Today’s report also covers research into the impact of cutaneous T-cell lymphoma on pregnancy, morphea disease activity during pregnancy, and more (1,577 words, 7.5 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
Good morning and welcome to this edition of the Women in Dermatology e-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.
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that disproportionately affects women. Patients can often experience misdiagnoses or disease progression before obtaining an accurate diagnosis. Since clinic visits are time-constrained, it may be difficult for medical professionals to meet patient needs. Consequently, optimizing clinic visits is essential.
A study published in the International Journal of Women’s Dermatology (Oct. 2022; 8(3):p e040) described the priorities of HS patients during clinic visits to help optimize practitioner care. From Oct. 2021 to Jan. 2022, the researchers distributed an anonymous survey to three online HS support groups to gain insight into patients’ perspectives. Of 158 respondents, 146 (92.2%) were women.
Patients were asked about their priorities during initial clinic visits. Roughly 80% of the respondents reported discussing treatments as a priority, and 71% prioritized discussing symptoms and self-management of flares. In follow-up visits, 64.6% of participants prioritized emotional well-being, and 61.4% prioritized discussing treatment plans. About one-quarter of the respondents stated they wished to discuss weight loss or sexual health during a visit. Nearly half of the respondents said they would recommend their HS physician to others; patients who attended a specialty clinic were more likely to do so.
The study also found that 50.6% of participants restrain from asking many questions, and 47.3% minimize their symptoms, so they are not seen as complex patients. Downplaying symptoms and avoiding asking questions were more common in respondents less than 40 years of age. Younger patients were also less likely to understand their physician’s instructions fully.
Nearly half of the patients reported they would like their practitioner to use multimedia resources during the consultations. Participants valued receiving medication advice, assistance accessing medications, scheduling appointments for flares and coordinating referrals in-between visits.
Finally, the researchers found that online HS support groups, professional organization websites, and social media were primary patient education resources.
Bottom line
The study's results suggest that HS visits should take a gradual approach rather than attempting to cover every aspect of HS during an initial visit. Essential topics such as disease breakdown, possible treatments, and flare management should be discussed at baseline visits. Practitioners should also be aware that some younger patients may downplay their symptoms. Finally, including multimedia elements in consultations may improve a patien’ understanding of their condition.
This month marks the Diamond Anniversary of Cetaphil. Cetaphil began as a single product developed in Texas 75 years ago: the “Cetaphil Cleansing Lotion,” created to treat patients with sensitive skin. Now known as the Gentle Skin Cleanser, this formulation continues to be a leading brand. Galderma, maker of Cetaphil, has announced a commitment to improving inclusivity within dermatology and empowering people with sensitive skin to celebrate this milestone.
Galderma is launching a new global campaign called We Do Skin; You Do You to mark the occasion. This campaign aims to empower people with sensitive skin to do more of the things they love without hesitation.
“For 75 years, our sole focus has been to use science to understand and treat the unique needs of sensitive skin. Throughout our history and as we look to the future, we will continue to push the boundaries of innovation and research to bring the absolute best to our consumers. We’ll continue to prioritize initiatives that transform how sensitive skin is portrayed, understood, and treated,” said Walter Geiger, head of Global Consumer Business at Galderma, in a press release.
From the literature on women in dermatology
Cutaneous T-cell lymphoma and pregnancy
A study in the Journal of the American Academy of Dermatology explored the relationship between cutaneous T-cell lymphoma (CTCL) and lymphoproliferative disorders (LPDs) and pregnancy. The researchers found that CTCL and LPD symptoms worsened for most patients during pregnancy.
For this retrospective study, the authors obtained demographic data and medical history from patient files at the Department of Dermatology at the Northwestern University Feinberg School of Medicine in Chicago. They identified 37 patients from the cutaneous lymphoma clinic who had reported pregnancies, resulting in 77 pregnancies, including 19 spontaneous or induced abortions. The team then conducted semi-structured phone interviews to inquire about skin changes during pregnancy and breastfeeding.
According to the results, 56.8% of patients reported their skin condition worsened or flared. At the same time, nearly one-third of the patients reported stable disease, while three reported skin improvement. Additionally, no fetal complications were reported other than premature birth.
