Lived experience of acne and acne treatment in transgender patients
Today’s report also covers research into the impact of estradiol replacement therapy on hair growth, gender usage characteristics of Korean medical nail care, and more (1,400 words, 6.5 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
Good morning and welcome to the first edition of the Women in Dermatology e-newsletter from Chronicle Companies for 2024. 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
While many of the effects of gender-affirming hormone therapy have a positive impact on transgender and gender-diverse patients’ lives, the authors of a recent study in JAMA Dermatology (Jan. 2024) note that it is also associated with a higher incidence of acne. The study examined the lived experiences of transgender and gender-diverse patients with acne, aiming to address gaps in understanding these factors in gender minority groups.
For this mixed-methods analysis, the authors conducted semi-structured interviews and surveys at a multidisciplinary gender centre at a public safety-net hospital (a type of medical center in the U.S. that is legally obliged to provide healthcare for individuals regardless of their insurance status or ability to pay), and at the endocrinology and dermatology clinics at a tertiary academic centre from Jan. 4, 2021, to April 7, 2022. The interviews were recorded using audio technology and were later transcribed. These interviews identified specific themes and were cross-referenced with survey data, including information on gender, self-reported acne severity, impact on skin-specific quality of life, and treatment experiences.
A total of 32 participants were included in the study: 17 transgender men, 11 transgender women, and four non-binary people. Among the participants, 31% self-rated their skin as clear or almost clear, 34% reported mild acne, and 34% had moderate to severe acne. They also described experiences of rejection and bullying linked to acne and admitted avoiding social interactions that could result in acne-related discrimination, which led to feelings of depression and anxiety. Additionally, acne contributed to increased dissatisfaction with body appearance.
The research also found that transgender women believe acne interferes with feminine gender expression, while transgender men often view acne positively and as an early sign of testosterone action. Most participants reported experimenting with over-the-counter acne treatments and looked for advice from many sources, including doctors, peers, online forums, and social media. Barriers to treatment include cost, lack of multidisciplinary care, mistrust in the healthcare system, and a lack of transgender-specific acne care education.
The authors highlight the importance of developing strategies to reduce acne stigma in gender-diverse populations, providing transgender-specific acne care education, facilitating multidisciplinary acne care and creating transgender-friendly clinical environments.
Bottom line
Transgender and gender-diverse patients face acne-related stigma, which can lead to avoidance of social interactions and feelings of depression and anxiety. Transgender women feel acne interferes with feminine gender expression, while transgender men see acne as an early sign of testosterone action. Barriers to acne treatment include cost and inadequate transgender-specific acne care education. The findings emphasize the need for multilevel changes to reduce acne stigma and enhance transgender-specific acne care.
Evaluation of estradiol replacement therapy on hair growth
Research published in the Journal of Women’s Dermatology examined the impact of estradiol replacement therapy on hair growth in postmenopausal Japanese women with female pattern hair loss. The researchers found that hormone replacement therapy (HRT) improved the appearance of the frontal hairline. More specifically, HRT increased the telogen hair rate at three months, improved frontal hairline thinning score at six months, and increased plucking strength at six months.
The study involved 11 female patients undergoing HRT, evaluating them before initiating the treatment, at three months and six months. The authors measured and evaluated the subjects’ thinning hair score, hair density, telogen hair rate, telogen plucking strength, hair growth rate, and hair thickness.
A study published in Skin Research and Technology aimed to establish baseline skin pigmentation data for young Chinese females by conducting a comprehensive assessment and creating a body skin pigmentation map. The researchers found that the points with the most skin pigmentation in young Chinese women were the back of the neck, heels, elbows, and the back of the knees.
For this study, the authors recorded Individual Type Angle (ITA°) using CL 400 and Melanin Index (MI) using MX 18 at 100 body points on 20 Chinese females. A total of 12,000 measurements were recorded.
Divergent progression pathways in female pattern hair loss and male androgenetic alopecia
A study in the Journal of Cosmetic Dermatology evaluated the trichoscopic characteristics of male androgenetic alopecia (MAGA) and female pattern hair loss (FPHL) to understand the progression of these conditions. The researchers found that MAGA and FPHL exhibit different progression patterns. For example, FPHL progression is characterized by a decrease in hair number per follicular unit followed by a reduction in hair diameter, while MAGA exhibits the opposite progression. Additionally, hair density showed weak correlations in FPHL and none in MAGA.
For this study, the authors classified 126 male MAGA subjects using the Hamilton-Norwood Classification and 57 FPHL subjects using the Sinclair Scale. Then, they analyzed nine trichoscopic factors divided into three categories: hair-diameter-related, hair-number per follicular unit-related, and hair density-related factors.
Analysis of gender usage characteristics of Korean medical nail care
A study in the Asian Journal of Beauty and Cosmetology explored the treatment patterns of Korean consumers using non-invasive medical nail care for nail fungal infections, ingrown toenails, and pincer toenails. The researchers found that pincer toenails were more common in women, and most women opted for self-care and nail salons to treat nail conditions. They also found that the prevalence of resin gel procedures for ingrown and pincer toenails was higher for women.
In this study, the authors surveyed 500 Korean individuals in Dec. 2022 and examined three common nail issues: onychomycosis, ingrown toenails, and pincer toenails. The data was then analyzed by gender.
VIDEO: Surgery for hidradenitis suppurativa (HS) with Dr. Stephanie Goldberg
Virginia-based dermatologist Dr. Stephanie Goldberg talks about HS surgery and the differences between procedures performed in the clinic versus those performed in the operating room. She also provides insight on who performs these procedures, what to expect, incision vs. drainage, deroofing vs. excisional surgery, and why patients need to map out their goals for HS surgery to manage expectations.
A case of palmar papules as a manifestation of cutaneous oxalosis in primary hyperoxaluria
A case study published in Clinical Case Reports described a 23-year-old woman with primary hyperoxaluria and end-stage renal disease who presented light-coloured bumps on her palms that were initially suspected as warts. The patient had been undergoing dialysis for two years and required a kidney transplant. Her father and brother had previously died from the same condition. A biopsy revealed rhomboid crystals in the skin and mild low calcium levels. Based on the biopsy results and her medical history, she was diagnosed with renal insufficiency in the setting of primary oxalosis. This case highlights the importance of considering cutaneous oxalosis in kidney failure patients with skin issues.
“My goal was to create something that anyone could use, even people who have the most sensitive skin. My priority was ensuring all my products were free of teratogens and mutagens, which are chemicals that can cause birth defects. No reproductive hormone disruptors, no toxic environmental persisters, and no allergens, either. It’s really hard to make something that’s cosmetically elegant and super effective. In addition to not wanting any of those chemicals, I wanted to leverage your skin barrier biology to help your skin stay healthy and heal itself.”
—Dr. Cheryl Lee Eberting, a dermatologist based in Alpine, Utah, in an interview with U.S. journalist Katie Couric.
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