The Women in Dermatology e-newsletter is supported by unrestricted support from Galderma Canada
Good morning and welcome to this edition of 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 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.
Lack of diagnostic criteria can lead to significant delays in diagnosis in rare conditions such as autoimmune progesterone dermatitis (APD). APD is a hypersensitivity disorder that affects women during peak progesterone production. Some symptoms of APD, which usually appear three to four days before menstruation, include urticaria, acute allergic reactions, dermatitis and rashes.
A retrospective review published in the International Journal of Women’s Dermatology (Oct. 2022; 8(3):p e009) examined the clinical presentations, risk factors, diagnostic test results and treatment outcomes in adult-onset APD patients. The study included the cases of 14 adult patients diagnosed with APD between January 1, 1997, and April 30, 2021, at the Mayo Clinic in Rochester, Minn. According to the authors, while most cases of APD are related to endogenous progesterone, the condition has also been reported to be triggered by exposure to exogenous progesterone or pregnancy.
The researchers found that the most common symptom of APD was urticaria, followed by dermatitis. Additionally, 13 patients had been pregnant in the past, and nine had a history of exogenous progesterone exposure. The authors also found that the most common therapy was an oral contraceptive, which resulted in a partial response for three of four patients. Other hormonal treatments such as intrauterine device removal, hysterectomy, progesterone desensitization, estrogen modulators, and spironolactone were also attempted with mixed results. Accessing proper treatment can be challenging because there are no well-established outcome measures for APD and no standardized therapies, the researchers said.
Finally, the authors note that there is often a nearly four-year delay between the appearance of APD symptoms and diagnosis. They add that this delay may result from vague and variable signs and symptoms of APD. Furthermore, patients and physicians may not be aware of this condition since no rigorous diagnostic criteria exist for APD.
Bottom line
The lack of universal diagnostic measures and criteria leads to a significant delay in diagnosing APD. The authors add that large-scale multicentre studies are needed to develop accurate tests, establish diagnostic criteria, and define treatment outcomes.
Hijab and hair loss: A cross-sectional analysis of information on YouTube
A study published in the International Journal of Dermatology examined hijab and hair loss content on YouTube to assess what patients might learn from the video streaming platform.The authors found a significant demand for information about hijab and hair loss, but most of the information on YouTube was from non-dermatologists.
For this study, the authors reviewed the first 30 videos on YouTube found by a search for the term “Hijab Hair Loss.” Duplicate videos and videos that were not relevant were excluded. After screening the 30 initial videos, 27 met the inclusion criteria. All of the videos were created by non-dermatologists. Fifteen videos discussed hair care, 10 videos recounted personal anecdotes about hair loss and hair care, and two videos showed different ways to tie a hijab to reduce the risk of hair loss. The three most discussed factors for hijab-related hair loss were increased tension on the hairline, hair care negligence and reduced breathability of the scalp. Additionally, the most common hijab-styling recommendations to prevent hair loss were implementing protective hairstyles, maintaining moisture with hair oils, and deep conditioning treatments. None of the videos recommended consulting a dermatologist for evaluation and treatment.
An article published in the British Journal of Dermatology conducted a qualitative interview study to understand the patient experience with vulvar lichen sclerosus (VLS) and its impact on their lives. The authors found that healthcare professionals need to improve awareness and knowledge of VLS. Additionally, some patients reported disempowering encounters with healthcare professionals. The authors suggest those who work with these patients should avoid using language that blames the patient or minimizes their experiences.
For this study, the researchers conducted semi-structured remote interviews with a sample of 20 women living with VLS in the UK. The participants were recruited via online support groups and social media.
The authors then divided the results into three main themes to interpret the experience of living with VLS:
Missed opportunities: Most participants experienced delayed diagnosis, lack of information, and unfortunate encounters with healthcare professionals.
Learning to live with a chronic condition: The amount of work involved in learning how to self-manage the disease and the impact on everyday life.
Having a secret life: The experiences of the condition were often kept in secrecy, and there was a significant stigma associated with vulvar skin conditions, which resulted in patients feeling isolated and lonely.
Pregnancy outcomes in women exposed to rituximab before or during pregnancy
A study published in the International Journal of Women’s Dermatology reported the pregnancy outcomes of patients with pemphigus treated with rituximab (RTX) before or during pregnancy. The authors detected no serious relevant adverse pregnancy outcome attributed to RTX exposure, except for one case of neonatal sepsis in which the baby survived after medical treatment.
The researchers identified 19 women with RTX exposure before or during pregnancy for this study. The cases were then categorized into three groups of exposure: within six months (A), between six and 12 months (B), and longer than 12 months (C). The pregnancy outcomes of different RTX exposure intervals were compared. There were 17 live births, one spontaneous abortion, and one termination.
Three of the live births were preterm deliveries, and four were low-birth-weight newborns. Additionally, one newborn was hospitalized due to early-onset neonatal sepsis, and another had hydronephrosis. However, none of these adverse effects could be attributed to RTX. Despite no adverse pregnancy outcomes being detected, the authors suggest that RTX should not be used one year before or during pregnancy because not enough data is available.
The role of gynecology and dermatology in total body skin exams
According to a study published in the Dermatology Online Journal, there is a lack of standardized training in total body skin examinations (TBSEs), particularly regarding skin examination of the genital area and breasts. The journal surveyed practicing dermatologists and obstetrician-gynecologists (OB/GYNs) to understand this practice and physician training satisfaction better. The authors found that most of the surveyed dermatologists are dissatisfied with the training regarding examining the female genitalia. Additionally, only 52.2% of surveyed OB/GYNs inspect the perianal skin during pelvic region examinations. The investigators emphasize the need for standardization in evaluating breast and genitalia skin during dermatology and OB/GYN residency training.
For this cross-sectional study, the researchers surveyed 73 practicing dermatologists and 69 practicing OB/GYNs. Dermatologists reported the frequency percentage of examining breasts and the female pelvic region was 67.2% and 36.1%, respectively. Additionally, physicians reported low satisfaction with their training regarding the female pelvic region.
Dr. Veronique Bataille, a London, UK-based dermatologist, discusses childhood eczema, the causes and how to treat it.
Cannabidiol-induced skin rash in four women
A case study published in the journal Frontiers in Pharmacology reported the cases of four women who presented with a skin rash between six hours and 11 days after starting cannabidiol (CBD). They were volunteers in a Brazilian clinical trial evaluating the anxiolytic effects of oral CBD oil on healthcare frontline workers during the Covid-19 pandemic between June and Nov. 2020.
All four of the women developed skin lesions shortly after starting CBD therapy. One of the women chose to continue using CBD despite the rash, and her skin condition worsened. In all patients, the lesions disappeared within a few days of stopping CBD use with no need for additional therapy, except for one patient who required oral corticosteroids. Additionally, two patients agreed to resume CBD use, and there was no recurrence or emergence of new rashes.
According to the authors, the four cases can be diagnosed as skin rashes induced by CBD oil. They also state these findings support the proposal that CBD use should be guided by evidence-based medicine and that it is necessary to balance the benefits of use with the potential adverse effects.
“One of the things that I’ve tried to do with my family is [to] lead by example. I do this by using sunscreen every day, modelling the behaviour, and wearing a hat when we’re doing outdoor activities. I also made sunscreen a part of my daughter’s routine from an early age. It comes down to finding a product that you like and trust and that you’re willing to use on a daily basis. If you find a product that is suitable for your skin type, it becomes easy to incorporate it daily.”
— Dr.Julia Carroll, a Toronto-based dermatologist, in an interview with La Spa, a Canadian natural beauty products company.
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
