Assessing the impact of juvenile vulvar lichen sclerosus in adult women
Today’s report also covers research into dermatologic manifestations associated with PCOS, vulvar exam terminology considerations for dermatologists, and more (1,165 words, 5.5 minutes)
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Good morning, and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We’re pleased to have you join us. This biweekly bulletin will update you on new findings regarding dermatologic issues that affect women and the dermatologists who treat 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
Researchers from the Erasmus MC University Medical Center in Rotterdam, Netherlands, note that the long-term consequences of juvenile vulvar lichen sclerosus (JVLS) in adulthood are not fully understood. Research published in the Journal of Lower Genital Tract Disease (May 2024; 28(3):10.1097) evaluated these long-term effects in adult women.
For this study, the authors recruited 27 adult women with a biopsy-proven history of JVLS. These women had participated in a previous 2021 JVLS study and had already answered an online dermatology and sexuality questionnaire. Between June and October 2022, the participants underwent a physical examination and completed new on-site surveys. The vulvar examinations were conducted by two gynecologists and one dermatologist, who evaluated disease severity.
Among the participants, 52% did not receive any treatment, 11% used maintenance therapy, and 37% used topical agents on demand. Additionally, 63% of the women had signs of active disease, and 33% had moderate to severe active disease. More than half of the participants reported experiencing symptoms in the past year.
The study found that JVLS caused significant physical consequences in adulthood. Most participants reported permanent changes in the appearance of their vulvar regions, with 93% having some form of structural alteration and 85% having moderate to severe changes. Common structural changes included labial fusion and clitoral hood fusion. Additionally, 40.7% of the women also reported crinkly vulvar skin.
Despite these physical findings, most participants reported that JVLS had a minimal impact on their quality of life. The authors note that timely diagnosis and adequate care of JVLS could reduce the incidence of permanent vulvar changes.
Takeaway: The consequences of JVLS in adulthood are primarily physical, with most women reporting permanent structural vulvar changes, including labial and clitoral hood fusion. Despite these physical discomforts, most women reported that JVLS had a minimal impact on their quality of life.
From the literature on women in dermatology,
The management of scabies in children under two months, pregnancy and breastfeeding
A study published in the Journal of theEuropean Academy of Dermatology and Venereology assessed how dermatologists manage scabies in children younger than two months, pregnant women, and breastfeeding mothers. The researchers found that topical permethrin was the most recommended treatment, and more than 50% of dermatologists preferred using topical steroids for post-scabies itching in all three groups.
For this study, the authors surveyed 120 dermatologists across 34 European countries. The results showed that 85% of dermatologists recommended treating all household members, including infants, and 98% advised washing bed linens and clothes often. Additionally, the preferred treatment schedule involved overnight application of topical medications, typically one to three times per week for two cycles. The study highlighted the need for specific guidelines for each patient group.
The management of dermatologic manifestations associated with polycystic ovary syndrome
Research in Reproductive and Developmental Endocrinology evaluated the management of dermatologic manifestations of polycystic ovary syndrome (PCOS) across Europe. The researchers found that skin concerns associated with PCOS, particularly hirsutism and acne, comprised a large proportion of referrals to dermatologists. They also found that laser hair removal was the most popular treatment for hirsutism across all countries, followed by oral contraceptives and shaving.
The researchers conducted a multinational retrospective study that included all women older than 18 attending their first PCOS consultation between Jan. 2020 and Dec. 2023 in the UK, Turkey, Greece, and Georgia. The final sample included 700 women. The study revealed that 74.6% of all referrals were due to dermatologic concerns. It also showed that the most common reasons for referral across all countries were irregular periods, hirsutism, and acne.
Vulvar exam terminology considerations for dermatologists
An editorial in the International Journal of Women’s Dermatology addressed the importance of using patient-centred terminology to reduce anxiety and discomfort for patients with vulvar dermatoses. The authors recommended avoiding commanding, condescending, or confusing terms during vulvar exams to foster a safer and more comfortable environment for patients.
In the editorial, the authors emphasized avoiding terms such as “spread,” “scoot,” and “smear.” They explained that “spread” can feel authoritarian and trigger traumatic memories, especially for patients with histories of sexual abuse. Similarly, they cautioned against using “scoot,” which may be perceived as patronizing and underscore unequal power dynamics between patient and physician. Additionally, the term “smear” can lead to confusion when giving instructions for applying topical medications, potentially affecting treatment adherence and effectiveness. The authors urged dermatologists to opt for patient-centred language that is direct and respectful.
Prescription retinoid and contraception use in women in Australia
A study published in the Australasian Journal of Dermatology examined the patterns of prescription retinoid and concurrent contraception usage among reproductive-aged women in Australia. The researchers noted a doubling in the rates of oral retinoid prescriptions among this group over the past decade. However, evidence of simultaneous contraceptive use was found in only 25% of cases.
For this study, the authors analyzed data from Australian Pharmaceutical Benefits prescription claims from 2013 to 2021, focusing on a sample of Australian women. The results revealed a total of 1,545,800 retinoid prescriptions for reproductive-aged women during the study period, with 57.1% of these prescriptions consisting of oral retinoids. While the rate of oral retinoid prescriptions doubled over the study period, the rate of topical retinoid prescriptions remained unchanged.
VIDEO: A Canadian population-based study of surgically managed Hidradenitis Suppurativa
Rochester, Minnesota-based dermatologist Dr. Afsaneh Alavi presents the findings of a population-based study on the surgical management of hidradenitis suppurativa (HS).
A case of allergic contact dermatitis to isobornyl acrylate in an at-home nail glue kit
A case report in Contact Dermatitis described a 40-year-old atopic woman who presented with a two-month history of itchy, painful fingertip and fingernail dermatitis, also affecting her face and eyelids. The patient reported having used an at-home gel nail kit. Patch testing revealed positive reactions to 2-hydroxyethyl methacrylate, ethyl acrylate, and, unexpectedly, isobornyl. The patient stopped using the nail products, which led to symptom clearance. The authors note that this case raises awareness about the undeclared presence of isobornyl acrylate in home gel nail kits.
“As you age, you’re more likely to have dry, more sensitive skin—so you’re more likely to need a thicker moisturizer, especially in your late 40s. Ideally, you’re looking for something that’s going to support that skin barrier that’s a little bit more compromised due to those hormonal changes as you enter perimenopause.”
— Dr. Carmen Castilla, a New York City-based dermatologist, in an interview with The Strategist.
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