Sex Hormone Treatment

Female preponderance and primary manifestation or exacerbation of preexisting LE during pregnancy is interpreted as involvement of sex hormones in the pathogenesis of LE (Piette et al. 1995, Wilder 1998). Consequently, therapeutic implementation of sex hormones has been controversially discussed in the past (Piette et al. 1995, Asherson and Lahita 1991). Nandrolone and danazol have been studied as weak androgens, but results have been ambiguous (Englert and Hughes 1988, Hazelton et al. 1983, Masse et al. 1980, Morley et al. 1982, Torrelo et al. 1990). Nandrolone did not show any effects in female patients but worsened symptoms in male patients. Whereas the beneficial role of danazol in the treatment of SLE-associated immune thrombocytopenia is appreciated, positive effects on CLE have been demonstrated in only a few patients. Hirsutism and weight gain as well as skin rash at higher doses further limit its therapeutic range. The adrenal steroid hormone dehydroepiandro-sterone has been used in SLE for a decade, with controversial results regarding its effects (Gescuk and Davis 2002). Moreover, effects on skin symptoms have not been explicitly studied. Cyproterone acetate, a synthetic hydroxyprogesterone derivative, was shown to reduce the frequency of SLE flares as well as oral ulcerations (Jungers et al. 1985), whereas tamoxifen, an estrogen antagonist, was ineffective in a doubleblind crossover study of SLE (Sturgess et al. 1984).

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