Interest grows in sunscreen safety during pregnancy and lactation
Today’s report also covers research into preventing dermatitis in breast cancer patients, pregnancy outcomes after gestational exposure to ustekinumab and more (1,590 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 bi-weekly 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.
Sunscreen reduces the risk of skin cancer and prevents skin damage. While various dermatology associations have provided different recommendations regarding sunscreen, there is no specific guidance for pregnant or nursing women. This lack of guidelines may lead women to search for sunscreen recommendations online.
In a recent research letter published in the International Journal of Women’s Dermatology (June 2022; 8(1): p e018), researchers from Michigan State University completed an internet-based analysis of the changes in sunscreen recommendations for pregnant and nursing women before and after May 2019. For this study, the authors used Google Trends to compare search queries from the United States between April 30, 2017, and May 1, 2019, and between May 1, 2019, and April 30, 2021. The search terms they included in their study were: “sunscreen for pregnancy,” “safe sunscreen pregnancy,” “sunscreen pregnancy,” “sunscreen lactation,” “safe sunscreen breastfeeding,” and “sunscreen nursing.”
The first 50 results were examined to determine the type of sunscreen recommendation and whether it came from a dermatologist or a non-dermatologist. This study did not include advertisements, duplicates, or websites lacking publication dates.
The researchers found a statistically significant increase in Google searches for “sunscreen for pregnancy,” “safe sunscreen pregnancy,” and “sunscreen pregnancy” between 2019 and 2021 compared to the 2017 to 2019 period. Additionally, 65 YouTube videos and 45 web pages from Google searches met the search and exclusion criteria for "safe sunscreen pregnancy" and "safe sunscreen lactation."
Regarding Google searches, a higher proportion of recommendations were found for mineral sunscreens after May 2019 (86%) compared to previous dates (60%). Similarly, after May 2019, there was a lower proportion of recommendations for chemical and mineral sunscreens (11%) compared to dates before May 2019 (30%). Around half of these recommendations come from dermatologists.
Finally, YouTube analysis indicated that mineral sunscreen alone was recommended in 71% of videos after May 2019 compared to 57% before May 2019. However, the overall amount of chemical sunscreen recommendations increased from 0% to 10% after May 2019. Unlike Google, most YouTube recommendations came from non-dermatologists.
Bottom line
The authors conclude that public interest in sunscreen safety is growing and that it would be helpful to have guidelines from dermatological academies and organizations regarding which sunscreens are safe for pregnant and lactating women. Guidelines from professional associations are essential because the Google trends analysis revealed that sunscreen recommendations are not necessarily based on expert opinion.
From the literature on women in dermatology
Efficacy of epigallocatechin-3-Gallate in preventing dermatitis in breast cancer patients
A study published in JAMA Dermatology evaluated the efficacy of epigallocatechin-3-gallate (EGCG) solution in reducing the incidence of radiation-induced dermatitis (RID) in patients undergoing radiotherapy after breast cancer surgery. The researchers found that the EGCG solution drastically reduced the occurrence and severity of RID in patients receiving radiotherapy for breast cancer. They also noted that this treatment has the potential to become a new skincare option for these patients.
For this phase 2 double-blind, placebo-controlled randomized clinical trial, 180 patients with breast cancer receiving postoperative radiotherapy at Shandong Cancer Hospital and Institute in Shandong, China, between Nov. 2014 and June 2019 were enrolled. The participants were randomly assigned to receive either an EGCG solution or a placebo from day one of the radiation treatment until two weeks after completion. Compared to the placebo group, the occurrence of grade 2 or worse RID was significantly lower in the EGCG group. Additionally, symptom indexes were also lower in patients receiving EGCG.
Development and validation of a dermoscopic severity score for female pattern hair loss
A study published in the journal Skin Appendage Disorders aimed to develop a dermoscopic severity score for female pattern hair loss (FPHL). According to the study’s abstract, the researchers managed to create and validate an objective and reliable severity score of FPHL. The authors also noted that this score could be used as an additional outcome in clinical trials.
This cross-sectional study involved 76 women with FPHL and 12 controls. The researchers took standardized dermoscopic photos of the scalp to assess the main findings of FPHL. They used multivariate analysis methods to define the variable selection and scores in the final model. Additionally, 20 participants were re-tested to evaluate the reliability, and another 10 participants were tested before and after treatment to determine the treatment’s sensitivity to change after six months.
Pregnancy outcomes following peri-conceptional or gestational exposure to ustekinumab
A recent article published in the journal Alimentary Pharmacology & Therapeutics assessed the pregnancy outcomes in patients exposed to ustekinumab during pregnancy to determine if there was a higher risk of congenital anomalies or adverse pregnancy outcomes among these patients. The researchers did not find a higher risk of adverse pregnancy outcomes.
