Today’s report also covers research into the impact of vulvar disease on quality of life, sexual dysfunction and hidradenitis suppurativa, and more (1,385 words, 6.5 minutes)
The Women in Dermatology e-newsletter is supported without restriction by 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.
Bullous systemic lupus erythematosus (BSLE) is a rare form of the most common type, systemic lupus erythematosus (SLE). BSLE manifests as severe blistering eruptions. According to clinical research, this rare blistering form of SLE is more prevalent in women, especially those of African descent. Due to its rarity, the prevalence of BSLE is unknown.
A review published in the International Journal of Women’s Dermatology (Oct. 2022; 8(3): e034) analyzed the characteristics of BSLE in female patients. The study’s abstract notes that performing a biopsy is essential for an accurate diagnosis of the condition. There are many proposed criteria for BSLE diagnosis, including:
Features or a diagnosis of SLE based on the American College of Rheumatology criteria
A newly developed bumpy and blistered rash
Histopathologic evidence of a sub-epidermal blister and a dermal infiltrate consisting primarily of neutrophils
Evidence of antibodies to type VII collagen
Exclusion of other blistering disorders
According to the authors, the production of autoantibodies against type VII collagen is the primary cause of the disease. The formation of autoantibodies against type VII collagen weakens the area between the epidermis and the dermis, which leads to the formation of sub-epidermal blisters. They also note that the severe blistering rashes seen in BSLE usually affect areas exposed to sunlight, though they can appear in areas with no sun exposure. Additionally, large blisters or bullae can arise from red spots, inflammatory plaques or previously healthy skin.
In mild disease with stable underlying SLE, treatment with dapsone should be considered by clinicians. Off-label usage of rituximab (an anti-CD20 B-cell depleting drug) is effective and safe when the condition does not respond to dapsone, glucocorticoids, or steroid-sparing immunosuppressants.
The researchers found that other systems are usually affected by this condition. For instance, up to 90% of patients with BSLE develop comorbid kidney disease. The blood is also commonly affected—approximately 40 to 90% of BSLE patients also experience anemia, leukopenia, or a combination of the two. The authors note that these abnormalities may be due to BSLE or the immunosuppressive therapies used to treat BSLE and SLE.
Bottom line
BSLE is a rare form of SLE that usually manifests as an abrupt and severe blistering eruption, primarily in women. For an accurate diagnosis, physicians should perform a biopsy and evaluate patients for concurrent involvement of internal organs. Patients with mild disease are generally treated with dapsone. Those patients with more severe disease or who do not respond to dapsone can be prescribed steroids (with or without immunosuppression) or rituximab.
Approximately 5.2 million Canadians have acne, but there may be an additional acne burden beyond what is first seen. Facial acne is only half the story. More than 50% of patients with facial acne also have truncal acne, yet only one in four patients with facial acne bring up their truncal acne during consultations. Patients may be embarrassed about their truncal acne and avoid talking about it. They may be uncomfortable showing doctors the acne-prone parts of their body due to social and cultural barriers. Patients can overcome their facial and truncal acne. Galderma invites doctors to start that conversation with their acne patients this month.
From the literature on women in dermatology
Quality of life impact and treatment response in vulvar disease
A study in the Australasian Journal of Dermatology compared the quality of life of patients with vulvar lichen sclerosus (VLS), vulvar lichen planus (VLP) and chronic vulvovaginal candidiasis (CVVC). The objective was to understand the impact of vulvar disease on the well-being of women. They found that vulvar disease, in general, has a significant impact on quality of life, especially in patients living with CVVC.
For this retrospective, single-centre cohort study, the authors analyzed data from a dermatology and gynecology practice from Mar. 2018 to Nov. 2021. Over three years, the study included 200 women: 59 with CVVC, 79 with VLP, and 62 with VLS.
Differential proteomic expression in indolent vulvar lichen sclerosus, transforming vulvar lichen sclerosus, and normal vulvar tissue
A study in the journal Experimental Dermatology identified tissue differences in patients with vulvar lichen sclerosus (VLS) who developed vulvar squamous cell carcinoma (VSCC) compared to those who did not. The authors found evidence that supports the hypothesis that VLS is a risk factor for VSCC.
For this study, the researchers used laser capture microdissection and nanoLC- tandem mass spectrometry to evaluate protein expression in women with normal vulvar tissue, indolent VLS, and those who developed VSCC after being diagnosed with VLS.
Healthcare worker knowledge and opinion regarding screening for intimate partner violence
A research letter in the International Journal of Women’s Dermatology assessed intimate partner violence (IPV) opinions and knowledge among dermatologic healthcare practitioners. The authors found that dermatology providers want to conduct IPV screenings but require further education and support to do so confidently.
For this study, the researchers distributed a cross-sectional survey to healthcare workers with direct patient interaction in the department of dermatology at an academic teaching hospital. The results indicated that most participants are interested in IPV training and believe dermatology clinics should always screen for it. The researchers also found that while more women supported IPV screening in dermatology settings than males, the difference was not statistically significant. Finally, nearly half of the healthcare workers were unaware of legal reporting requirements, and only one participant reported regularly asking patients about abuse.
Sexual dysfunction in patients with hidradenitis suppurativa
A study published in the International Journal of Dermatology analyzed the relationship between sexual dysfunction and hidradenitis suppurativa (HS). The authors found that female HS patients experience more sexual impairment than males.
For this systematic review and meta-analysis, the researchers searched multiple medical databases for English language studies assessing HS and sexual function published before April 2020. After the initial search, 16 studies met inclusion criteria, and nine were eligible for meta-analysis. The results showed that women with HS performed worse on sexual function inventories than men with HS. Additionally, women with HS reported worse sexual function inventory scores than healthy sex-matched controls.
VIDEO: The Nurse Practitioner’s Role in Dermatology
Vanna Padilla, nurse practitioner at Skin Solutions Dermatology and Skin Cancer Surgery in Nashville, Tennessee, talks about her work's cosmetic, medical, and surgical aspects. She also discusses the psychosocial effects of skin conditions.
A case of intermammary hidradenitis suppurativa
A case study published in the International Medical Case Reports Journal reported a 24-year-old woman who presented a painful lump between her breasts and scars that leaked pus. The lesions first appeared two years prior as red spots and bumps on both breasts without pain or itching. The nodules became painful abscess-like lesions that burst and leaked pus one year later. The patient was prescribed oral antibiotics, which eased her symptoms.
One year after her first round of antibiotics, the woman developed painful hypertrophic scars between the breasts that discharged pus. An examination of the intermammary area indicated a sinus tract formation. A histopathological examination of the intermammary area revealed results consistent with hidradenitis suppurativa (HS). The patient was diagnosed with HS and then prescribed 600 mg rifampicin once a day and 300 mg clindamycin twice daily for ten weeks. The skin lesion improved within three weeks.
“When I was in training, when I was in my residency, we were taught that diet has no effect on skin. I actually challenged the scientific dogma at the time. I published a ground-breaking study in the Journal of the American Academy of Dermatology in 2010 called "Diet and Acne," and I made an argument that when you go from a high-glycemic to a low-glycemic diet, it can benefit acne, and there are certain implications when it comes to dairy as well. And we now have revised our textbooks. Dermatologists now widely accept that nutrition is a part of how we counsel our patients.”
— Dr. Whitney Bowe, a New York City-based dermatologist, in an interview with Harper’s Bazaar.
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