Today’s report also covers research into the connection between the Mediterranean Diet and facial acne, female melanoma and estrogen receptors, and more (1,540 words, 7 minutes 45 seconds)
The Women in Dermatology e-newsletter is supported by an unrestricted grant from Galderma Canada.
Good morning and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We are pleased to have you join us. This bulletin will update you on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them every two weeks. 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.
A recent study published in the Journal of the German Dermatological Society (JDDG) (May 2022; 20(5):653-683) reviewed the scientific literature on the treatment of psoriasis during pregnancy and lactation. The primary objective of the research was to contribute to the limited amount of evidence regarding psoriasis management during pregnancy. According to the study, treatment decisions for pregnant psoriasis patients often may be based on the attending physician’s experience with the medications and the summary of product characteristics because of a lack of prospective studies on pregnant women with psoriasis.
According to the authors, the most extensive data on psoriasis treatment during pregnancy is for topical corticosteroids (TCS), making them the primary recommendation in cases where the indication is appropriate. The researchers found that TCS can properly control mild to moderate psoriasis in pregnant women while having no connection to increased risk of congenital malformations, premature births, or fetal death. Additionally, medically controlled UVB therapy was also considered safe during pregnancy.
In the case of systemic treatments, the authors note that it is necessary to examine each medication. For example, specific treatments such as methotrexate, retinoids or leflunomide can have teratogenic effects and therefore are not advised during pregnancy. Other treatments such as TNF-alpha inhibitors can be safely used during pregnancy. However, the authors explain that most systemic treatments have not been thoroughly explored during gestation, and their effects on pregnancy are unknown.
Bottom line
The authors conclude that when treating female psoriasis patients of reproductive age who have not completed their family planning, the condition’s impact on the course of pregnancy and possible treatment options should be discussed. They also note that in mild psoriasis, low to medium potency topical corticosteroids (TCS) are usually enough to control the disease and are preferred over oral treatments during pregnancy. UVB treatment can be an option in treatment-resistant cases, though maternal folic acid levels and the possible development of melasma need to be considered.
A study published in the journal Skin Health and Disease assessed the burden of treatment (BOT) in women living with vulvar lichen sclerosus (LS). BOT is defined as the workload of healthcare experienced by patients and its consequences on well-being and quality of life. The authors found that women with vulvar LS tend to have low BOT and that BOT, in general, is low for most LS patients, although some might be at risk of treatment-related burnout. They also found that higher BOT scores were moderately correlated with higher Mean Dermatology Life Quality Index (DLQI) scores. According to the researchers, these results are not surprising as treatment is based on relatively infrequent topical therapy without the need for systemic treatment and associated monitoring.
Thirty-five women with vulvar LS completed a detailed Treatment Burden Questionnaire to assess their BOT for this prospective study. Out of all the participants, 19 (54.3%) obtained a score of 35 or less, which means low BOT. Another 10 (28.6%) scored between 36 and 65, meaning moderate BOT, and six (17.1%) scored above 65, signifying high BOT.
Lifestyle habits and impact of the Mediterranean diet on facial acne severity in French women
A study published in the International Journal of Women’s Dermatology analyzed the association between the Mediterranean Diet and the severity of facial acne in French women. The researchers found that women who did not adhere to the Mediterranean Diet experienced more severe acne than those who did. They conclude that adopting a specific diet, such as the Mediterranean Diet, could help reduce acne severity, but a holistic approach is necessary and recommended.
For this case-control observational study, 40 female participants with different severities of acne were recruited. The data collected included their age, weight, height, BMI, consumption of fast-release sugars and dairy products, snacking habits, family history of acne, smoking status, alcohol consumption except for wine (because wine consumption is advised in the Mediterranean Diet), the use of cosmetics and previous use of local and systemic treatments. The study also included 40 healthy control subjects.
Female melanoma and expression of estrogen receptors
A recent study published in the journal Melanoma Research evaluated the presence of estrogen receptors alpha (ERα) and beta (ERβ) in melanoma specimens from female patients with a previous history of breast cancer. The researchers found that melanoma in women treated with anti-estrogen therapy is more likely to exhibit estrogen receptors than women of the same age and carcinoma stage who did not receive anti-estrogen treatment. For this study, conducted at the IRCCS Policlinico di Sant’Orsola Hospital’s Melanoma Unit in Bologna, Italy, from Jan. 2017 to Dec. 2019, 28 specimens were analyzed. Patients were divided into groups, including one in which all patients underwent ovarian stimulation. The results showed that ERβ nuclear presence was detected in all cases of women with a history of breast cancer and that women undergoing ovarian stimulation ad a lower count of estrogen receptors.
Prevalence of female pattern hair loss in postmenopausal women
A study published in The Journal of the North American Menopause Society aimed to identify the prevalence of female pattern hair loss (FPHL), hair characteristics, and associated factors in healthy postmenopausal women. The researchers found that the prevalence of FPHL is high in postmenopausal women. They also note that early detection and proper treatment of FPHL would increase the quality of life in this group and that it is necessary to raise hair loss awareness in menopause clinics.
For this study, 200 postmenopausal women between 50 and 65 y.o. were recruited. Each participant was evaluated for FPHL according to Ludwig’s classification using standardized global photography and trichoscopy for hair density and diameter. Time since menopause, levels of scalp sebum, serum testosterone, estradiol, thyroid-stimulating hormone, and hemoglobin and family history of hair loss were also evaluated. In total, 178 postmenopausal women were assessed for hair loss patterns. The prevalence of FPHL among the group was 52.2%.
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Marie Antoinette syndrome after Covid-19 vaccination
An article published in the International Journal of Dermatology reported the case of a 39-year-old Caucasian woman who presented sudden greying of the hair, which was followed by diffuse hair loss. This process started four days after the patient’s first dose of the Pfizer Covid-19 vaccine. The patient had no history of pre-existing alopecia areata (AA) or other autoimmune conditions. She also did not have any history of recent trauma or infectious disease. A physical examination showed a widespread hair loss in the central area of the scalp and some nail pitting on the patient’s fingers. After the second vaccine dose, the alopecic area significantly expanded.
After further examination, the patient was diagnosed with Marie Antoinette syndrome, a rare AA variant. She was then treated with a tapering course of oral prednisone and topical clobetasol. After four weeks, a trichoscopy showed some exclamation mark hairs and yellow dots on a background of re-growing hair. After six weeks of treatment, the patient showed almost complete hair regrowth with partial repigmentation.
After a thorough review of PubMed, the researchers report that they found another 14 cases of patients diagnosed with AA after receiving a Covid-19 vaccine. According to their findings, the published cases show a clear female predominance and personal or family history of AA is considered a significant risk factor. The authors conclude that alopecia areata can occur after mRNA vaccines against SARS-CoV-2. Still, studies about the long-term follow-up of these patients are needed to better understand and explain the outcome of this rare adverse event.
“When I was in medical school, I considered going into plastic surgery, which appealed to me as a hands-on mix of my passions for art and science. However, the thing that surgery was missing for me was the patient interaction – not so easy to connect with your patient when she’s under anesthesia on the surgical table. As an alternative, dermatology turned out to be the perfect combination of everything I wanted in my medical career. Being a cosmetic dermatologist allows me to help improve my patients’ confidence as they pursue their work and dreams.”
— Dr.Kim Nichols, a Connecticut-based cosmetic dermatologist in an interview for her personal website.
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