For this study, the authors summarized cumulative data on ustekinumab-exposed pregnancies from Janssen’s Global Safety Database (JGSD). Descriptive data for pregnancy outcomes were presented overall and by patient subgroups. As of August 31, 2020, the JGSD identified 408 medically verified, future, maternal ustekinumab-exposed pregnancies with reported outcomes. Of the 420 pregnancy outcomes, 81% were live births, 12.1% spontaneous abortions, 6% were elective or induced abortions, 0.7% were stillbirths, and 0.2% were ongoing pregnancies with congenital fetal anomalies. Among the live births, 9.7% were born prematurely. According to the researchers, the reported adverse outcome rates were similar to what would be predicted based on data from the overall US population. Additionally, they add that while this study contributes to the clinical data evaluating the safety of ustekinumab usage during pregnancy, further studies that include control groups are needed.
Racial, ethnic, and sex disparities in nail psoriasis clinical trials
An article published in the journal Skin Appendage Disorders identified the representation of racial/ethnic groups and women in nail psoriasis (NP) randomized clinical trials (RCTs). The researchers found women and racial/ethnic minorities are underrepresented in NP research. They also found that this condition disproportionally affects quality of life in women compared to men and emphasize a significant need for increased diversification of NP clinical trial participants.
For this study, the authors conducted a systematic search of MEDLINE. In total, 45 RCTs were analyzed, with 91.1% of studies reporting the sex of the participants. In these studies, 67.9% of participants were men. Additionally, only 35.6% of the examined RCTs reported race or ethnicity. Enrollment of non-white participants was significantly lower. Treatment type, route of administration, location, funding, and journal type were significantly associated with race and ethnicity reporting.
VIDEO: Dermatology, longevity, and overall health with Dr. Doris Day
Check out this episode of the DermDocs Podcast, in which Dr. Doris Day, a dermatologist based in New York City, shares insights about the latest trends and developments in dermatology. She also shares personal anecdotes, such as how the AIDS crisis of the 1980s motivated her to leave her career in journalism and attend medical school to become a doctor.
A case of recurrent group A streptococcal vulvovaginitis in a premenopausal woman
A case study published in the International Journal of Women’s Dermatology reported the case of a 42-year-old woman with no previous history of vulvar symptoms who suddenly developed rapid-onset vulvar pruritus. She self-treated the area with miconazole 2% cream for three nights. The patient reported that she experienced a full day of mild relief, but her symptoms quickly returned. She was diagnosed over the phone with candida vulvovaginitis and was prescribed terconazole 0.4% cream once daily for seven nights. On the third night of treatment, unbearable vulvar pruritus caused her to visit the emergency department.
A vulvar examination revealed beefy red erythema and swelling with fissuring in the interlabial sulci. Additionally, speculum examination of the vagina showed greyish-white discharge in the posterior fornix without cervical motion tenderness. Studies for chlamydia, gonorrhea, yeast and bacterial vaginosis were negative. She was prescribed metronidazole 0.75% gel for five nights. On the second day of treatment, the patient’s pruritus worsened, and she developed a sore throat. She tested positive for strep throat and was treated per protocol with penicillin twice daily for ten days. Within 24 hours of beginning the penicillin, vulvovaginitis symptoms improved. Despite the response to penicillin, group A streptococci (GAS) was considered unlikely.
After three weeks of treatment, her sore throat returned, and the vulvar erythema and pruritus recurred following oral sex with her partner. A vulvar swab revealed Streptococcus pyogenes. The patient’s partner was presumed to be an asymptomatic carrier of strep and was treated with penicillin. The patient herself received another course of penicillin. She reported complete resolution of symptoms in 10 days, with no return of vulvovaginitis.
Coming Up in Women in Derm:
June 22-25 → 97th Canadian Dermatology Association Annual Conference
July 19-20 → International Conference on Skin Diseases, Disorders, Problems and Treatments
July 21-24→ AAD 2022 Summer Meeting – American Academy of Dermatology (Vancouver)
The coming two weeks:
June 26 is United Nations International Day in Support of Victims of Torture
June 26 is National Cancer Wellness Awareness Day
June 27 is PTSD Awareness Day
June 29 is World Scleroderma Day
Something to think about
“I had bad acne in high school. I had many experiences where I went to dermatologists and felt like we weren’t speaking the same language. I gave up and was convinced this is how it was going to be. My mom took me to one of two black dermatologists in Birmingham, Alabama and, within a month, my skin was clear.”
— Dr. Elyse Love, a New York City-based dermatologist, in an interview with RUN GRL, a digital media and event platform for Black female runners.