The changing spectrum of hair and scalp disorders over the last decade in a tertiary medical centre
A study in the Journal of the European Academy of Dermatology and Venereology assessed developments in hair and scalp-related disorders (HSRDs) patients at a tertiary medical centre’s outpatient dermatological clinic over ten years. The authors found that over the decade, there was a growing predominance of female patients, with an average female-to-male ratio of 2 to 1.
The researchers reviewed the medical records of HSRD patients that visited the dermatology clinic at the Sheba Medical Center in Israel between Jan. 1, 2010, and Dec. 31, 2020. The results showed that the most prevalent HSRDS were androgenetic alopecia, alopecia areata, diffuse non-scarring alopecia, non-scarring folliculitis, and seborrheic dermatitis. Additionally, the visits related to androgenetic alopecia increased to 32% from 17% over the decade.
Prevalence of hyperkalemia in women taking spironolactone for acne, hair loss, and hirsutism
A study in the Journal of the American Academy of Dermatology measured the incidence of hyperkalemia in women taking spironolactone for acne, hair loss, and hirsutism. Spironolactone is a potassium-sparing diuretic and can cause high blood potassium. This study aimed to explore the differences in hyperkalemia rates among women of different ages, races, and ethnicities. The researchers found that the overall rate of hyperkalemia among patients was low. They also found that age, race, and ethnicity were not significant indicators of an increased likelihood of hyperkalemia.
The authors reviewed the Weill Cornell Medicine (WCM) Department of Dermatology’s internal system. They looked for female patients who were prescribed spironolactone for acne, hair loss, androgenic alopecia, androgenetic alopecia, and hirsutism. Patients with hypertension, heart failure, and renal failure were excluded.
Diversity trends in the leadership of the American Society for Laser Medicine and Surgery
A study published in the Journal of Cosmetic Dermatology analyzed the changes in diversity within the American Society for Laser Medicine and Surgery (ASLMS) board of directors from 1996 to 2021. The authors found that while the ASLMS leadership has become more diverse over time, women and ethnic minorities remain underrepresented. They also found that most Board members were dermatologists.
The researchers reviewed a list of ASLMS’s Board of Directors from 1996 to 2021. They recorded board director characteristics such as age, gender, race, ethnicity, and specialties. According to the findings, female representation grew to 30.8% in 2021 from 10.5% in 1996. Additionally, dermatologists held board member seats at a 56.5% rate on average.
Houston-based dermatologist Dr. Andrea Suarez, popularly known as Dr. Dray, comments on the skin signs of low iron. She also discusses low iron and hair loss and the common symptoms of low iron and iron deficiency anemia.
Morphea disease activity during pregnancy
A case series study published in the Journal of Dermatology described the clinical presentation, pregnancy outcomes, and medical management of morphea during pregnancy. The authors reported the cases of 10 pregnant women who were part of the longitudinal MAC (Morphea in Adults and Children) cohort from July 2007 to Feb. 2022.
All ten women had been diagnosed with morphea before getting pregnant, and five patients reported having pediatric-onset morphea, while five reported adult-onset morphea. Additionally, eight patients had linear morphea, and two had plaque morphea.
In seven patients, damage scores remained stable, with no increased morphea activity during pregnancy. The other three patients experienced reactivation of morphea activity during pregnancy. Only one patient required immunosuppressive therapy. Most patients had no adverse pregnancy outcomes directly related to morphea.
“Do your homework, put your trust in the person you know has the best education, credentials, and know-how, and put your trust in the science of the products: stick with your regimen long term in order to get long-term results. Consistency is key. The worst thing you can do is expect that a topical product which is truly going to build collagen and other key components to skin is actually going to work in a mere week or two and abandon the effort. You need to stick with the products for months to accumulate real change and real improvements to your skin. Quick-fix products are usually irritants that peel or inflame or bleach the skin, giving you short-term results usually at the expense of long-term harm.”
— Dr. Macrene Alexiades, a Wainscott, N.Y.-based dermatologist, in an interview with Beauty Matter.
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