Today’s report also covers research into the prevalence of itchy skin during pregnancy, pattern-based approaches for vulvar dermatoses, and more (1,250 words, 6 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
Good morning and welcome to the last edition of the Women in Dermatology e-newsletter from Chronicle Companies for the year 2022. We wish all of our readers a safe and happy holiday. May this holiday season be everything you wish for and more. The Women in Dermatology e-newsletter will return on January 12th, 2023. 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
Research suggests that feminine hygiene wipes have gained popularity in the last couple of decades. They are widely available and claim to maintain the freshness and cleanliness of the vulva. According to the American Gynecological & Obstetrical Society, many of these products are marketed as being “fragrance-free” and gentle, ideal for the vulva's sensitive skin. However, these marketing statements do not mean these products are necessarily allergen-free. A study published in the International Journal of Women’s Dermatology (Dec. 2022; 8(4):p e e060) assessed the presence and prevalence of allergens in the most used feminine hygiene wipes. According to the study’s abstract, specific allergens could cause issues such as vulvar contact dermatitis.
The authors conducted an internet-based search to identify the best-selling name brands of feminine hygiene wipes and generic products. After the search, 28 different brands and 34 unique products were selected. The researchers then analyzed each product’s ingredient list and compared it to the North American Contact Dermatitis Group (NACDG) 80 allergen series.
According to the results, every product contained at least one potential contact allergen. Allergens were most commonly present as fragrances, oils, fruit extracts, and tocopherol (vitamin E). Additionally, two brands contained six allergens in total and 27 contained three or more allergens. Only two products contained just one allergen.
The authors note that nine products were marketed as being “natural,” “fragrance-free,” “soothing,” “organic,” or indicated for “sensitive skin.” However, these wipes did not have significantly fewer allergens than products without those labels. Furthermore, products marked as “sensitive” often contained the same number of allergens as “regular” products.
Finally, the study notes that vaginal and vulvar tissues are susceptible to contact allergens. Some contact allergens could cause vulvar contact dermatitis. Manufacturers should warn consumers about allergens by including warning labels on the packages. At the same time, care providers should inform patients about the presence of allergens in feminine hygiene wipes, even if labelled as “natural” or “sensitive,” and encourage cleansing the vulva using only water.
Bottom line
Most feminine hygiene wipes contain at least one allergen. Contact allergens can cause vulvar contact dermatitis because vulvar and vaginal tissues are highly susceptible. Even products marked as “natural” or “sensitive” can contain allergens. Manufacturers should specify the presence of these elements using warning labels. At the same time, care providers should encourage women to clean the vulvar area with water instead of using these products.
Reliability of a standardized tool for evaluating the severity of cellulite in the female posterior thigh
A study published in the Journal of Cosmetic Dermatology assessed the reliability of a standardized grading system for scoring the overall severity of cellulite on the posterior thigh in women. The study evaluated the reliability of the method’s inter-rater and intra-rater (test/re-test). The researchers found the system was a straightforward and reliable method of rating cellulite severity. Additionally, the method had good inter-and intra-rater reliability.
During the first stage of the study, the researchers assessed the inter-rater reliability across five evaluators asked to analyze 24 photographs using a cellulite-graded severity chart. During the second stage, the same images were studied by two evaluators who had received additional training, which was crucial for a more accurate evaluation.
Histopathological features of pemphigoid gestationis and polymorphic eruption of pregnancy
A study published in the Journal of Cutaneous Pathology compared the histopathologic features of pemphigoid gestationis (PG) and polymorphic eruption of pregnancy (PEP) to determine the main differences between the two conditions. The researchers found PG was characterized by a high level of white blood cells and eosinophilic epitheliotropism. They also found that direct immunofluorescence (DIF) results are the best way to differentiate the two conditions.
For this retrospective cohort study, two dermatopathologists blindly analyzed the skin biopsies of 31 women. In total, the researchers identified 21 PG and 10 cases of PEP. One of the main differences between the two conditions was that PG had higher-than-normal levels of white blood cells than PEP.
A study published in the European Journal of Molecular & Clinical Medicine evaluated the prevalence and characteristics of pruritus in pregnant women. The researchers found that itchy skin is common and frequent during pregnancy. Additionally, they found that while the condition can result from natural physiological changes during pregnancy, it could indicate an underlying, unrelated disease.
For this prospective cross-sectional study, the authors analyzed the clinical data of 256 pregnant women using the outpatient services of the Department of Obstetrics and Gynecology in a tertiary care teaching hospital in North India from May 2021 to April 2022. The prevalence of itchy skin among the participants was 18.3%. The most common area where subjects experienced itch was the abdomen, followed by the chest. Finally, itchy skin was uncommon in women in their first and second trimesters and mothers with three or more pregnancies.
Vulvar dermatoses: Can a pattern-based approach improve diagnostic yield?
An article in the Journal of Cutaneous Pathology studied the utility of the 2006 International Society for the Study of Vulvovaginal Disease (ISSVD) classification for reporting vulvar dermatoses. The objective was to evaluate if a dermatopathology review could increase the accuracy of the diagnosis. The authors found that having a dermatopathologist review difficult vulvar biopsies did increase the diagnostic accuracy for vulvar dermatoses.
The researchers examined 106 vulvar biopsy reports from histopathology case files. The diagnosis stated in the case file was considered the initial diagnosis. Then, three dermatopathologists reviewed each file using the 2006 ISSVD guidelines. Diagnoses derived from this review were considered the review diagnosis. The researchers then compared and analyzed the initial and reviewed diagnoses. The non-specific report rate decreased from 83.6% to 1.8% after the dermatopathologist’s review.
Dr. Kimberly Brown, a St. Louis-based dermatologist and Physician Assistant at the SLUCare Hair Loss Clinic, discusses the cultural factors that contribute to hair loss in the Black community.
A case of systemic lupus erythematosus with acrocyanosis after AstraZeneca Covid-19 vaccination
A case study published in the Kaohsiung Journal of Medical Sciences reported on a 37-year-old woman who presented with a painful, blueish spot on her right index finger two weeks after receiving her first dose of the AstraZeneca Covid-19 vaccine. A laboratory examination revealed a reduced count of white blood cells, elevated levels of D-dimer, low protein S levels, and high levels of anti-nuclear antibodies. The patient was admitted for a thorough examination.
Upon admission, a physical examination revealed low in-blood oxygen or cyanosis on the upper part of her right index finger. A skin biopsy and angiography showed no signs of vasculitis or thrombosis. She was diagnosed with systemic lupus erythematosus with acrocyanosis. Her doctors prescribed hydrocortisone, hydroxychloroquine, and nifedipine. The treatment was effective and resulted in increased blood flow in the fingers.
“Having a diverse team that patients can relate to is associated with higher ratings in terms of satisfaction, trust, adherence to care which overall contribute to better health outcomes, and such diversity also fosters culturally competent healthcare delivery and inclusivity.”
— Dr. Adeline Kikam, a Texas-based dermatologist, in an interview with Healthline.
You are receiving this newsletter because you are a subscriber 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: 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; Kylie Rebernik, Jeremy Visser, Editors; Catherine Dusome, Operations Manager. Content is copyright (c) 2022, Chronicle LifeSci America Corp, except as indicated. Are you interested in contributing to this newsletter or learning more about Chronicle’s services? Please write to us at health@chronicle.org.
