Management of psoriasis in women of childbearing age
Today’s report also covers research into the physiological skin changes during pregnancy, menstrual cycle patterns and scalp disorders, and more (1,830 words, 9 minutes)
Good morning, and welcome to the first edition of the Women in Dermatology e-newsletter from Chronicle Companies for 2025. 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
Psoriasis can have a significant negative impact on a patient’s quality of life, especially for women of childbearing age, since diagnosis and initiation of treatment often overlap with peak reproductive years for women, according to a study in the International Journal of Women’s Dermatology (Mar. 2025; 11(1):p e189). The study assessed the perspectives of women of childbearing age with psoriasis regarding pregnancy and how dermatologists manage the disease in these women in Australia and Japan. The researchers found that women of childbearing age with psoriasis in Australia and Japan largely felt inadequately informed about pregnancy planning, had significant concerns regarding the safety of treatments during pregnancy, and lacked clear treatment guidance.
For this study, the authors used online surveys targeting women aged 18 to 45 who had been diagnosed with moderate to severe psoriasis and had experienced pregnancy within the past five years. The patients were recruited from consumer panels and answered the questionnaires between Sept. and Oct. 2018. Dermatologists from Australia and Japan treating patients with the participants’ profiles were also invited to answer a survey between Oct. and Dec. 2020.
A total of 58 women, 27 from Australia and 31 from Japan, participated in the survey. In Australia, 59% of patients were diagnosed with psoriasis during pregnancy, while 94% of patients from Japan were diagnosed before pregnancy. Most patients also reported their disease to be of moderate severity. In Australia and Japan, 56% and 19% of patients used tumour necrosis factor inhibitors (TNFi) before pregnancy.
Survey results revealed significant information gaps for women of childbearing age with psoriasis and dermatologists. Most women in both countries expressed that they were not adequately informed about how their psoriasis treatment might impact pregnancy and lactation. Approximately one-third of patients delayed their decision to have children due to their psoriasis diagnosis. Among patients who delayed motherhood, hereditary concerns were the most common reason for doing so.
During pregnancy, medical concerns about the child were the most common category of concern among patients. Most patients expressed worries regarding the safety of TNFi during pregnancy and discontinued their treatments. After giving birth, most patients discussed the possibility of breastfeeding with their physician. Among patients, 30% of patients from Australia and 90% of patients from Japan breastfed their babies, with the most common reasons for not breastfeeding being treatment-related concerns.
A total of 137 dermatologists, 40 from Australia and 97 from Japan, participated in the survey. Most of them expressed feeling uncomfortable prescribing TNFi to pregnant women or those planning to conceive, primarily due to limited safety data on the effects of TNFi during pregnancy and breastfeeding. Furthermore, 80% of dermatologists expressed concern about adverse events, including infection and birth outcomes.
The Takeaway: The study found that women of childbearing age with psoriasis in Australia and Japan felt inadequately informed about pregnancy planning and treatment safety. Many delayed having children due to disease management concerns, particularly about tumor necrosis factor inhibitors (TNFi). Dermatologists in both countries were hesitant to prescribe TNFi during pregnancy, citing limited safety data and concerns about adverse events.
Research in the Journal of Pakistan Association of Dermatologists examined the physiological cutaneous changes during pregnancy. The researchers found that common skin changes included striae gravidarum, melasma, linea nigra, increased sweating, pigmentation of areola, nail brittleness, acne vulgaris, palmar erythema, and diffuse hair loss.
For this cross-sectional observational study, the authors analyzed the data and complete medical history of 271 pregnant women. They also conducted general physical and cutaneous examinations to assess physiological skin changes during pregnancy. The results showed that most women experienced at least one cutaneous change, with striae gravidarum being the most common.
Certolizumab pegol for plaque psoriasis in women of childbearing potential, pregnant or breastfeeding in clinical settings
A study in the Journal of the European Academy of Dermatology and Venereology evaluated the effectiveness and safety of certolizumab pegol in women of childbearing potential with moderate to severe psoriasis. The researchers found certolizumab pegol effectively managed moderate to severe psoriasis in these women, including pregnant and breastfeeding patients, with sustained disease control and minimal fetal drug exposure.
For this prospective study, the authors analyzed 193 women of childbearing potential, including 24 pregnant and 12 breastfeeding patients. The researchers observed significant improvements in psoriasis severity and quality of life scores over one year, particularly with on-label certolizumab pegol dosing. Pregnant participants showed consistent disease control regardless of BMI, prior biologic exposure, or trimester of treatment initiation. Adverse events occurred in 36.3% of women, with no new safety concerns identified. Among the 15 pregnancies, there were 13 live births with no congenital malformations reported, aligning with outcomes in the general population. The study also found a low treatment discontinuation rate, suggesting sustained therapeutic benefits of certolizumab pegol.
