Today’s report also covers research into the patient perspective on HS, the association between prenatal vitamin D consumption and atopic dermatitis in children, and more (1420 words, 7.5 minutes)
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’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.
New research suggests that gut microbiome may be linked to skin health and multiple mood disorders such as anxiety and depression.
In a narrative review published online in the journal Dermatology and Therapy (June 2022), researchers provided updated perspectives on the gut microbiota with an emphasis on estrogen’s direct actions on the skin and the estrobolome—the bacteria in the gut that metabolize and modulate the body’s circulating estrogen—in dermal health. For this study, the authors reviewed journals from Jan. 2018 to Feb. 2022 using the keywords diet, estrogens, estrobolome, isoflavonoids, gut microbiome, gut-skin axis, phytoestrogen and skin, as well as keyword combinations. They conducted searches on PubMed, Science Direct, Scopus and Google Scholar.
According to research, estrogen supports homeostasis and directly affects dermal health. The authors note that the gut microbiome influences the skin microbiome, which regulates the circulation of estrogen. This helps boost immune function, combats inflammation, and lowers the risk of hormone-dependent skin cancers.
The authors also add that estrogen increases the variety of gut microbiota and enhances the enzymes that metabolize estrogen. This effect positively regulates the gut microbiome. The authors write that several bacterial species found in the gut produce the enzyme β-glucuronidase, which is involved in estrogen metabolism.
Another relevant finding was that a higher ratio of the remains of estrogen broken down by microbes to unmodified estrogen was associated with microbial diversity in the colon in postmenopausal women. Additionally, phytoestrogen supplements can modify the gut flora and may offer an alternative to women with estrogen deficiencies.
Finally, the study suggests that diet plays a crucial role in shaping microbiome composition and function. Foods high in fat or protein are associated with higher activity of the enzyme β-glucuronidase in the lower gut, whereas fibre consumption decreases activity. A fibre-rich diet is recommended to maintain healthy skin, especially after menopause.
Bottom line
The authors conclude that adequate estrogen levels are necessary for maintaining skin health in women. They note that estrogen intake changes the microbiota living in the gut, which can change how a woman’s body reacts to estrogen, including in the skin. Additionally, they say that gut microbial enzymes regulate the hormonal signalling involved in female health. They also emphasize the importance of a high-fibre, gut-friendly diet to maintain good skin, gut and hormonal health.
A study published in the journal Advances in Skin & Wound Care sought to determine the effects of hidradenitis suppurativa (HS) on women’s self-perception and life experiences. The authors found that somatic features, especially pain, were the most troubling issues among women with HS. Additionally, the emotional burden of the disease also played a significant role in women with HS.
For this study, the researchers conducted semi-structured interviews with 22 women of different ages and family status. Overall, they identified several themes and sub-themes as among the major concerns for women with HS. These concerns involved physical, emotional, coping, and functional aspects related to HS. However, the participants also showed personal strength and expressed optimism for the future.
Atopic dermatitis associated with preeclampsia and endometriosis
A letter to the editor published in the journal JID Innovations presented a study that evaluated the connection between atopic dermatitis (AD) and preeclampsia, and endometriosis. The authors found that both conditions were more common in women with AD than those without this skin condition.
The researchers conducted a retrospective cohort study using the Optum Clinformatics Data Mart (Optum) between Jan. 2016 and July 2020 and data from The Health Improvement Network (THIN) through Feb. 2015. In both Optum and THIN, patients with AD were matched with up to five patients without AD to assess for any association between AD and preeclampsia. Similarly, to evaluate for a potential association between AD and endometriosis, patients with AD were matched with patients diagnosed with a nevus or seborrheic keratosis. In both cases, a logistic regression was used to examine differences in the frequency of preeclampsia and endometriosis. The results showed that preeclampsia was more common in women with AD than in the control groups in both the Optum and THIN cohorts. However, the association was not statistically significant in the Optum cohort. Endometriosis was also more common in women with AD than controls in both cohorts.
Facial skin thickness associated with gender, age, and BMI
A study published in the journal BMC Medical Imaging aimed to estimate the epidermal and dermal thicknesses using high-frequency ultrasound at eight facial sites in healthy adults to determine its correlation with gender, age and body mass index (BMI). The researchers found that in women, the epidermal and dermal thicknesses of the neck change drastically as age increases.
For this study, a facial skin assessment was performed on 118 participants. According to the study, the epidermal and dermal thicknesses in men were significantly higher than in women. Additionally, the dermal thickness around the cheekbones and below the jaw in young women was substantially higher than in middle age and older women. With the increase in age, facial skin thickness also decreased in women, primarily on the forehead, between the eyebrows, around the cheekbones and below the jaw.
Maternal prenatal cholecalciferol supplementation and offspring risk of atopic eczema
A study published in the British Journal of Dermatology examined how mothers using cholecalciferol supplementation during pregnancy changed the risk of atopic eczema in children aged 12, 24 and 48. The authors found that this supplementation might have a protective effect on the offspring.
In this trial, pregnant women received either a daily dose of cholecalciferol or a matched placebo from around 14 weeks until delivery. Except for an extended breastfeeding duration in the intervention group, the characteristics of the mothers and children were similar between the intervention and placebo groups. Additionally, the children of mothers who received daily cholecalciferol had lower odds of developing atopic eczema at 12 months. However, at ages 24 and 48 months, the effect weakened and was not statistically significant.
VIDEO: Social media in dermatology with Dr. Mamina Turegano
Check out this episode of the LearnSkin Podcast, in which Dr. Mamina Turegano, a Louisiana-based dermatologist, talks about the always-changing landscape of social media. Listen in as she discusses the do’s and don’ts and the positive impact social media interaction can have on dermatology practices.
A case of cutaneous lymphangioma secondary to breast cancer radiotherapy after mastectomy
A case study published in the journal Clinical Case Reports reported the case of a 60-year-old woman who presented with shiny and translucent papules on her right breast. The lesions were not itchy or painful and had been presentfor eight years. She had a history of medullary breast carcinoma, which was treated with chemotherapy and radiotherapy. She had also undergone quadrantectomy and axillary dissection. After a thorough physical examination, the physicians performed a biopsy of the breast skin lesions with differential diagnoses of lymphangioma and metastasis.
Additionally, the rete ridges around the lymphatic channels grew longer and thinner. There was also epidermal atrophy over the lymphatic channels. The patient was then diagnosed with superficial lymphangioma, and because the lesions were benign, she refused treatment.
“The risk of developing melanoma is lower in people of color than it is for those with lighter skin tones. But it is more likely to be fatal [in people of color] when it does occur, usually because it goes undetected until it is too late to treat.”
— Dr. Caroline Robinson, a Chicago-based dermatologist, in an interview with The Cut, a supplement to New York Magazine.
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