Determining the dermatologic needs of Middle Eastern and North African and Hijabi women
Today’s report also covers research into the effect of oral tranexamic acid on hair melanin, HAIR-AN syndrome in women of reproductive age, and more (1,520 words, 7.3 minutes)
Good morning, and welcome to the Women in Dermatology newsletter from Chronicle Companies. We’re pleased to have you join us. It 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. This bi-weekly bulletin is presented with the support of Galderma Canada.
Correction (Edition of June 26, 2025)
An earlier version of the Women in Dermatology newsletter misstated the title of a case report by Dr. Carly Kirshen. The correct title is: “A case of genital psoriasis successfully treated with topical roflumilast.”
We regret the error. The online version of the newsletter has been corrected.
A study in the International Journal of Women’s Dermatology (June 2025; 11(2):e e211) evaluated the dermatologic care needs of Middle Eastern and North African (MENA) patients and Hijabi women. The study aimed to provide practical recommendations for improving clinical experiences, encouraging patient education, and fostering culturally sensitive environments. The researchers found that MENA and Hijabi women face unmet dermatologic needs, particularly regarding hair thinning, limited knowledge of hair protective practices, and a strong preference for care from providers of the same gender.
The authors conducted a 20-question survey at the Muslim American Society - Islamic Circle of North America’s Muslim Convention. The final sample included 80 participants. Of the respondents, 70% identified as Arab or Middle Eastern, 13% as Southeast Asian, 5% as White and 4% as African American. In clinical settings, 71% of respondents preferred the presence of only the dermatologist during examinations, and 20% preferred having a family member present. Regarding clinical environment preferences, most favoured private clinic settings, followed by hospitals and health fairs. Ethnic and gender concordance also mattered, with 37% of participants preferring dermatologists of the same ethnicity and 90% preferring one of their same gender.
The survey also explored communication styles and comfort preferences. Nearly half of the respondents wanted exam steps explained during the appointment, while one-third preferred a detailed explanation beforehand. Factors that contributed to comfort included friendliness, professionalism, and thorough education about results. Barriers to seeking dermatologic care included a perceived lack of necessity, long wait times, concerns about privacy, and financial costs.
Participants reported a wide range of skin and hair issues. Acne was the most common concern, followed by dry skin and hyperpigmentation. More than half reported hair thinning or loss, with 79% aware that wearing a hijab could contribute to this issue, yet only 35% were familiar with protective methods. About 56% of respondents relied on the internet or social media for skin health information, while just 11% cited healthcare professionals. Although 60% had seen a dermatologist previously, 62% lacked knowledge about how to perform a skin self-exam for cancerous skin lesions.
Sun protection was practiced daily by 32% on hot or sunny days, by 31% when the ultraviolet index was high and by 6% during prolonged sun exposure. For sun protection, 67% relied solely on sunscreen, 23% also used protective clothing, and 8% mentioned incorrect practices, highlighting gaps in education around prevention and skin cancer awareness.
The authors concluded that MENA patients, especially Hijabi women, face unique barriers in dermatologic care that are often unaddressed by standard practice. To meet these needs, they created an educational pamphlet with guidance on hair care for hijabi women, promoting protective practices for hair health. This initiative underscores the importance of cultural competence in dermatology.
The Takeaway: The researchers found that MENA and Hijabi women experience specific dermatologic concerns, particularly hair thinning, and often lack access to culturally sensitive guidance. Most participants preferred private clinical settings and female dermatologists. Although many were aware that wearing a hijab could contribute to hair issues, only a few knew about protective hair practices, and most relied on the internet rather than professionals for skin health information. The authors created an educational pamphlet on culturally appropriate hair care to address this population’s unmet needs.
The effect of oral tranexamic acid on hair melanin in Asian women
A study published in Dermatologic Therapy evaluated the effects of oral tranexamic acid (TXA) on hair melanin content in middle-aged Asian women. The researchers found no significant changes in melanin levels or hair colour after three months of daily 500 mg TXA treatment.
For this study, seven middle-aged East Asian women completed a three-month prospective observational study, taking 500 mg oral TXA daily, excluding during menstruation periods. Hair samples were collected from 10 different scalp regions before and after treatment, using a segmental analysis approach based on hair growth rates. Melanin content was measured using liquid chromatography-tandem mass spectrometry, and hair colour changes were assessed with a colorimeter, measuring lightness values to reflect pigmentation. The findings suggest that oral TXA does not significantly affect hair pigmentation.
A distinctive clinical phenotype of discoid lupus erythematosus in Papuanese women
A study in the Journal of Biomedicine and Translational Research examined the clinical and sociodemographic features of discoid lupus erythematosus (DLE) among Papuanese patients in East Indonesia. The researchers found that DLE in Papuanese women presents as a distinctive, highly uniform clinical phenotype with exclusive female predilection, strong links to sun exposure, and a universal malar distribution.
