Today’s report also covers research into striae gravidarum’s effect on quality of life, a preventable problem in pregnancy, and more. Edition #90 (1,539 words, 7.5 minutes)
Good morning, and welcome to the Women in Dermatology 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 research in the Australasian Journal of Dermatology (Apr. 29, 2025), genital psoriasis presents unique diagnostic challenges due to the absence of classic features such as scaling, making it more difficult to treat. Furthermore, the condition can diminish the quality of life for patients, often leading to avoidance of intimate relationships. The study evaluated the clinical characteristics, management strategies, and impact of quality of life associated with vulval psoriasis. The researchers found that vulval psoriasis significantly impairs quality of life, is frequently underdiagnosed, and often requires systemic or biologic therapies for effective management.
The authors conducted a retrospective chart review of 350 women diagnosed with vulval psoriasis between 2016 and 2024 at a large dermatology practice. The inclusion criteria involved adult women with documented clinical signs or photographs of vulval psoriasis. The data collected included demographic information, clinical features, microbiological findings, treatments, and responses.
Researchers used the Vulval Quality of Life Index (VQLI) to assess patients’ symptoms, emotions, daily activities, relationships, sexual function, future health concerns, and treatment impact. The study found that 72% of patients had extragenital psoriasis, although only 20.3% had previously been diagnosed with psoriasis. Family history was also significant, with 30% of women reporting a first-degree relative with psoriasis.
The most reported symptom was itching, affecting 89.1% of patients, followed by pain or fissuring in 36.6%. Dyspareunia, discharge, and dysuria were reported less frequently. Erythema and well-demarcated edges were common features, with the labia majora most commonly affected by the sulcus, labia minora, and perianal area.
The study also found that treatment primarily involved topical therapies, with 80% receiving a combination of coal tar solution and moderate-potency corticosteroids. Systemic treatments, including methotrexate, acitretin, phototherapy, and biologics such as secukinumab, bimekizumab, and tildrakizumab, were necessary for about 15% of patients.
The response to systemic treatments was varied. Biologic agents, particularly secukinumab, were most effective, achieving complete clearance in 63.6% of patients. Acitretin demonstrated higher efficacy than methotrexate in achieving complete clearance, with 33.3% of patients on acitretin achieving full resolution. Phototherapy was also successful in some cases, with a relatively quick response time. The study observed that potent corticosteroids were safely used in patients without significant adverse effects.
The study also highlighted that the VQLI showed significantly improved follow-up. Improvements were noted across most domains, especially future health concerns, feelings and emotions, symptoms, and daily activities. Sexual function and treatment-related quality of life also improved, though relationship scores showed less change and were not statistically significant. The authors note these findings suggest that effective treatment, including systemic therapy, can substantially alleviate the psychosocial and functional burden of vulval psoriasis.
The Takeaway: The study found that vulval psoriasis is frequently underdiagnosed due to its lack of classic features. Itching is the most common symptom of vulvar psoriasis, followed by pain or fissuring. Biologics, especially secukinumab, are the most effective systemic treatments, achieving complete clearance in more than half of the study’s participants. Quality of life significantly improved with treatment, particularly in emotional well-being, symptoms, and daily functioning.
Save the date for the 2025 Summit on Atopic Dermatitis
The 2025 edition of the Summit on Atopic Dermatitis virtual conference will be held on May 10 from 10:00 a.m. to 1:00 p.m. Eastern Time.
Chaired by Dr. Marissa Joseph (Toronto), the Summit on Atopic Dermatitis will address the unmet need for education among healthcare providers on the incidence of AD and the latest therapies.
Join us for an in-depth discussion on the diagnosis, treatment, and latest therapies for atopic dermatitis in Canada.
The 2025 program will be held virtually and will be available to attend at no charge to delegates.
Register for the webinar using the link below, and watch this space for further details.
Self-esteem, self-perception, and self-image of women with acne vulgaris
A study published in Dermatology Reports examined the psychological effects of acne vulgaris in women across different age groups, highlighting its link to low self-esteem, emotional distress, and social withdrawal. The researchers found that women older than 27 experienced more severe impacts from acne vulgaris, including lower self-esteem, compared to the younger group.
