Exploring sex-related biological and sociocultural influences on dermatologic disease patterns
Today’s report also covers research into risk factors for androgenetic alopecia, patient perspectives on hidradenitis suppurativa and infertility and more (1,200 words, 6 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
Good morning and welcome to 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
Sex and gender play significant roles in the development and presentation of dermatologic conditions, according to a study published in the Journal of Cutaneous Medicine and Surgery (July 2023).
The study’s lead author Dr. François Lagacé of the Division of Dermatology, Faculty of Medicine, McGill University, Montréal and his co-authors write that while sex and gender have often been grouped as a single risk factor in scientific literature, both may have a distinct impact on disease characteristics. The study reviewed sex- and gender-related epidemiologic and clinical differences for various skin conditions. Understanding these differences is crucial for providing tailored and effective care to patients.
The authors found that psoriasis prevalence is similar in both sexes, but disease severity is usually worse in males. At the same time, atopic dermatitis affects both sexes equally but is often more prevalent in female patients after puberty. This pattern is also seen in other allergic conditions, such as asthma and allergic rhinitis.
The authors did not find a significant difference in the prevalence of allergic contact dermatitis and irritant contact dermatitis between the sexes. However, the way these conditions present clinically may vary by sex, they note. Head and neck dermatitis is more common in females, likely due to practices such as cosmetic and jewelry use.
Occupational contact dermatitis is 50% more common in females and is associated with gender-related occupations such as nurses, housekeepers or cleaners, hairdressers, cooks, and bakers. In males, contact dermatitis is more frequently associated with carpentry, electrical work, construction, and the rubber industry.
The study found that acne vulgaris, rosacea, hidradenitis suppurativa, hyperhidrosis, vesiculobullous disorders, and autoimmune diseases such as systemic lupus erythematosus, cutaneous lupus erythematosus, systemic sclerosis, morphea and dermatomyositis are more common in female patients. The authors also found infectious diseases, skin cancers, and androgenic alopecia are more prevalent in male patients.
Other disease categories, such as pigmentary disorders and cutaneous adverse drug reactions, do not seem to have a specific gender preference.
Bottom line
The authors found that autoimmune conditions, as well as psycho-cutaneous diseases, are more common in females. Conversely, skin cancers, infectious diseases, and hair disorders are more prevalent in males. The incidence of pigmentary disorders, contact dermatitis, and allergic skin reactions was similar among both sexes.
An overview of risk factors for androgenetic alopecia in a cohort of Indonesian women
A study published in the Journal of General - Procedural Dermatology & Venereology Indonesia evaluated the risk factors for androgenetic alopecia (AGA) in women living in Padang City, Indonesia. The researchers found that, within the specific cohort, AGA was more common in women who were over the age of 65 years, married with children, overweight, had a maternal family history of AGA, or had regular menstrual cycles. They also found that hypertension, type 2 diabetes mellitus, and PCOS were not significant risk factors.
For this cross-sectional study, the authors interviewed 40 women diagnosed with AGA living in Pasar Ambacang Sub-district, Kuranji District, Padang City.
The relative effect of monotherapy with 5-alpha reductase inhibitors and minoxidil for female pattern hair loss
Research in the Journal of Cosmetic Dermatology compared the efficacies of oral finasteride, oral minoxidil, and topical minoxidil in hair regrowth for female pattern hair loss. The authors found the most effective regimen was 5 mg finasteride per day for 24 weeks, but each therapy's efficacy may vary depending on the dosage. For example, a 5% topical minoxidil solution twice a day for 24 weeks was significantly more effective than the same agent once daily for the same amount of time.
For this network meta-analysis, the researchers systematically reviewed peer-reviewed literature using “change in total hair density” as an outcome measure. The study included data from 13 trials.
The occurrence of proliferating pilar tumours in the scalp in a hospital in Mexico City
A study published in Dermatologic Surgery assessed the frequency of proliferating pilar tumours in the scalp in a Mexico City hospital over a period of 23 years. The authors found that most patients affected by pilar tumours in the scalp were women. However, most tumours seemed to be benign and painless.
For this study, the researchers reviewed the database of the dermatopathology department of the Dr. Manuel Gea González Hospital in Mexico City from Aug. 1999 to Aug. 2022. They selected cases of proliferating pilar tumours, pilar cysts, trichilemmal cysts, or proliferating trichilemmal cysts in the scalp. Of 17 cases, 13 were women, and only three cases were malignant.
Patient perspectives on hidradenitis suppurativa and infertility
A study in Dermatology aimed to understand the perspectives of women living with hidradenitis suppurativa (HS) regarding the impact of the disease on reproductive health and fertility treatments. The researchers found that women with HS have high rates of infertility compared to the general population and that most fertility treatments do not impact HS symptoms.
The authors distributed an anonymous survey through HS online support groups from June to July 2022. A total of 312 women answered the survey. Approximately 66.6% of the respondents had been pregnant before, 79.5% had attempted to conceive, and 41.5% had unsuccessfully tried to conceive for one year or longer. Of those who had never attempted to become pregnant, 39% reported that HS had impacted this decision. Respondents facing fertility challenges but not pursuing fertility treatments reported that the main barriers were concerns about financial support or insurance coverage and worry about fertility treatments worsening HS.
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A case of allergic contact dermatitis to drometrizole trisiloxane in a woman with frontal fibrosing alopecia
A case study published in the journal Contact Dermatitis described a 45-year-old woman who presented with facial dermatitis and a dry cough that she attributed to a specific sunscreen product. She had previously experienced itchy reactions to sunscreens, cosmetics, sanitary pads, and bra paddings. Patch tests confirmed an allergy to nickel sulphate and mercapto mix, which were present in some of the products she had used. However, subsequent patch tests with its individual ingredients, including drometrizole trisiloxane and ethylhexyl salicylate, were negative.
One year later, the patient developed frontal fibrosing alopecia and continued to experience eczematous reactions. Further patch and photo-patch tests revealed an allergy to drometrizole trisiloxane. The patient was instructed to avoid products containing drometrizole trisiloxane and ethylhexyl salicylate, significantly improving her symptoms.
“With the skin, people can see the problem. My colleagues can talk to their patients about heart disease and diabetes until they’re blue in the face, but that can fall on deaf ears because the person can’t see their heart disease and diabetes. But if they’ve got a spot and find out you’re a dermatologist, it doesn’t matter if you’re at a party or in an airline terminal.”
— Dr. Shadi Kourosh, a Boston-based dermatologist in an interview with The Harvard Gazette
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