International treatment practices differ for atopic dermatitis in pregnant and breastfeeding women
Today’s report also covers research into inflammatory skin disorders in patients with IBD, styling practices and scalp health in Black women, and more (1,420 words, 7 minutes)
Good morning, and welcome to the Women in Dermatology newsletter from Chronicle Companies. We’re pleased to have you join us. It 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. This bi-weekly bulletin is presented with the support of Galderma Canada.
A study in the Journal der Deutschen Dermatologischen Gesellschaft (June 8, 2025) evaluated international treatment practices for atopic dermatitis (AD) in pregnant and lactating women. The researchers found that systemic treatment practices for AD during pregnancy and breastfeeding vary widely across countries, often diverging from established guidelines, with many physicians favouring corticosteroids and antihistamines while showing hesitation about immunosuppressive therapies due to safety concerns.
Photo by OWUROOLA ADEWALE
According to the study, AD is the most common skin disease during pregnancy, accounting for up to one-half of all pregnancy-related dermatoses. Hormonal changes during pregnancy can trigger new or worsen existing AD, with about 50% of patients experiencing a flare. Existing guidelines recommend cyclosporine for severe cases, but safety concerns surrounding systemic agents, including biologics and JAK inhibitors, can lead to medication avoidance.
To better understand international treatment practices, the authors surveyed physicians within the ADCARE network, which is affiliated with the Global Allergy and Asthma Excellence Network, between June and November 2023. A total of 103 physicians from 32 countries participated, with the majority being dermatologists or allergists. Physicians completed an electronic questionnaire on the use of systemic agents in pregnant and breastfeeding AD patients.
The results showed that antihistamines were the systemic drug most often considered to be used during pregnancy or breastfeeding, with 90.1% of respondents viewing them as a feasible option. Short-term corticosteroids were deemed suitable for acute flares by 71.6% of physicians, but fewer were willing to use them during the first trimester. Although not formally approved for use during pregnancy, nearly half of the respondents considered biologics as a treatment option, especially dupilumab, though caution was shown during early pregnancy.
Conventional immunosuppressants were rarely favoured. Cyclosporine was the most cited among them, but only 23.5% of respondents considered any immunosuppressant appropriate during pregnancy or lactation. Long-term corticosteroid use was rarely endorsed, and one-third of physicians reported not using systemic treatments at all in this population. The use of teratogenic agents such as methotrexate or JAK inhibitors was reported by a small number of physicians despite known safety risks.
Only six respondents reported pregnancy complications related to systemic treatment, including prematurity, fetal loss, and malformations. The study concluded that despite international guidelines, systemic treatment patterns for AD in pregnancy vary widely. The authors emphasize the need for updated physician education and a more comprehensive global consensus.
The Takeaway: The study found that systemic treatment practices for atopic dermatitis in pregnancy and breastfeeding vary and often diverge from guideline recommendations. Antihistamines and short-term corticosteroids were the systemic drugs most often considered. Physicians showed significant hesitation toward using immunosuppressants and biologics during early pregnancy. Only a minority of physicians supported the guideline-recommended use of cyclosporine, and one-third avoided systemic treatments entirely. The authors stressed the need for improved education and international consensus on safe AD treatment during pregnancy.
A survey study in the International Journal of Women’s Dermatology explored alopecia among Orthodox Jewish women who cover their hair after marriage. The researchers found that 34.2% of participants reported experiencing hair loss, with tight hairstyles and clip attachments being associated with an increased incidence of frontal alopecia.
For this study, the authors conducted an anonymous online survey between July and Aug. 2024 among 152 Jewish women who regularly used head coverings, including wigs, scarves, and hats. The results showed no significant association between hair loss and the type or duration of head covering use; however, tight hairstyles and clip attachments were linked to an increased incidence of frontal alopecia. Half of the women had not sought treatment, and more than one-quarter said they would feel uncomfortable doing so, often due to concerns about providers’ cultural understanding.
