Fertility trends and adverse pregnancy outcomes in female patients with psoriasis
Today’s report also covers research into exposure to biologics during pregnancy, cultural and ethnic perceptions in women’s cosmetic surgery, and more (1,405 words, 7 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
According to a study published in JAMA Dermatology (June 2023), inflammatory diseases, such as psoriasis, have often been associated with negative pregnancy outcomes, but the relationship between psoriasis and pregnancy outcomes is not well understood. This study examined fertility rates and pregnancy outcomes in patients with psoriasis compared to those without psoriasis.
For this population-based cohort study, the authors used data from 887 primary care practices that contributed to the U.K. Clinical Practice Research Datalink GOLD database between 1998 and 2019. The final analysis included 63,681 patients with psoriasis and 318,405 matched healthy controls.
The study found patients with psoriasis had higher fertility rates compared to the matched healthy controls. However, when the severity of psoriasis was considered, patients with moderate to severe psoriasis had lower fertility rates.
Results also showed that women with psoriasis had a higher risk of miscarriage. There were no significant differences in stillbirth or preterm birth rates between the two groups, but pregnancies in women with moderate to severe psoriasis were less likely to end in a live birth.
According to the authors, pregnant patients with psoriasis had a slightly increased risk of venous thromboembolism, but the skin condition did not seem to be associated with a higher risk of developing gestational diabetes, preeclampsia or prenatal bleeding.
Bottom line
The authors conclude that while patients with psoriasis seem to have higher fertility rates, they face increased risks of pregnancy loss. They say it is important for healthcare providers to be aware of these potential risks and provide appropriate care to patients with psoriasis who are planning to conceive or are already pregnant. They add that further research is needed to develop strategies to optimize pregnancy outcomes in patients with psoriasis.
Galderma Canada has launched Restylane® Eyelight™, a hyaluronic acid dermal filler specifically designed for under-eye concerns. This treatment targets infraorbital hollowing, reducing the appearance of dark circles, shadows, tiredness, and other signs of aging.
Restylane Eyelight contains hyaluronic acid (HA) with Galderma's proprietary NASHA® gel technology to restore volume and correct under-eye hollowing. The treatment provides a refreshed and rejuvenated look, making patients appear less tired and more rested. It’s the only product with a dedicated indication for treating infraorbital hollowing.
“The under-eye region is often one of the first parts of the face to show signs of aging. When people visit my clinic, they are looking for treatment options that can address the tired look, which can also make you feel older than you are,” said Dr. Lisa Kellett, a Toronto-based dermatologist, in a press release. “It is exciting that there are multiple treatment options that are safe and effective to meet the various needs of patients.”
From the literature on women in dermatology
Exposure to biologic therapy before and during pregnancy in patients with psoriasis
A study published in the Journal of the European Academy of Dermatology and Venereology assessed pregnancy outcomes in women with psoriasis who were exposed to biological drugs before or during pregnancy.The authors found that exposure to biologics for psoriasis during pregnancy or conception does not increase the risk of miscarriage or congenital malformations.
For this systematic review and meta-analysis, the researchers conducted a bibliographic search using PubMed, Embase, Scopus and Web of Science. A total of 51 observational studies were included in the review. The prevalence of miscarriage was estimated at 15.3%, but elective abortions accounted for 10.8% of the total cases. Congenital malformations occurred in approximately 3.0% of live births exposed to biologics during pregnancy, similar to the general population. The authors concluded that biologics are safe overall during pregnancy or conception.
Gender disparities in health-related quality of life in patients with cutaneous T-cell lymphoma
Research in the International Journal of Women’s Dermatology assessed the potential gender differences in health-related quality of life (HRQoL) in patients with cutaneous T-cell lymphoma (CTCL). The researchers discovered that women with CTCL experience significantly worse HRQoL than men.
The authors partnered with the Cutaneous Lymphoma Foundation (CLF), based in Warren, Mich., to distribute an anonymous electronic survey from February to April 2019. The survey was distributed via the CLF’s Facebook Group. A total of 292 patients completed the survey.
Cultural and ethnic perceptions in women’s cosmetic surgery
A study published in Clinical, Cosmetic and Investigational Dermatology summarized recent findings on beauty perceptions across ethnicities and cultures, focusing on female beauty standards for the face, breast, and gluteal region in cosmetic surgery. The researchers found significant differences in preferences and beauty standards depending on the country, ethnic background, and culture.
For this study, the authors conducted a literature search using Scopus and PubMed databases. The search terms were related to aesthetic and cosmetic surgery and ethnic, racial, and cultural aspects of acceptance, attitude, and perception. The results showed that beauty standards are heavily influenced by culture. For example, Latin American and Caribbean populations prefer smaller, narrower noses with tips that project more, whereas South Indians and Middle Easterners prefer straight and small noses. In terms of the gluteal area, the authors found that Black and Hispanic women often desired larger buttocks than Caucasian women.
Autoimmune, inflammatory, atopic, thyroid, and psychiatric outcomes of children born to mothers with alopecia areata
A study in JAMA Dermatology assessed the risk of autoimmune, inflammatory, atopic, thyroid, and psychiatric disorders in children born to mothers with alopecia areata (AA). The authors found maternal AA is associated with an elevated risk of autoimmune/inflammatory, atopic, thyroid, and psychiatric disorders in children.
For this retrospective population-based birth cohort study, the researchers used a birth registration database from the Nationwide Health Insurance Service database of South Korea. The analysis included newborns born to mothers with AA and matched control children born to mothers without AA from 2003 to 2015. The results showed that the risk of AA, vitiligo, atopic disorders, hypothyroidism and psychiatric disorders was significantly higher in children born to mothers with AA.
Dr. Joyce Park, a Seattle-based dermatologist, explains hormonal acne causes, treatments, and the recent claims that spearmint tea can be used for the treatment of hormonal acne.
A case of early-onset generalized pustular psoriasis of pregnancy after hydroxychloroquine use
A case study published in the Annals of Dermatology described a 33-year-old pregnant woman who presented with red patches and pus-filled blisters on her body in her 18th week of gestation. She had been diagnosed with systemic lupus erythematosus six weeks prior and had been taking hydroxychloroquine (HCQ) when the lesions appeared. The physicians initially suspected HCQ-induced acute generalized exanthematous pustulosis, so the patient stopped taking HCQ and received treatment with systemic and topical corticosteroids and anti-histamines for two weeks. However, her condition worsened, and she was ultimately diagnosed with generalized pustular psoriasis during pregnancy.
The patient was treated with oral cyclosporine, which led to symptom remission, and she was discharged at 22 weeks of gestation. Almost six weeks after discharge, the patient underwent an emergency C-section due to preeclampsia. Following delivery, her skin lesions almost completely cleared, and she did not experience a relapse.
“SPF makeup is not actually that important or valuable, to be honest. The majority of people using SPF makeup will not even remotely apply enough SPF makeup to get adequate UV coverage and defence. For example, you need around half a teaspoon of SPF at least to protect the face and neck. Most people would not use that much foundation, but companies are testing their SPF makeup formulas in quantities designed for traditional sunscreens, so to get true SPF protection, you need to be applying that amount. And people are certainly not going to reapply their foundation every two hours to get continuous SPF protection.”
— Dr. Geeta Yadav, a Toronto-based dermatologist in an interview with the National Post.
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