Efficacy and safety of combined ethinylestradiol with minoxidil versus topical minoxidil in female pattern hair loss
Today’s report also looks at how air pollution influences skin microbiome, the connection between vulvar lichen sclerosus and oral lichen sclerosus, and more (Issue number 78; 1,260 words; 6 minutes)
Female pattern hair loss (FPHL) is widespread and significantly affects women's quality of life. The authors of a recent study published in Clinical and Experimental Dermatology (Oct. 16, 2024) write that while minoxidil is the standard treatment for FPHL, research suggests potential benefits from using 17α-estradiol, either alone or with minoxidil, though results vary. They compared the safety and efficacy of topical estradiol combined with minoxidil to minoxidil alone in FPHL treatment. The researchers found that the combination product is not statistically significantly more effective than minoxidil alone.
For this study, 43 women with FPHL applied either a combination of topical 17α-estradiol 0.01% with minoxidil 2% or topical minoxidil 2% alone twice daily for six months. Researchers evaluated progress through clinical and trichoscopic assessments at baseline and the end of the treatment.
The results showed both groups experienced hair improvement after treatment. Although improvements appeared slightly better in the 17α-estradiol-minoxidil group, the differences were insignificant. Notably, more women using the combined treatment reported menstrual irregularities.
The authors concluded that while combining 17α-estradiol with minoxidil may offer minor advantages, it doesn’t seem significantly more effective than minoxidil alone and could increase the risks of menstrual irregularities. However, the study’s limitations, including small sample size, brief follow-up, and lack of cellular-level examination or assessment of systemic absorption of the treatments, could impact the accuracy of comparing the treatments’ efficacy and safety. Further research with larger samples and in-depth cellular analysis is needed to understand better the potential benefits and risks of adding 17α-estradiol to minoxidil for FPHL treatment.
The Takeaway: The study shows that adding 17α-estradiol to minoxidil treatment does not yield significant improvements in female pattern hair loss over minoxidil alone. Women using the combination treatment reported slightly better hair outcomes but experienced more menstrual irregularities. Researchers suggest larger studies are needed to better understand the combination’s potential benefits and risks.
The influence of air pollution on the skin microbiome
Research published in Archives of Dermatological Research explored how air pollution affects the skin microbiome and its barrier function. The researchers found that women exposed to highly polluted air had reduced microbial diversity and increased presence of pathogenic microbes, correlating with higher pH and lower skin hydration levels. They note that these changes potentially compromise the skin’s barrier, increasing water loss and disrupting its protective functions.
For this study, the authors compared microbiome samples from the forehead skin of women in highly polluted Bangkok and less polluted Songkhla in Thailand.
Gender representation in authorship of academic dermatology publications during the Covid-19 pandemic
A study published in JMIR Dermatology examined the impact of the Covid-19 pandemic on female authorship in dermatologic literature. The researchers found that the proportion of female authors increased to 45.2% in 2022 from 41.7% in 2018, while the percentages of female first authors and senior authors fluctuated over the same period. For this study, the authors analyzed dermatology articles, letters, reviews, and editorials published from 2018 to 2022 in top dermatology journals, using genderize.io, a gender-predicting website, to estimate author gender by first names. They calculated annual percentages of total female authors, female first authors, and female senior authors to compare trends before and during the pandemic. The results showed that the total proportion of female authorship increased from 2018 to 2022. While female first authorship saw a slight rise, female senior authorship peaked in 2021 before declining in 2022, with overall publication volume reaching its highest in 2021.
The relationship between body dysmorphic disorder and depressive symptoms with health-related quality of life in women with vitiligo
A study in the Journal of Clinical Research in Paramedical Sciences evaluated the impact of body dysmorphic disorder and depressive symptoms on health-related quality of life in women with vitiligo. The researchers found that body dysmorphic disorder and depressive symptoms significantly impair health-related quality of life in women with vitiligo. For this cross-sectional study, researchers recruited 152 women with vitiligo from dermatology and cosmetic clinics in Ahvaz, Iran, in 2023. They collected data on health-related quality of life, body image, and depressive symptoms. The results showed that body dysmorphic disorder and depression significantly impact the health-related quality of life of women with vitiligo. Furthermore, the researchers found that body dysmorphic disorder has the most significant influence on health-related quality of life compared to other factors.
Lack of oral involvement in a large cohort of women with vulvar lichen sclerosus
A study published in the International Journal der Deutschen Dermatologischen Gesellschaft assessed the prevalence of oral lichen sclerosus in women with vulvar lichen sclerosus (VLS). The researchers found that oral involvement in women with VLS is rare, occurring in only 2% of cases and typically presenting as lichen planus.
This prospective, observational study included 300 women with histologically proven VLS who underwent thorough examinations of their oral cavities and lips between Jan. 2020 and July 2023. Participants provided informed consent, and those with suspicious lesions underwent a biopsy for histologic analysis. The results showed that while 21 women exhibited extragenital cutaneous lichen sclerosus, only six patients had white, non-removable oral lesions diagnosed as lichen planus. The results also showed that 36% of the study’s participants had concurrent autoimmune diseases, predominantly thyroiditis. Additionally, periodontal disorders were also observed in 25.3% of the participants, with fissured tongue being the most common condition. The authors concluded that oral involvement in VLS patients is rare, suggesting that the oral mucosa is less prone to lichen sclerosus development.
VIDEO: Alopecia areata: Don’t call it “just” hair loss
In this episode, Prof. Dr. Johannes Ring, Director of the Department of Dermatology and Allergy, Biederstein, Munich and Prof. Dr. Lidia Rudnicka, Chair of the Department of Dermatology at the Medical University in Warsaw and author of a European consensus statement recently published by the Journal of the European Academy of Dermatology and Venereology, discuss treatments for alopecia areata, urging healthcare professionals to be empathetic, put themselves in their patient’s shoes, and never think “it’s just hair.”
A case of mycosis fungoides, vitiligo, and a new hand nodule
A case study in the International Journal of Dermatology described a 70-year-old African American woman in remission from stage IV mycosis fungoides who presented with a gradually enlarging, red, ulcerated nodule on her hand. A biopsy showed abnormal cell growth, atypical cells, and increased blood vessels. An immunohistochemical staining test revealed a fusion of YAP1::MAML2 (mastermind-like transcriptional coactivator 2). The lesion was diagnosed as an eccrine porocarcinoma. The authors emphasize the need to consider eccrine porocarcinoma in patients with extensive skin treatments or immunosuppression.
“As a board-certified dermatologist, I know that losing up to 100 hairs a day is within the range of normal. However, I tell my patients that if they are concerned, I am concerned. Only you know your hair baseline, and what is a significant change for you. It is not helpful to be told that everything is fine because you still have hair. You need to act when you notice a considerable increase in shedding that persists beyond a few washes, or when you notice visible hair thinning/decreased density, or patches without hair.”
— Dr. Elizabeth Geddes-Bruce, an Austin, Texas-based dermatologist, providing advice to patients in an interview with lifestyle blog Camille Styles.
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
