Atopic dermatitis in women: special considerations in the childbearing years
Today’s report also covers research clinical features of melasma in Iranian women, the effects of spironolactone on skin biophysical properties in women with acne, and more (1,365 words, 6.5 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
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
A study in the International Journal of Women's Dermatology (June 2024; 10(2):p e151) addressed the management of atopic dermatitis (AD) in women of childbearing age, highlighting the lack of formal guidelines for this demographic. According to the findings, topical therapies for AD should be used cautiously during pregnancy, while other therapies should be avoided. The study emphasized the importance of weighing the risks and benefits of therapies during preconception, pregnancy, and breastfeeding to ensure optimal outcomes for both the mother and the child.
The study recommended the cautious use of topical therapies in this cohort. When prescribing topical corticosteroids (TCS), it is best to use the lowest potency possible, but superpotent steroids can be used judiciously for short periods in non-pregnant women of childbearing age. Alternatively, topical calcineurin inhibitors (TCIs) aid in limiting the local and systemic side effects of long-term steroid use. Specifically during pregnancy, the recommendations are that TCS should be used sparingly, and superpotent TCS should be avoided. There is no data regarding TCIs use during pregnancy, but reports indicate they may be safe to use. Other topical medications, such as ruxolitinib, a topical JAK inhibitor, and crisaborole, a topical phosphodiesterase inhibitor, are not recommended during pregnancy or breastfeeding.
For systemic therapies, the study suggested systemic corticosteroids only as rescue therapy during pregnancy, due to concerns about fetal growth restriction and other adverse effects. Cyclosporin is largely discouraged because it increases the risk of low birth weight and maternal hypertension, though it can be used for treatment-resistant AD when the benefits to the mother outweigh the risks to the fetus. Azathioprine is also discouraged due to potential risks such as spontaneous abortion, increased prematurity, increased preterm delivery, neonatal leukopenia, and neonatal pancytopenia. Neither is recommended during breastfeeding.
The study noted that biologic therapies such as dupilumab or tralokinumab have shown promise in treating severe AD but lack sufficient safety data for use during pregnancy and breastfeeding. In contrast, JAK inhibitors, such as upadacitinib and abrocitinib, are considered contraindicated in pregnancy due to potential teratogenic risks based on preclinical animal studies. JAK inhibitors shouldn’t be used while breastfeeding either. The authors advise against methotrexate use during pregnancy as it can cause skeletal abnormalities and embryopathy. It is also contraindicated during pregnancy because it can cause immunosuppression in the infant. Mycophenolate mofetil should also be avoided as it poses a significant miscarriage risk.
Takeaway: Effective management of AD in pregnant and breastfeeding women requires a personalized, multidisciplinary approach. Topical therapies should be used cautiously and at low doses. Systemic corticosteroids should only be used as rescue therapy. There is not enough data regarding biologic therapy use for AD during pregnancy, but reports suggest it could be safe. JAK inhibitors, methotrexate, and mycophenolate mofetil should be completely avoided during pregnancy.
Delta opioid receptor expression correlates to skin aging and melanin expression in Asian women
Research in the International Journal of Women’s Health examined opioid receptor (OPr) expression changes in the skin of 30 healthy female Asian volunteers across different age ranges, focusing on delta-opioid receptors (DOPr). The authors found that delta-opioid receptor (DOPr) expression decreases with age, regardless of past sun exposure. This reduction in DOPr expression correlates with increased skin melanin levels, suggesting a potential connection between DOPr activity and pigmentary changes during aging.
For this study, the researchers took excisional biopsies from both sun-exposed and sun-protected areas of the volunteers' arms. They later assessed DOPr expression via immunohistochemistry. The study found that epidermal thickness showed significant hypertrophy in sun-exposed areas compared to sun-protected areas. The results suggest that DOPr expression may be a marker for intrinsic biological ageing in the skin.
Effects of spironolactone on the biophysical properties of skin in women with acne treated with oral spironolactone
A study in the Journal of Dermatology explored the effects of oral spironolactone (SPL) on skin biophysical properties in women with acne. The researchers found that SPL did not impair the skin barrier and notably enhanced skin mechanical properties such as elasticity and tightness, with improvements observed in both the face and truncal areas.
