Today’s report also covers research into the association between disinfectant use and childhood allergies, signs of skin aging in women, and more (1520 words, 7 minutes 35 seconds reading time)
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.
Psoriasis is a chronic inflammatory skin condition that is slightly more prevalent among women than men. There are sex-dependant differences in psoriasis manifestation, severity, treatment options, subjective disease perception, and impact on quality of life. A better understanding of these differences could improve outcomes for women with psoriasis and reduce inequalities in care.
A recent study published in the International Journal of Women's Dermatology (June 2022; 8(2): p e010) discussed the gender- and sex-specific aspects of psoriasis. The main objective of this narrative literature review was to specify the considerations that physicians should take into account when treating women with this condition.
The authors conducted a literature search using MEDLINE (PubMed) and the Cochrane Library for systematic reviews. Eligibility criteria included papers describing novel insights and society guidelines. Additional studies were also found by using the bibliographical information of relevant articles. The study did not include psoriatic arthritis, pustular psoriasis or subtypes other than plaque psoriasis. Finally, the authors followed the Scale for the Assessment of Narrative Review Articles (SANRA) to obtain a higher quality narrative review.
The researchers found that psoriasis tends to present at a younger age in women compared to men. Additionally, women respond differently to treatments, and differences in prescribing patterns were observed. The authors also note that while some data suggest that women are slightly more prone to psoriasis than men, most evidence suggests that other factors, including genetic predisposition and environmental conditions present a higher risk for the development of psoriasis.
According to the study, female sex hormones also affect the disease manifestation and severity of psoriasis. For example, high estrogen levels and increased estrogen-to-progesterone ratios correlate with improvement of psoriasis symptoms. This is shown by studies that have reported a significant improvement in psoriasis during pregnancy. Sex hormones also influence cytokine imbalances in psoriasis patients.
Finally, the study also determined that women with psoriasis on average had a lower socioeconomic status and used health services more frequently than men. When it comes to the treatment of women of childbearing age, the authors state that many safe options are available. Still, some safety concerns exist for new biological therapies during pregnancy and lactation.
Bottom line
The authors conclude that future psoriasis therapies should, and will eventually, be tailored to address sex differences. They say they believe that it is necessary to explore if there are differences in disease phenotypes between men and women and how these differences could influence treatment options. Furthermore, it is necessary to examine if different therapies result in different outcomes and, if so, whether some treatments are better for women than for men or vice versa.
Analysis of multi-part phenotypic changes in skin to characterize the trajectory of skin aging in Chinese women
A study published in the journal Clinical, Cosmetic and Investigational Dermatology analyzed the signs of external skin aging in Chinese women. The authors concluded that in Chinese women, the skin begins to age at 24 years. They also found that wrinkles around the eyes, mouth and hands were strongly correlated with age.
For this study, the authors collected wrinkle, texture phenotypes, and collagen samples from the face, neck, hands, and arms of 326 Chinese women. They then evaluated the correlation between phenotypes and ages and the differences in phenotypes by age. The researchers found that ages 32 and 58 years showed the largest number of differentially changed aging phenotypes. They also found that eye aging was the most swiftly changing phenotype between 19 and 30 years old. Finally, the number of aging phenotypes increased between the ages of 24 and 30 years, suggesting that the skin was aging rapidly after the age of 24 years.
Curl pattern classification: A potential tool for communication and risk of stratification
A study published in the International Journal of Women's Dermatology identified and classified curl patterns to optimize communication between physicians and patients when treating hair loss disorders. According to the abstract, there is a lack of proper tools for objective assessment of hair and hair loss disorders, which can impact women. The researchers identified four different curl patterns and discovered that the subtypes of alopecia varied considerably across the four patterns. They also found that curl pattern appears to be more significant than ethnicity in determining the risk of developing the associated alopecia subtypes.
For this study, 74 participants were enrolled with 61 reporting their ethnicities (43 were Caucasian, nine were Hispanic, eight were Black, and one was Asian). Curl patterns were divided into pattern 1 (straight), pattern 2 (wavy), pattern 3 (curly), and pattern 4 (coily). The authors found that although androgenetic alopecia occurs with similar frequency across the four curl patterns, the risk of central centrifugal cicatricial alopecia increases with increasing curl pattern. The study also found that the distributions of alopecia types and curly hair patterns differ significantly between European or Caucasian patients and African or African American patients.
Cutaneous metastasectomy: Is there a role in breast cancer?
A recent systematic review published in the Journal of Surgical Oncology evaluated the role of cutaneous metastasectomy in breast cancer and provided an overview of the existing types of treatment. The researchers found that cutaneous metastases are common in breast cancer patients. They also found a wide variety of therapy approaches with varying levels of success, and there is no evidence that any particular approach is superior. Overall, they conclude there is a need for well-designed clinical trials that compare treatment protocols focusing on long-term survival.
For this study, the researchers identified relevant articles published between Jan. 1980 and Jan. 2022. After screening titles and abstracts for eligibility, the authors selected 110 articles for the review.
Prenatal occupational disinfectant exposure and childhood allergies
A study published in Occupational and Environmental Medicine examined whether occupational disinfectant use during pregnancy was associated with the development of allergic diseases in children. The authors found that pregnant women who used disinfectants regularly had a considerably greater chance of their offspring developing eczema or asthma than those who did not use disinfectants at all. However, there were no associations between disinfectant use and food allergies.
For this study, the researchers used data from 78,915 mother/child pairs who participated in the Japan Environment and Children’s Study between January 2011 and March 2014. They then analyzed the associations between maternal disinfectant use during pregnancy and allergic diseases such as eczema, asthma and food allergies in their children.
Physician Assistant Kimberly Brown discusses the cultural factors contributing to hair loss in the black community.
Pregnancy-triggered pemphigus vulgaris with favourable fetal outcomes
A report published in the journal Clinical Case Reports presented the case of a 41-year-old woman with pemphigus vulgaris triggered by pregnancy. This was her fourth pregnancy, and all her previous pregnancies had resulted in fetal deaths from severe metabolic disorders due to consanguineous marriage. According to the patient, the lesions started as papular and urticarial lesions on her trunk and abdomen at four weeks of gestation. During the eighth week, the patient developed bullous lesions on her oral and genital mucosae and lesions on her back, trunk, and abdomen. The blisters were not tender nor pruritic, and there were no signs of excoriation. A skin biopsy revealed a suprabasal bulla with a single layer of basal cell tombstone appearance, a moderate lymphocytic infiltration, and a few eosinophils in the dermis. She was diagnosed with pemphigus vulgaris.
The patient was then prescribed 65 mg of once-daily prednisolone. Within four weeks, her lesions partially improved, and prednisolone dosage was lowered. After five months, the prednisolone dose was gradually reduced to 20 mg once daily. The patient's pregnancy follow-up was normal, and she did not develop any new lesions. She had a C-section at 33 weeks of pregnancy due to premature membrane rupture, and a healthy male child was born. The mother’s pemphigus vulgaris continued to be controlled by a low prednisolone dose in the postpartum period.
“I think it was good for me as a doctor [to deal with cystic acne], because it really taught me just how shameful the experience is. Even though I’m very compassionate, and I try to really get into the hearts of my patients, you don’t know what they’re feeling until you’re in it yourself. I became a more understanding physician about the psychological component that acne has on patients, and how it affects them from the minute they wake up—every free thought that they have, the waste of energy.”
— Dr.Zenovia Gabriel, a Newport Beach, Calif., -based dermatologist in an interview with Glamour Magazine.
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