For this study, the authors surveyed patients at a cosmetology and aesthetic medicine clinic in Katowice, Poland, between September 2023 and July 2024, using the Teenagers’ Quality of Life Index and the Rosenberg Self-Esteem Scale. Many participants expressed a need to conceal skin lesions and reported heightened concern about their appearance, contributing to reduced quality of life and emotional distress. The study highlights that low self-esteem and negative self-beliefs are common among acne patients, potentially influenced by prevailing beauty standards and societal pressures for clear skin.
Dupilumab shows no elevated risk for maternal adverse pregnancy outcomes
A retrospective study published in the Journal of the European Academy of Dermatology and Venereology assessed the safety of dupilumab during pregnancy in women with type 2 chronic inflammatory diseases (T2IDs). The researchers found no increased risks for adverse pregnancy outcomes in women treated with dupilumab.
For this study, the authors compared 293 pregnant women with T2ID treated with dupilumab to untreated controls. They applied propensity score matching and statistical analyses to assess risks for various maternal pregnancy complications. The results showed that no increased risks for adverse pregnancy outcomes were noted in the women treated with dupilumab. Furthermore, the treatment group had reduced risks for premature obstetric labour and adverse pregnancy outcomes.
A study in the Journal of Sexual Medicine explored the potential link between hormonal contraceptive use and clitoral adhesion severity. The researchers found no significant link between hormonal contraceptive use and adhesion severity, though 76% of patients reported hormonal contraception use.
For this study, the authors conducted a retrospective chart review of 75 patients who underwent in-office lysis of clitoral adhesions between January 2021 and October 2024. They assessed adhesion severity and documented contraceptive use history, using a generalized linear mixed effects model to examine potential links between hormonal contraceptive use and adhesion severity. The results showed that there were no significant predictors of clitoral adhesion severity. While most participants had a history of hormonal contraceptive use, neither the type nor duration of contraceptive use showed a meaningful correlation with severity.
Striae gravidarum and its effect on quality of life
A study published in Razi International Medical Journal assessed the impact of striae gravidarum on dermatology-specific quality of life among pregnant women in Libya. The researchers found that striae gravidarum significantly reduced dermatology-specific quality of life, particularly among older women and those with a family history of the condition.
The authors evaluated 150 pregnant women with striae gravidarum for this cross-sectional study. Most participants were between 20 and 40 years of age, with 64% reporting a family history of striae gravidarum and 36.7% having four or more pregnancies. Striae gravidarum were most common on the abdomen and thighs, with rapid weight gain and multiple pregnancies perceived as the primary causes. Emotional effects included embarrassment, reduced self-esteem, and relationship difficulties. Quality of life scores were significantly worse in women over 40 and those with a family history of striae gravidarum. The findings suggest striae gravidarum can negatively affect emotional well-being and daily life, underscoring the need to address psychological outcomes in pregnancy care.
VIDEO: The Intersection of Dermatology and Metabolism
Palo Alto, Calif.-based dermatologist Dr. Faranak Kamangar discusses the critical 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. She highlights the impact of diet on skin health and emphasizes the need for dermatologists to understand metabolic factors to enhance patient outcomes.
A preventable problem in pregnancy
A case study in the Journal of Nephrology described a 30-year-old woman at 37 weeks of her fifth pregnancy who presented at Mansoura University Hospital in Egypt with high fever, low blood pressure, and respiratory distress. She had a history of renal tubular acidosis and well-controlled hypothyroidism. Upon admission, she had severe hypokalemia and metabolic acidosis. Over the previous four weeks, she had developed extensive skin necrosis attributed to injectable heparin, which she had been self-administering every other day since early pregnancy to prevent miscarriages despite no clear indication. After hemodynamic stabilization, potassium replacement, antibiotic therapy, and cesarean section, her condition improved markedly, and she delivered a healthy full-term baby. The skin lesions resolved following discontinuation of unfractionated heparin and surgical debridement.
“Using sponge to scrub your skin frequently can strip your skin of natural oils and create micro-tears or micro-trauma in the skin; it can introduce bacteria and other micro-organisms into the skin. It can also cause itchy skin. If you have itchy skin, try not to use the sponge while bathing and see if that helps.”
— Dr. Folakemi Cole-Adeife, a Lagos, Nigeria-based dermatologist in an interview with the Nigerian website Business Day.
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