Sexual health consequences in women with lichen sclerosus
Today’s report also covers research into the risk of hyperkalemia in women taking spironolactone for hair loss, scalp cooling in breast cancer patients, and more (1,345 words, 6.5 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
Good morning and welcome to 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
Lichen sclerosus (LS) is a chronic inflammatory skin disease that primarily affects the vulva. Common symptoms of LS include vulvar pain and severe itching. Research has indicated a high rate of sexual dysfunction among women with LS, but many effects of the condition on sexual health are not well known. A study published in Sexual Medicine Reviews (Jan. 2023; 11: 8-14) looked to identify the sexual health consequences in women with vulvar LS.
The authors conducted a systematic review of existing literature, searching PubMed, MEDLINE, and Scopus databases for reports regarding the effects of LS on female sexual health. They included observational studies, randomized controlled trials, and comparative studies. All the selected articles were originally written in English and published between Jan. 1991 and April 2022.
After the initial search, the authors identified 20 studies that met the inclusion criteria. One of the selected studies was a series of taped qualitative interviews with 19 women who had undergone vulvar surgery due to LS. Among the main reasons for surgery reported by the participants was the desire to sexually satisfy a male partner and to experience sexual enjoyment again. Additionally, 11 participants said they had ceased all sexual activity before surgery because of LS symptoms. All participants reported a lack of sexual desire and arousal, dryness, discomfort, and distress about sexual function.
The researchers also found six studies that investigated the sexual health symptoms of women with LS. Across all six studies, up to 55% of women reported LS harming their sexual function. A total of 76% of women also reported reduced frequency of intercourse, and between 22-76% said they experienced pain during sex. Also, 53% of women expressed a change in their ability to reach orgasm, and 38% stated the condition directly affected their intimate relationships. In one prospective case-control study, women with LS had less frequent sexual activity and were less satisfied with their sexual lives than healthy controls.
The authors also included eight studies that evaluated the Female Sexual Function Index (FSFI). Across these eight studies, women with LS scored at the lower end of the index. Four other articles used the Female Sexual Distress Scale (FSDS) to evaluate sexual dysfunction. All participants had high levels of distress, according to the FSDS.
Finally, four studies used the Dermatology Life Quality Index (DLQI) to evaluate the impact of LS on the quality of life of women. The scores were diverse and ranged from “very small impact” to “very large impact.” However, all patients reported sexual difficulties.
Bottom line
The authors concluded that LS significantly impacts the sexual life of women. The most common sexual health consequences among women with LS are sexual pain, overall sexual dysfunction, sexual distress, and negative impact on sexual relationships. Most women with LS experience a significant impact on their quality of life, especially in terms of sexual function.
Dermatologic diseases and healthcare pathway among pregnant women
A study published in Gynecology, Obstetrics, Fertility & Senology created an inventory of skin lesions during pregnancy to identify healthcare pathways among pregnant women. The researchers found that skin lesions are frequent during pregnancy and that most women consulted their general practitioner first instead of their gynecologist.
For this prospective, observational study, the authors sent a self-administered survey to women in the postpartum period between April and Aug. 2021. A total of 377 women answered the questionnaire. Among the respondents, 9.3% reported skin conditions before pregnancy. During pregnancy, 36.1% of women reported skin issues, the most frequent being stretch marks and hyperpigmentation.
Retrospective analysis of the risk of hyperkalemia in elderly women taking spironolactone for female-pattern hair loss
A British Journal of Dermatology study examined the incidence of high potassium levels (hyperkalemia) in women over 65 years of age who had been prescribed spironolactone for female-pattern hair loss (FPHL). The researchers found that spironolactone doses higher than 50 mg per day slightly increased the risk for hyperkalemia, suggesting that lower daily doses may be safer for older women.
For this retrospective analysis, the researchers examined the cases of 87 women with FPHL using spironolactone. The doses ranged between 12.5 mg and 200 mg daily. Nine patients (10.3%) developed hyperkalemia, with six having high potassium levels at baseline. In the end, eight patients had persistently elevated potassium levels and required spironolactone dose reduction or discontinuation.
Treating co-existent genitourinary syndrome of menopause in a patient with lichen sclerosus improved symptoms
An article published in the International Journal of Women’s Dermatology reported the case of a 60-year-old woman with a history of lichen sclerosus (LS) who presented for a follow-up evaluation after being prescribed topical halobetasol twice daily for two months. She had total resolution of her clinical LS symptoms but experienced a burning sensation on the vulva. She was prescribed topical estradiol cream nightly for two weeks, followed by twice weekly after the initial treatment course. The patient reported total resolution of symptoms at the three-month follow-up and said the estradiol was “life-changing.”
The authors used this case to note the importance of treating LS in menopausal patients considering that genitourinary syndrome of menopause (GSM) could be a comorbidity. According to the authors, treating GSM symptoms such as vaginal dryness, burning, or discharge will improve LS symptoms in patients with both conditions.
A retrospective cohort study of scalp cooling in breast cancer patients
Scalp cooling is a technique that helps prevent alopecia in patients undergoing chemotherapy by using a cooled cap during chemotherapy infusions. A study in Supportive Care in Cancer evaluated how factors such as age, ethnicity, insurance status, cancer stage, and chemotherapy history influenced breast cancer patients’ decisions to add scalp cooling into their treatment plan. The researchers found that these factors significantly influence breast cancer patients’ likelihood of opting for scalp cooling. For example, younger patients and patients with private insurance were more likely to use scalp cooling. Additionally, non-White patients were less likely to undergo scalp cooling than White patients.
Dr. Davin S. Lim, an Australia-based dermatologist, explains how polycystic ovary syndrome (PCOS) affects the skin and can trigger other issues, such as hair loss.
A case of labial adhesion due to lichen sclerosus masked by vulvar Hailey–Hailey Disease
A case study published in the Journal of Menopausal Medicine reported on an 84-year-old woman who presented with vulvar labial adhesions, pain, and inflammation. The patient had been diagnosed with Hailey–Hailey disease (HHD) three years prior and applied low- and high-potency topical corticosteroids (TCS) to the inflamed area without improvement. A clinical examination revealed red spots with hyperpigmented borders, lineal fissures, and overlying crusty blisters in the vulva, perineum, and inner groin area. The lesions were consistent with the diagnosis of HHD. The labia minora and majora were completely fused.
The gynecologists and dermatologists performed a vaginoscopy and separated the fused labia. The vaginoscopy showed mucosal atrophy without wounds or other lesions. The patient was diagnosed with lichen sclerosus and was treated with vaginal dilators and topical clobetasol. She saw symptom improvement after one month.
“I’m not a fan of DIY skincare. We see this a lot on TikTok where people take lemon or grapefruit and create their own concoctions with it, and it can cause some really bad irritation. We should leave science to the chemists and companies that make the product.”
— Dr. DiAnne Davis, a Dallas, -based dermatologist, in an interview with Us Maganize.
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