The Women in Dermatology e-newsletter is supported by an unrestricted grant from Galderma Canada.
Good morning and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We are pleased to have you join us. Every two weeks, this bulletin will provide you with updates 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
In recent years, women in the medical profession have made significant progress. The Association of American Medical Colleges reports that the number of female medical students has steadily increased to roughly 50% of all students in medical schools in the United States today. In Canada, the percentage is very similar. The Canadian Medical Association reported that 56% of first-year medical students in 2017/18 were female. This influx, however, has not been matched by comparable growth of women in medical, academic, and leadership roles.
A paper published in the Indian Dermatology Online Journal (Feb. 2022; 13(1):3-9) analyzed the disparities in gender representation in medical professions and defined the need for gender equality, focusing on dermatology. The authors state that gender equality is essential for many reasons. One reason is that if the development of medical devices does not consider the size of female hands and the physiologic strength of women for particular surgical tools or devices, there is an increased risk of musculoskeletal injuries to women physicians compared to their male counterparts. Another aspect of patient care is the difference in patient outcomes according to the gender of the practitioner. For example, the authors cited a study that showed patients with acute myocardial infarction treated by a male physician had a greater death rate than patients treated by a female physician. However, this impact was decreased when the male doctor worked with a team of female doctors.
In dermatology, the researchers found that in 2012, only 17% of female dermatologists held full dermatology professorship status in the U.S. They also found a low number of female dermatology program directors, meaning that young female physicians have few female role models and mentors. Additionally, the researchers reference a cross-sectional study performed in the U.S. between 2008 and 2017 that showed leadership positions in medical societies were held predominately by men. The largest gap revealed was in the specialty of dermatology.
The authors note the importance of female-centric dermatologic associations, such as the Women’s Dermatologic Society (WDS), founded in 1973 by Dr. Wilma Bergfeld. These associations help to encourage women to reach major elected offices at the American Academy of Dermatology (AAD) and empower female dermatologists.
Bottom line
The authors conclude that because the gender balance in medicine has improved over the last three decades, it is shocking to see that the gender balance in academic and leadership positions is still inferior. This disparity creates a loss of opportunities for female physicians to be promoted to higher positions, obtain funding for research, and have access to a professorship. However, the transition toward fair representation is being led by a core group of female dermatologist leaders who meet at dermatology congresses, publish together, and hold leadership positions in national associations.
A recent systematic review that examined the cutaneous side effects of the various Covid-19 vaccines found these side effects were most common in women. Although severe cutaneous side effects of the Covid-19 vaccines are rare, cases of erythema, itchiness, morbilliform eruptions, Pityriasis rosea, swelling, burning, and urticarial rash on the neck, upper limbs, and trunk were observed.
The researchers concluded that approved Covid-19 vaccines have mostly satisfactory safety profiles, and mild or moderate cutaneous reactions should not discourage people from getting vaccinated. They also note that pre-vaccination the appearance of cellulite, and assurance is recommended in patients with allergies and a history of local injection reactions.
A study published in the Journal of Clinical Medicine evaluated the effectiveness of microwave therapy for cellulite in women. The researchers found this treatment is safe and effective for improving the appearance of cellulite and reducing body circumference.
In this study, 26 women with severe or moderate cellulite underwent four sessions of microwave therapy on the buttocks and posterior thighs. The treatment showed a significant reduction in cellulite severity between the initial treatment and the three-month follow-up. Aside from no adverse effects, the treatment also resulted in an improvement in patient satisfaction and a reduction in the buttocks and posterior thigh circumference.
A study published in the French journal Annales de Dermatologie et de Vénéréologie examined the clinical and pathological features of vulvar sebaceous adenitis/vulvar acne. The researchers found that this condition is clinically recognizable due to painful recurrent inflammatory lesions that affect the labia minora and the inner labia majora, which are sites of Fordyce granules. For this reason, the authors suggest using a more specific denomination: “vulvar Fordyce adenitis”. They also found a connection between acne vulgaris and hidradenitis suppurativa, which they state requires further investigation.
The files and photographs of 45 patients with papules or nodules on the labia minora or the inner labia majora were extracted from a vulvar clinic database for this retrospective cohort study.
Maternal stressful life events during pregnancy and atopic dermatitis in children
A prospective cohort study published in the International Journal of Environmental Research and Public Health assessed the relationship between maternal exposure to stressful life events (SLEs) during pregnancy and children’s current atopic dermatitis (A.D.), location-specific A.D., and history of A.D. in children aged approximately four to six years of age. The researchers did not find a significant connection between SLEs and A.D. in children. However, they suggest that further and larger studies need to be conducted before reaching a conclusion.
For this study, 426 mother-child dyads in the United States were studied from pregnancy to middle childhood. The women reported SLEs experienced during the 12 months before delivery and A.D. outcomes in their children.
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Pyoderma gangrenosum after breast cancer resection
A report published in Plastic and Reconstructive Surgery–Global Open presented the case of an 82-year-old female patient who arrived at a clinic with a high fever and severe pain from breast wounds 12 days after a bilateral breast cancer resection. The symptoms began four days post-surgery and progressively worsened. Emergency surgery was performed, and the doctors resected the edges of necrotic ulcers, including the strongly reddish skin and subcutaneous necrotic tissue, until they reached the surface of the muscular layer. The opened wounds were sanitized every day, but a 38°C fever persisted.
The patient was later seen by dermatologists because her clinical course was significantly different from the suspected bacterial infections and necrotizing soft tissue infections. The specialists diagnosed the patient with pyoderma gangrenosum due to the physical findings of characteristic painful, sterile ulcerations, bullae and pustules, and the pathological abundance of neutrophils in the absence of infection and vasculitis. The patient was prescribed 30 mg/day of oral prednisolone until the symptoms and pain were reduced. The oral steroid intake was then reduced to 12.5 mg/day, and a skin grafting surgery was performed.
“New technologies have incorporated biocompatible microneedles into spreadable topical formulations to improve penetration of cosmeceuticals. I keep talking about enhancing penetration because that is key to treating skin of colour patients.”
— Dr. Heather Woolery-Lloyd, a Miami-based dermatologist, speaking at the seventh annual Skin Spectrum Summit in November 2021.
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