The Women in Dermatology e-newsletter is supported by an unrestricted grant from Galderma Canada.
Good morning and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We are pleased to have you join us. Every two weeks, this bulletin will provide you with updates on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them. We welcome your feedback and opinions, so let us know if you have any comments, observations or suggestions. You can email them to us at health@chronicle.org
The causes of adult female acne are not completely clear. In endocrine and reproductive literature, acne is regarded as a possible symptom of hyperandrogenism (androgen excess). Many polycystic ovary syndrome (PCOS) guidelines even consider acne due to androgen excess. In dermatologic literature, however, acne is regarded as an inflammatory skin disease determined by several factors that may or may not include hyperandrogenism. Research suggests there might be a strong connection between hyperandrogenism and adult female acne. This connection may indicate that dermatologists and endocrinologists could work together to develop new treatment guidelines.
A study published in the Journal of the Endocrine Society (March 2022; 6(3): bvac003), provided evidence-based and expert opinion–based recommendations for the evaluation, diagnosis, and treatment of adult female acne and its association with hyperandrogenism.
The authors state that hyperandrogenism promotes acne formation by increasing sebum production and changing the lipid profile of sebum. They also note that because androgen excess usually begins around puberty, persistent adult female acne (a type of adult acne that starts during adolescence and lasts throughout adulthood) is more linked to hyperandrogenism than adult female acne that begins later in life.
The researchers found several studies that have assessed the correlation between hyperandrogenism and adult female acne, but the results are highly variable. In the most extensive study they reference, 55% of 835 women with adult acne had increased androgen levels. This leads them to conclude that the prevalence of hyperandrogenism in adult acne can be estimated at approximately 50%. The authors also reference a small study where nine of 15 patients with adult acne and normal androgen levels had increased androgen metabolites. According to the authors of that paper, this result may suggest some form of androgen excess or increased androgen sensitivity.
Polycystic ovary syndrome (PCOS), the most common cause of hyperandrogenism, also has a significant association with adult female acne. The researchers estimate that the prevalence of adult acne in women with PCOS is about 30% to 40%. This conclusion also suggests an important link between androgen excess and female adult acne.
Bottom line
The authors conclude a significant association exists between hyperandrogenism and female adult acne. They recommend measuring serum androgen values (total testosterone, free testosterone, and DHEAS) in women with adult acne to determine an appropriate treatment. They also conclude that women with adult acne and proven hyperandrogenism should follow a treatment regimen combining topical or systemic acne therapies with estroprogestins. This last conclusion suggests that dermatologists and endocrinologists should work together when treating adult female acne.
Treatment of female androgenetic alopecia with minoxidil monotherapy versus minoxidil and finasteride
A recent literature review examined the benefits of dual therapy of minoxidil combined with finasteride versus monotherapy of minoxidil alone when treating female androgenetic alopecia. The authors of the study, published in the Lynchburg Journal of Medical Science, found that dual therapy is more effective than monotherapy for hair regrowth in women with androgenetic alopecia.
For this review, the authors conducted a PubMed literature search using the keywords androgenetic alopecia, women, minoxidil, and finasteride. After the initial search, 19 articles were selected and served as the basis for the clinical review. A second PubMed literature search was conducted using the keywords female to male transgender, androgenetic alopecia, and finasteride. Two additional articles were included in the study from this search.
A study published in the British Journal of Dermatology evaluated the prevalence of body dysmorphic disorder (BDD) symptoms among patients with different common dermatologic conditions and healthy skin controls. The researchers found that BDD symptoms were five times more prevalent in patients with skin conditions when compared to healthy patients. They also found that younger females were more likely to experience BDD symptoms.
This observational, cross-sectional, comparative multi-centre study included 5,487 participants with different skin diseases who were recruited from dermatologic outpatient clinics across 17 European countries. The study also included 2,808 healthy skin controls.
Associations between skin structural and functional changes at sacral and heel skin after mechanical loading
According to a study published in the Journal of Tissue Viability, mechanical loading can cause an increase in transepidermal water loss, stratum corneum and epidermal hydration, erythema and temperature in sacral and heel skin. The study’s abstract states that mechanical loading causes skin occlusion and deformation, affecting structural and functional skin properties. The researchers examined structural and functional skin parameters after mechanical loading at the sacral and heel skin to describe possible associations.
The authors conducted a secondary data analysis for this study based on a clinical trial that involved 15 women. The researchers found strong associations between changes of the elastic function and elastic recovery and between changes of epidermal and stratum corneum hydration at both skin areas.
Protective effects of a day/night dual-antioxidant serum on skin exposed to air pollution
A review published in the Journal of Cosmetic Dermatology assessed the effectiveness of a skincare system consisting of individual day and night serums in Chinese women exposed to air pollution. The researchers found that the treatment combined with a basic moisturizer was more effective than a basic moisturizer alone in reducing skin pigmentation and redness in the target population. They also found that the two-serum treatment mitigates sebum production, which leads to clearer skin.
For this single-centre, vehicle-controlled study, female patients were randomized to either a treatment group (the two-serum system plus basic moisturizer) or a control group (basic moisturizer). Skin colour, sebum content, elasticity, and texture were measured at baseline and at each follow-up visit (days 28, 56, and 84). Air pollution metrics were also collected throughout the study. The researchers noted that air pollution levels were consistently high during the duration of the study.
VIDEO: Tapinarof cream for plaque psoriasis by Dr. Linda Stein Gold
Dr. Linda Stein Gold discusses tapinarof cream 1% once daily for plaque psoriasis. She gives an overview of the background, trial design, and the results from the trial.
Case report: A rare case of amelanotic nodular melanoma misdiagnosed as a benign skin lesion
A report published in the Annals of Medicine and Surgery presented the case of a 79-year-old female patient from Syria who presented with an asymptomatic lesion on the medial heel of the right foot. The woman had been examined by a local doctor in her village who treated her lesion with topical ointments. However, the lesion increased in size so her doctor referred her to a specialist. The patient had no medical history of previous melanoma or related skin cancer.
An incisional biopsy was performed, and the sample was sent to a pathology laboratory. The sample was stained with S100 and HMB-45 stains, and both were positive. Additionally, no melanin pigmented cells were seen, so the diagnosis was amelanotic nodular melanoma. The lesion was surgically removed and sent to the pathology lab to ensure the margins were free of cancer. At the 18-month follow-up, the patient was still in good health.
“Atopic dermatitis is not just dry skin and not just a skin problem. We know that, particularly when moderate to severe, it is associated with significant physical, psycho-social and even financial impacts, which can influence someone holistically.”
— Dr. Rachel N. Asiniwasis, aSaskatchewan-based dermatologist, speaking at the seventh annual Skin Spectrum Summit in November 2021.
You are receiving this newsletter because you are a subscriber to Women in Dermatology or other Chronicle journal, have attended a Skin Spectrum Summit live event or webinar, or have previously requested a subscription to one of our newsletters. If you no longer wish to subscribe to this newsletter, please send an email with the subject line “Unsubscribe Women in Dermatology” to health@chronicle.org
Women in Dermatology is published by Chronicle Companies: 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3
Mitchell Shannon, Publisher; R. Allan Ryan, Editorial Director; Cristela Tello Ruiz, Client Services; John Evans, Managing Editor; Katherine Brenders, Kylie Rebernik, Jeremy Visser, Editors; Catherine Dusome, Operations Manager; Peggy Ahearn, Consultant Content is copyright (c) 2022, Chronicle LifeSci America Corp, except as indicated. Interested in contributing to this newsletter or in learning more about Chronicle’s services? Please write to us at health@chronicle.org