For this study, 25 Thai women with acne were treated with oral SPL and monitored for six months. Skin parameters, including hydration, transepidermal water loss (TEWL), skin surface lipid (SSL) levels, mechanical properties, colour, pH, and pore size, were measured at baseline and at two, four, and six months. The results showed that TEWL, SSL levels, colour, pH, and pore size remained stable throughout the study, but skin mechanical properties improved after four months.
Clinical and epidemiological features of melasma in women of Iran
A study in the Open Public Health Journal examined the clinical and epidemiological characteristics of melasma in women attending a dermatology clinic in Jiroft, Iran. The researchers found that melasma in Iranian women was predominantly centro facial, with no significant associations with factors such as age, childbirth, or hormonal treatments. However, there was a positive melasma family history in 43% of cases.
This cross-sectional study included 100 women referred to the dermatology clinic of Imam Khomeini Hospital in Jiroft City in the first half of 2021. The authors collected their clinical data using a researcher-made checklist and analyzed it using statistical software. The results showed that melasma is a relatively common disease in Iran, especially in women with a family history of melasma. The researchers didn’t find a significant association between melasma and various factors, including age, childbirth, disease duration, marital status, family history, hormonal treatments, pregnancy effects, thyroid conditions, polycystic ovary syndrome, or the use of night creams and sunscreen.
Temporal analyses of melanoma trends among men and women suggest etiologic heterogeneity
A study in the Journal of Investigative Dermatology assessed how the incidence of cutaneous melanoma has varied over time and across generations by age, sex, and anatomic site. The researchers found that cutaneous melanoma incidence patterns vary significantly by sex, with women experiencing higher rates on the limbs.
For this study, the authors analyzed long-term cutaneous melanoma incidence data (1982-2018) from Queensland, Australia; the United States; and Scotland. Key findings showed that men consistently had the highest melanoma incidence on the trunk. Women showed higher rates of melanomas on the lower limbs compared to men, particularly in younger and middle-aged groups. Birth cohort analyses indicated shifts in melanoma incidence trends across generations, suggesting changing patterns of UV radiation exposure and inherent sex-specific susceptibilities to melanoma sites.
VIDEO: New treatments for atopic dermatitis for infants and children
Peterborough, Ont. -based dermatologist Dr. Melinda Gooderham discusses new topical eczema treatments for pediatric patients.
Two cases of perianal ulcers from prolonged anti-hemorrhoidal ointment use
A case report in Advances in Skin & Wound Care described two women, aged 68 and 58, who developed perianal ulcers (PAUs) after using a topical anti-hemorrhoidal ointment containing hydrocortisone acetate, lidocaine, zinc oxide, and aluminum subacetate. Both patients had a history of hemorrhoids and had been applying the ointment for approximately two months. Despite this treatment, they experienced progressive pain and ulcer formation. After further examinations, both patients were advised to discontinue the anti-hemorrhoidal ointment. The 68-year-old patient used calcium alginate dressings, and her ulcers healed within two months.
Similarly, the second patient’s wounds completely healed within six weeks without further intervention. Neither patient experienced reoccurrence at the six-month follow-up. These cases underscore the potential adverse effects of prolonged anti-hemorrhoidal ointment use, suggesting a link between prolonged ointment use and PAU development.
“If you are thinking about doing cosmetic treatments, make sure to find a licensed practitioner who has plenty of experience with skin of color. Lightly invasive procedures like chemical peels, microneedling, and laser resurfacing can be especially irritating for skin of color, so you want an expert who will know how to adjust the approach.”
— Dr. Rosemarie Ingleton, a New York City-based dermatologist, in an column for Oprah Daily.
You are receiving this newsletter because you subscribe to Women in Dermatology or another 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 email the subject line “Unsubscribe Women in Dermatology” to health@chronicle.org.
Women in Dermatology is published by Chronicle Companies: 1460 The Queensway, Suite 212, Etobicoke, Ont. M8Z 1S4
