Hidradenitis suppurativa in pregnant and breastfeeding women
Today’s report also covers research into the incidence of allergic contact dermatitis, a case of upadacitinib-induced alopecia areata, and more (1,520 words, 7.4 minutes)
A review published in Dermatology and Therapy (Sept. 4, 2024; 14:2407–2425) updates clinicians on managing hidradenitis suppurativa (HS) in special populations, including children, pregnant and breastfeeding women, and elderly patients.
The researchers found that HS is associated with increased risks for adverse maternal and neonatal outcomes. Additionally, pediatric patients often experience delayed diagnosis, and HS tends to be more severe in elderly populations. HS can significantly impact the quality of life of affected individuals, requiring careful consideration of treatment strategies across various age and demographic groups.
The authors reviewed existing literature regarding HS management in the cohorts listed above. They found that in children, early misdiagnosis is common due to the subtle presentation of symptoms resembling acne or skin infections. This often results in a prolonged average diagnosis time of 2.5 years. Management approaches for pediatric HS largely follow adult treatment guidelines, with many medications being used off-label.
The review emphasizes that HS disproportionately affects women of childbearing age. Some women experience symptom improvement during pregnancy, while others see no change or even experience worsening of symptoms. The authors also note that women with HS are at higher risk for adverse maternal and neonatal outcomes, including preterm birth, gestational diabetes, and cesarean sections.
The review found that treatment options for HS during pregnancy can vary. Topical agents such as antiseptic washes and clindamycin are generally considered safe. Systemic antibiotics can also be used cautiously, particularly in later trimesters. Medications such as rifampin and dapsone are considered on a case-by-case basis due to potential risks. Biologics are also typically safe during early pregnancy but require careful consideration as pregnancy progresses, especially regarding the risk of fetal drug exposure.
The authors note that breastfeeding poses unique challenges for mothers with HS because they may experience postpartum flares, and clinicians must consider the safety of medications entering breast milk. Most medications compatible with pregnancy are also regarded as safe during lactation, though clindamycin and metronidazole require caution. Biologics are generally safe for breastfeeding mothers, but there is limited safety data for newer treatments.
The review highlights that HS can manifest more severely in elderly patients and is often accompanied by multiple comorbidities. Treatment approaches should consider overall health and potential medication interactions. Standard topical therapies are generally safe, while systemic treatments should be chosen carefully to prevent adverse effects. Biologics are becoming increasingly used in geriatric patients, but caution is advised for those with a history of heart failure or cancer.
The Takeaway: HS significantly impacts quality of life across different age groups, particularly affecting women of childbearing age. Pediatric patients often face delayed diagnosis, with symptoms commonly misidentified as acne. Pregnant women with HS are at higher risk for adverse maternal and neonatal outcomes, including preterm birth and gestational diabetes. Safe treatment options during pregnancy generally include topical agents, while systemic antibiotics and biologics require careful consideration. Elderly patients experience more severe HS, requiring tailored treatment approaches that account for comorbidities and potential medication interactions.
Join us on October 5th for the 10th anniversary of the Skin Spectrum Summit, a landmark event for healthcare practitioners committed to advancing dermatologic care for Canada’s diverse population. This year, we celebrate a decade of education and innovation at the Art Gallery of Ontario.
On October 4th, the Indigenous Skin Spectrum Summit returns for its third year. This special session will focus on improving dermatologic care for Indigenous communities and addressing their unique challenges.
Secure your spot today and be part of this essential conversation on diversity and inclusion in dermatology.
Clinical efficacy and safety of a thermomechanical fractional injury device for neck rejuvenation
A study published in Dermatologic Surgery evaluated the efficacy and safety of a thermomechanical fractional injury device for treating neck wrinkles in women. The researchers found that the device significantly improved wrinkles among participants with moderate to severe neck wrinkles at one and three months post-treatment, with all participants reporting an enhancement in their aesthetic appearance.
For this study, 26 women with moderate to severe neck wrinkles were enrolled for four monthly treatments using a thermomechanical fractional injury device. The results indicated significant improvements in neck wrinkles. Additionally, there were no severe adverse events, and the participants experienced minimal pain during the procedure.
