Today’s report covers research into female androgenetic alopecia, adult female acne, a rare case of congenital vitiligo and more (1460 words, 7 minutes)
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. Every two weeks, this bulletin will provide you with updates 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
Atopic dermatitis (AD) is a common inflammatory skin disease. While it affects a similar number of male and female children, studies have shown it is more common in adult females than adult males. The sex differences in AD have not been fully explored, but recent research suggests that hormonal differences could play a key role.
An article published in the International Journal of Women’s Dermatology (Dec. 2021; 7(5): 606-614)highlighted the lack of data on the influence of sex, gender, and gender identity on the etiology and systemic therapies used for AD. The abstract noted the importance of focusing research on sex differences in AD to define those differences and develop appropriate treatments.
The researchers also sought to determine the impact of sex and gender on the pathophysiology of AD, with a focus on epidermal barrier function, immune dysregulation, and skin dysbiosis. According to them, contrasting data exists on the influence of sex on epidermal barrier defects. They suggest that the presence of a maternal FLG gene variant may affect early fetal development, possibly by affecting conditions during pregnancy that contribute to a greater risk for AD development. With this gene variant, the risk of AD is more significant than it is with the paternal transmission of an FLG gene mutation. The authors also found that basal transepidermal water loss is higher in men than women in adults without AD. However, in a study of children with AD, no sex differences were found in basal transepidermal water loss.
Some of the sex differences are related to hormones in terms of AD severity. For example, according to the study's authors, AD tends to worsen during the premenstrual phase in 33% to 64% of subjects during pregnancy in 52% to 61% of subjects, according to the study’s authors. While other biological variables may explain this observation, these facts suggest that an increase or decrease in estrogens and progestogens could contribute to AD mechanisms.
Bottom line
The authors conclude that sex and gender are understudied variables in AD. The role of sex in AD pathophysiology is not fully understood yet due, in part, to a lack of data. Extensive observational studies are needed to effectively address the impact of sex on the natural history, phenotypes and endotypes of AD, and response to treatments. These studies should also consider other key elements such as race, ethnicity, socioeconomic status, access to health care, age of AD onset, and the diverse gender landscape.
Survival of women previously diagnosed with melanoma with subsequent pregnancy
A recent study published in the Journal of Clinical Medicine aimed to determine whether pregnancy after a melanoma diagnosis worsens the prognosis. The researchers performed a systematic review, including the most recently published literature on the matter.
The authors did not identify a significant influence of a subsequent pregnancy on the prognosis of previously diagnosed melanoma. However, they concluded that female patients with a previous history of melanoma should be approached with caution.
A clinico-trichological study of female androgenetic alopecia
A study published in the International Journal of Trichology evaluated the clinical features of female androgenetic alopecia (FAGA), the trichoscopic characteristics in female androgenetic alopecia patients, and the correlation of trichoscopic features with clinical-grade of female androgenetic alopecia. The authors found that trichoscopy can be used in everyday clinical practice to diagnose various scalp problems, including FAGA, due to its non-invasive nature. Trichoscopy can be used to diagnose disorders in a safe and fast way, they write. It validates the diagnosis and links the trichoscopic characteristics of FAGA with clinical severity. The researchers also found that as the patient’s age increases, the grade of FAGA severity rises.
The study involved 50 patients diagnosed with FAGA, and the cases were divided into subgroups according to the Sinclair scale, which measures the severity and stages of androgenetic alopecia. The main limitation of this study was that the sample was relatively small.
The pleomorphic appearance of cutaneous metastases in breast cancer
A study published in Cureus Journal of Medical Science presented three cases of cutaneous metastases in female breast cancer patients to review the pleomorphic appearance of this type of lesion. The skin lesions described appeared as annular erythema, carcinoma en cuirasse, carcinoma erysipelatoid, an erythematous targetoid lesion, and/or zosteriform metastases, all of which looked different from one another.
The author states that cutaneous metastasis tends to occur in oncology patients due to persistent or recurrent neoplastic disease. They can, however, be the first sign of extranodal metastases in a person with advanced disease or the first sign of breast cancer in someone who has never been diagnosed. Pleomorphic skin lesions can take on a variety of shapes and sizes, and they might be mistaken for benign cutaneous lesions and tumours, and other conditions. A skin biopsy is always necessary to confirm the diagnosis of breast cancer cutaneous metastasis.
Adult female acne: Clinical and therapeutic particularities
A review published in the journal Experimental and Therapeutic Medicine aimed to provide up‑to‑date, evidence‑based information on the clinical presentation, etiopathogenesis and treatment of adult female acne. According to the study’s abstract, the prevalence of adult female acne ranges between 12 and 54% and two clinical types of acne can be distinguished: retentional and inflammatory. These two types usually tend to overlap.
The authors concluded that adult female acne differs from the adolescent variant in the clinical presentation and etiopathogenesis and its tendency for chronicity. Adult female acne tends to last longer, potentially persisting until the postmenopausal period. The authors also specify that it is necessary to have a unique treatment approach that addresses the specific needs of each individual.
There are currently few clinical studies addressing the specificity of acne in this population, and more information is needed, the authors write. It is essential to have more literature on the subject because acne does not only affect cosmetic appearance, but it can also have a significant psychological impact on those affected by it, they say.
VIDEO: How Climate Change Affects Your Skin by Dr. Mary Williams
Doctor Mary Williams, Clinical Professor of Dermatology at the University of California San Francisco, talks about the effects of air pollution and climate change on the skin.
Case report: A rare case of congenital vitiligo
A report published in the Journal of Clinical and Aesthetic Dermatology presented the case of a 27-day-old female neonate patient who had multiple rapidly progressing, depigmented patches all over the body since birth. Under a black light, the lesions showed a chalky white accentuation. The mother had a positive history of vitiligo. The infant was started on topical fluticasone propionate 0.05% in the mornings and tacrolimus 0.03% ointment at night. There were no new lesions throughout the one-year follow-up period, and existing lesions had partial re-pigmentation.
According to the report authors, the manifestation of vitiligo at birth is extremely rare. Its presentation at birth in this case suggests an important genetic link, as opposed to acquired factors. It also supports the in-utero hypothesis, adding to the limited literature currently available regarding congenital vitiligo.
“The scoring systems for severity of AD, such as SCORAD and EASI, rely on skin erythema and they underestimate the severity of AD in darker skin types. If we adjust for erythema score we will see that black children have a six times higher risk of being diagnosed with severe AD. So new severity measurement tools are required.”
— Dr. Danielle Marcoux, aMontreal-based dermatologist, speaking at the seventh annual Skin Spectrum Summit in November 2021.
You are receiving this newsletter because you are a subscriber to Women in Dermatology or other 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 send an email with the subject line “Unsubscribe Women in Dermatology” to health@chronicle.org
Women in Dermatology is published by Chronicle Companies: 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3
Mitchell Shannon, Publisher; R. Allan Ryan, Editorial Director; Cristela Tello Ruiz, Client Services; John Evans, Managing Editor; Katherine Brenders, Kylie Rebernik, Jeremy Visser, Editors; Catherine Dusome, Operations Manager; Peggy Ahearn, Consultant Content is copyright (c) 2022, Chronicle LifeSci America Corp, except as indicated. Interested in contributing to this newsletter or in learning more about Chronicle’s services? Please write to us at health@chronicle.org
