective in treating menopausal syndrome with a good tolerability profile. In spite of some unsolved issues in term of safety, T is still a good treatment option for early PMW.
    Gynecological Endocrinology 11/2010; 26(11):804-14. DOI:10.3109/09513590.2010.495437 · 1.33 Impact Factor

Publication Stats

407 Citations
101.20 Total Impact Points


  • 2008-2014
    • Istituto Dermopatico dell'Immacolata
      Roma, Latium, Italy
  • 2013
    • Ospedale Madonna Delle Grazie, Matera
      Matera, Basilicate, Italy
  • 2004-2013
    • Università degli studi di Cagliari
      • Department of Surgical Science
      Cagliari, Sardinia, Italy
  • 1998-2001
    • University of Rome Tor Vergata
      • Dipartimento di Biologia
      Roma, Latium, Italy