Incidence of allergic contact dermatitis in Finland 1998–2021
A study in Contact Dermatitis assessed the incidence and causes of allergic contact dermatitis (ACD) in Finland’s working-age population using national registry data from 1998 to 2021. The researchers found that the incidence of ACD in Finland increased from 1998 to 2016, particularly among women, but began to decrease afterward.
For this retrospective database study, the authors analyzed records from the Finnish Care Register for Health Care, identifying 26,701 individuals diagnosed with ACD. The results revealed that while the incidence of ACD rose steadily until 2016, it has since decreased, potentially due to changes in allergen prevalence and regulatory measures. Common allergens included metals and cosmetics.
Physician-level assessment of hirsute women and their eligibility for laser treatment using deep learning
Research in Lasers in Surgery and Medicine assessed the eligibility of hirsutism patients for laser hair removal, comparing evaluations made by healthcare professionals with those generated by convolutional neural network models. The researchers found that the convolutional neural network ensemble model performed comparably to dermatologists in assessing eligibility for laser hair removal, with a slight, non-statistically significant advantage. This highlights the challenges in ensuring accurate assessments.
The authors used a retrospective design for this study, using separate sources for training and test images. They assessed five deep learning models against a consensus reference standard and evaluations from 20 healthcare professionals, including dermatologists. The results showed that the convolutional neural network ensemble model achieved an eligibility assessment accuracy of 52%, indicating a moderate level of agreement with expert evaluations. In comparison, board-certified dermatologists had a mean accuracy of 48%. Additionally, the analysis showed that when dermatologists assessed the same cases, their agreement varied, ranging from 32% to 65%.
Vulvar lichen sclerosus patient willingness to perform self-examination
A study published in the Journal of Lower Genital Tract Disease explored the willingness of patients with vulvar lichen sclerosus (VLS) to perform vulvar self-examination and identified the barriers they face. The researchers found that most patients were willing to perform vulvar self-examination when advised by a healthcare professional. They noted that increasing recommendations for vulvar self-examination could lead to earlier detection of VLS complications.
The authors conducted a cross-sectional survey for this study at a tertiary referral dermatology clinic in Australia from June 2022 to Jan. 2023. It included 78 participants. The results revealed that 68% of participants had examined their vulva at least once, with 49% having been recommended vulvar self-examination by a healthcare professional. Additionally, 79% of all patients indicated they would likely perform vulvar self-examination if recommended. Factors associated with a higher likelihood of performing vulvar self-examination included a higher education level and tampon use. In contrast, self-reported back problems were linked to a lower possibility of performing vulvar self-examination.
VIDEO: Skin, Mind, Body Connection | The Future of Dermatology Podcast
San Francisco-based Dr. Keira Barr discusses her unconventional path in dermatology. She emphasizes the mind-body connection in skin health and advocates for a positive, holistic approach to aging and skin care. She highlights the psychological aspects of cosmetic consultations, the impact of stress and trauma, and the importance of personalized dermatology and skin cancer awareness.
A case of drug-induced alopecia areata related to upadacitinib
A case study in Cureus described a 55-year-old woman with severe atopic dermatitis (AD) who was prescribed upadacitinib, starting at 15 mg daily, increased to 30 mg after three months for better disease control. The patient reported significant improvement in her AD symptoms, but nearly one year into the treatment, she developed two round patches of hair loss on her scalp. She was later treated with intralesional triamcinolone injections. The patient had no prior history of alopecia areata (AA). Laboratory tests were standard, and her treatment plan continued with upadacitinib for the AD and triamcinolone injections for the AA patches. This case highlights the rare occurrence of AA following upadacitinib therapy, prompting further investigation into the relationship between JAK inhibition and autoimmune responses.
“The historic lack of representation of clinical images on dark skin types can be a contributing factor to the underdiagnoses of dermatologic disease in skin of color. This is especially troubling for trainees who do not receive exposure to diverse patient populations and may enter the workforce without the proper tools to diagnose common diseases in different skin types.”
— Dr. Stephanie Florez-Pollack, a Richmond, Texas-based dermatologist, in an interview with Elle Magazine.
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