Styling practices, crown thinning, and scalp health in Black women
A study published in the UC Davis Dermatology Online Journal explored the relationship between hairstyling practices and scalp health among Black women, with a specific focus on central centrifugal cicatricial alopecia (CCCA). The researchers found that hairstyling practices such as heat styling, chemical processing, and tight braiding were not significantly associated with scalp symptoms in Black women. The research surveyed 122 Black women between May and July 2023, examining self-reported symptoms such as irritation, crown thinning, frontal thinning, and chemical burns in relation to practices such as tight braiding, heat styling, and chemical processing. Statistical analysis revealed no significant association between these hairstyling methods and scalp symptoms, suggesting that such practices alone are unlikely to be the primary causes of CCCA. However, many women with crown thinning reported symptomatic improvement after transitioning to natural hairstyles. The findings highlight the complexity of CCCA, suggesting that while genetics plays a significant role, reducing mechanical and chemical stress through natural hairstyles may benefit women at risk of developing CCCA.
Alopecia as a side effect of fertility treatments in women
A study published in the International Journal of Women’s Dermatology analyzed online data sources to evaluate public interest in alopecia related to assisted reproductive technology (ART). The researchers found that while many women report alopecia during fertility treatments, there is a significant lack of medical literature addressing ART-related hair loss despite growing public concern and rising Google search trends and Reddit discussions.
For this study, the authors searched PubMed and UpToDate for clinical references, reviewed Google Trends data from 2014 to 2024, and examined Reddit posts in fertility forums over the same period. PubMed and UpToDate searches yielded no dedicated articles on ART-related alopecia, despite known associations between hair loss and ART drugs such as letrozole and leuprolide. On Google Trends, the researchers observed a significant rise in searches linking hair loss to common fertility treatments starting in 2020, likely influenced by the growth of assisted reproductive technology (ART) use, the pandemic, and high-profile celebrity accounts. On Reddit posts in fertility-related forums, the authors found an 875% increase in discussions of alopecia. Most posts described women’s personal accounts of hair loss during IVF or medication use. Many users expressed emotional distress and concern about whether to continue treatment.
Prevalence of inflammatory skin disorders in patients with inflammatory bowel disease
Research in the Archives of Dermatological Research evaluated the prevalence and characteristics of cutaneous manifestations in patients with inflammatory bowel disease (IBD) in Iran. The researchers found that women with IBD were more likely to develop cutaneous manifestations, particularly aphthous stomatitis and atopic dermatitis.
For this cross-sectional study, the authors examined 226 individuals with inflammatory bowel disease (IBD) between March 2020 and March 2021 at a hospital in Tehran. A gastroenterologist and a dermatologist clinically evaluated all patients. The results showed that 38.1% of patients with IBD had skin disease at the time of examination, with a higher prevalence in those with Crohn’s disease compared to ulcerative colitis. The most common skin conditions overall were aphthous stomatitis and atopic dermatitis. At the same time, perianal fissures were more frequent in Crohn’s disease. The authors note that women and married individuals are considered high-risk groups for skin lesions, advising regular skin examinations for these groups.
VIDEO: The Intersection of Dermatology and Metabolism
Palo Alto, Calif.-based dermatologist Dr. Faranak Kamangar discusses the relationship between dermatology and metabolic dysfunction. She explores how conditions such as obesity and insulin resistance can present with dermatologic symptoms, underscoring the importance of identifying these signs in clinical settings.
A case of vulval ulceration as a first presentation of systemic lupus erythematosus
A case study in the International Journal of Gynecology & Obstetrics described a 25-year-old woman who presented with a three-month history of recurrent vulval ulceration. On examination, she had superficial ulcers over the labia minora, perineum, introitus, and anus, along with an erythematous plaque on her nose. She had a history of pernicious anemia but no known autoimmune conditions. Infectious and malignant causes were ruled out.
Shortly after, she developed an acute photosensitive rash. Laboratory testing revealed positive antinuclear and anti-ribonucleoprotein antibodies, and punch biopsies showed features of interface dermatitis. The patient was diagnosed with systemic lupus erythematosus.
“Alopecia can be either scarring or non-scarring. Non-scarring alopecia is the most common form. Scarring alopecia is the minority of circumstances, but it's troubling because there tends to be more of an inflammatory component. I liken it to, instead of growing a lawn of grass, our scalp has replaced the lawn of grass with concrete; and it's a scenario where, oftentimes, once the hair is gone, it's very hard, if not impossible, to regenerate.”
— Dr. Renee Beach, a Toronto-based dermatologist in an interview with CBC
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