The authors conducted a five-year retrospective analysis of patient records from a dermatology department in Papua, Indonesia, including 22 women diagnosed with DLE between 2019 and 2023. The results showed that all patients had lesions on the nose or malar region, with most showing dyspigmentation, scarring, and broken capillaries. All patients also reported photosensitivity and were managed with sun protection and topical steroids.
A systemic review published on Research Square analyzed the clinical and metabolic characteristics of Hyperandrogenism, Insulin Resistance, and Acanthosis Nigricans (HAIR-AN) syndrome in women of reproductive age. The researchers found that HAIR-AN syndrome predominantly affects obese women and is characterized by severe insulin resistance, elevated androgens, and pronounced acanthosis nigricans, all of which correlate with significant metabolic dysfunction.
For this study, the authors conducted a comprehensive literature search using PubMed, Embase, Scopus, and Web of Science databases up to June 2025. Eligible studies included observational and interventional designs reporting on women diagnosed with HAIR-AN syndrome. They extracted data on hormonal, metabolic, and anthropometric parameters and assessed study quality using the Newcastle-Ottawa Scale. The results showed that HAIR-AN syndrome primarily affects obese women and is marked by severe insulin resistance. Additionally, insulin-sensitizing treatments, particularly metformin and incretin-based therapies, improved hormonal and metabolic parameters.
Antiandrogen therapy for the treatment of female pattern hair loss
A review published in the Journal of the American Academy of Dermatology assessed the antiandrogen treatments for female pattern hair loss (FPHL) available in the U.S. and their limitations. The researchers found that while topical minoxidil is the only U.S. FDA-approved treatment for FPHL, off-label antiandrogen therapies, such as oral 5α-reductase inhibitors and topical antiandrogens, may offer additional benefits but carry safety concerns, especially for women who are pregnant, breastfeeding or have a history of hormone-sensitive cancers.
For this study, the authors conducted a narrative review of current and emerging antiandrogen treatments for FPHL, focusing on those available in the U.S. They found that antiandrogen treatment for female pattern hair loss is off-label and lacks robust safety data. They also note that antiandrogens are contraindicated in women who are pregnant, may become pregnant, or are breastfeeding, with no FDA post-marketing teratogenicity data available. Furthermore, finasteride exposure in pregnant animals caused dose-dependent genital abnormalities in male offspring, and its excretion in breast milk is unknown. Finally, the authors found that finasteride may raise serum estrone and estradiol levels, making it unsuitable for use in estrogen-sensitive cancers.
VIDEO: Revolutionizing Dermatology with Generative AI
Palo Alto, Calif.-based dermatologist Dr. Faranak Kamangar discusses the transformative role of generative AI in dermatology, particularly with Derm GPT. The conversation covers the evolution of health tech, the applications of AI in clinical practice, and the potential benefits for dermatologists in improving workflow and patient care.
A case of genital psoriasis successfully treated with topical roflumilast
Case submitted byCarly Kirshen, MD, FRCPC, FAAD, Program Director for Dermatology at the University of Ottawa
A 65-year-old female patient presented in May 2022 with an onset of vulvar itch and rash in Oct. 2021. On examination, her palms, soles and extensor elbows had well-demarcated erythematous plaques with silvery scale. Examination of her buttock crease and vulva revealed well-demarcated thin erythematous moist plaques. She was diagnosed with psoriasis. She had no signs or symptoms of inflammatory arthritis. The patient reported smoking, which worsens psoriasis symptoms.
She was initially treated with clobetasol ointment to the vulva and halobetasol propionate 0.01%/tazarotene 0.045% to the body, but both caused a burning sensation and were discontinued shortly after initiation. She requested systemic, but non-immunosuppressive treatment, and acitretin 10 mg orally once per day was prescribed. After one week, use was stopped due to a headache. She was lost to follow-up and returned to the clinic in Feb. 2023. She was then prescribed tacrolimus 0.1% ointment, calcipotriol 0.005%/betamethasone diproprionate 0.064% foam, and calcipotriol 50 mcg/betamethasone diproprionate 0.5 mg foam gel without success.
In Aug. 2023, she was prescribed roflumilast 0.3% cream to apply daily for eight weeks. The patient returned to the clinic after eight weeks, satisfied with the results and requiring no further treatment. Roflumilast is an efficacious once daily non-steroid topical indicated for psoriasis, seborrheic dermatitis, and atopic dermatitis that can safely be applied to the genitals.
“People of color are predisposed to conditions like melasma and dark spots caused by acne, called post-inflammatory hyperpigmentation, both of which can further increase the appearance of unevenness.”
— Dr. Victoria Barbosa, a Chicago-based dermatologist, professor of dermatology at the University of Chicago and president-elect of the Skin of Color Society, in an interview with Women's Health.
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