Menstrual cycle patterns as a key to understanding hair and scalp disorders
A study published in the Journal of Women’s Health and Development evaluated the prevalence of hair and scalp disorders in women aged 18 to 55 and their associations with menstrual cycle characteristics. The researchers found that hair and scalp conditions, such as itchy scalp, dandruff, and oily scalp, were more common in women with irregular menstrual cycles, with intermittent disorders peaking during premenstrual and menstrual phases.
This cross-sectional study included 17,009 menstruating participants from 20 countries. The participant’s data was collected using a digital questionnaire covering demographics, menstrual cycle traits, and 11 hair and scalp disorders. The results showed that 83% of participants reported at least one hair or scalp disorder, the most common being an itchy scalp, dandruff, oily scalp, and diffuse hair loss. Women with irregular menstrual cycles had significantly higher rates of these disorders than women with regular cycles. For example, itchy scalp was reported by 55.9% of women with irregular cycles versus 46.6% with regular cycles. Other disorders, including burning scalp sensations and hair thinning, were also more prevalent among those with irregular cycles.
Correlation between gender of department chairs and paid parental leave benefits in academic dermatology residency programs
A study published in Cureus investigated women's challenges in dermatology residency programs regarding parental leave policies in the United States and Canada. The researchers found that most dermatology residency programs do not explicitly advertise paid parental leave, and the gender of department chairs significantly influences the presence of such policies.
For this study, the authors used data from the American Medical Association’s Fellowship and Residency Electronic Interactive Database and the Canadian Residency Match System to identify accredited dermatology residency programs in the USA and Canada. They conducted manual searches between Dec. 2021 and Jan. 2022 to determine the gender of department chairs and the presence of parental leave policies in these programs. The results showed that out of 146 programs in the U.S. and 10 in Canada, most department chairs were male, and only 9.6% of programs, all from the U.S., explicitly advertised paid parental leave policies specific to dermatology residents. The study also found a significant correlation between the gender of the department chair and the presence of specific guidelines, especially in the northeastern region of the U.S.
VIDEO: It's not just skin, it's a journey | The Future of Dermatology Podcast
Palo Alto, Calif.- based dermatologist Dr. Faranak Kamangar discusses the evolving landscape of dermatology, the psychological impact of skin conditions, and the importance of mental health awareness with San Francisco-based dermatologist Dr. Kathy Fields. They reflect on a recent TEDx event, discuss the challenges posed by social media and AI, and emphasize the need for female leadership in medicine.
A case of ribociclib-induced vitiligo in a case of metastatic carcinoma of the breast
A case study in the Journal of the Egyptian Women's Dermatologic Society described a 48-year-old woman with hypothyroidism who presented with a progressively enlarging mass on her left breast. Imaging revealed a mass classified as BIRADS IV, suspicious of malignancy. A fine-needle aspiration confirmed the malignancy, and further scans showed breast carcinoma with metastases to the pleura, lungs, and bones. A core biopsy confirmed stage 2 invasive mammary gland carcinoma, with the tumour being estrogen and progesterone receptor-positive and HER2/neu-negative. The patient was treated with a combination of chemotherapy, CDK 4/6 inhibitors, including ribociclib, and hormonal agents. After seven cycles of therapy, she developed vitiligo-like depigmentation on her upper extremities and trunk. A skin biopsy for histopathological examination was advised but refused by the patient. She was subsequently treated with topical immunosuppressants, antihistamines, and oral antioxidants.
“When I started medical school, I had perhaps written dermatology off as ‘Oh, it's just mainly cosmetics.’ But it's so much more than that. We deal with everything from life-threatening issues such as skin cancer and systemic autoimmune conditions to things that affect patients' physical comfort, self-perception and sense of belonging. There's a huge range of mental and physical health issues that we take into account. Growing up, I personally didn't even know that dermatology would serve me or people who look like me. So being able to change that perception and encourage people to seek the help they deserve from medical providers is really important to me.”
— Dr. Leandra Barnes, a Stanford, Calif.-based dermatologist in an interview with Stanford Medicine.
You are receiving this newsletter because you subscribe to Women in Dermatology or another Chronicle journal, have attended a Skin Spectrum Summit live event or webinar, or have previously requested a subscription to one of our newsletters. If you no longer wish to subscribe to this newsletter, please email the subject line “Unsubscribe Women in Dermatology” to health@chronicle.org.
Chronicle Companies publish women in Dermatology: 1460 The Queensway, Suite 212, Etobicoke, Ont. M8Z 1S4
