Today’s report also covers research into common dermatoses in postmenopausal women, "colourism" and the use of skin-lightening products, and more (1,336 words, 6.5 minutes)
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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
The relationship between hormones and skin cancer has been a topic of ongoing discussion and research. A recent study published in Scientific Reports (June 2023; 13, 10572) highlights the importance of understanding this correlation for better patient care. To assess the potential risk of developing skin cancer, the researchers studied a Korean cohort and evaluated the impact of menopausal hormone therapy (MHT).
This retrospective cohort study utilized data from the National Health Insurance Service of Korea from December 31, 2019, to January 1, 2022. Women over 40 who had experienced menopause between 2002 and 2011 were selected as MHT cases or controls. The MHT group included women who used MHT for at least six months during the study period, while the control group consisted of women who had never used MHT agents.
The MHT agents investigated in this study were tibolone, estrogen and progestin combined by the manufacturer (COPM), estrogen, estrogen and progestin combined by the physician (COPP), and topical estrogen. The researchers also analyzed factors such as smoking, alcohol consumption, physical exercise, age at menarche, age at menopause, and Body Mass Index (BMI).
The final sample included 192,202 women in the MHT group and 494,343 in the non-MHT group. Overall, the results showed that MHT did not affect the incidence of melanoma in menopausal Korean women. Only 0.05% of non-MHT and 0.03% of the MHT group developed melanoma. In the MHT group, melanoma developed in 0.03% of those treated with tibolone, 0.03% of COPM, 0.05 of oral estrogen, and 0.08% of COPP and topical estrogen users, respectively.
The study also found that specific MHT agents, such as tibolone and combined estrogen and progestin, were associated with a lower risk of non-melanoma skin cancer (NMSC). Additionally, older age, obesity, and rural living were associated with an increased risk of NMSC, while smoking and physical exercise were associated with a decreased risk.
The authors emphasize that while the study provided insights into the relationship between MHT and skin cancer risk in a Korean population, the lack of detailed data on UV exposure and the subtype of NMSC could have influenced the results.
Bottom line
Menopausal hormone therapy does not seem to affect the incidence of melanoma in menopausal Korean women directly. Specific MHT agents are associated with a lower risk of NMSC. Further research is needed that would consider UV exposure and NMSC subtypes.
A study published in Cureus assessed epidemiological and clinical patterns of postmenopausal dermatoses in a cohort of women in Bihar, India. The researchers found that cutaneous dermatosis was the most common dermatosis among postmenopausal women, followed by genital dermatosis.
For this single-centre observational cross-sectional study, the authors evaluated the clinical data of 223 postmenopausal women attending the dermatology outpatient department of a tertiary healthcare centre in Bihar. Overall, 83.4% of the women presented with cutaneous dermatosis, 29.1% had genital dermatosis, 33.6% had hair disorders, and 26% had nail disorders.
‘Colourism’ attitudes and use of skin-lightening agents in the United States
Research in the International Journal of Women’s Dermatology examined skin-lightening habits among skin of colour (SOC) individuals in the United States and the role of “colourism” in this practice. (The term describes prejudice or discrimination against individuals with a dark skin tone, typically among people of the same ethnic or racial group.) The authors found that skin lightening is more prevalent among women and is a common practice among SOC people. They note that skin-lightening can pose a significant health risk. Many users are unaware of product ingredients, do not consult a healthcare provider before use, and might have access to potentially unsafe formulations.
For this study, 455 SOC participants answered a cross-sectional survey through ResearchMatch. Of all the participants, 21.3% reported using skin-lightening agents, 73.2% of the skin-lightening users used the products to treat a skin condition, and 26.8% used the agents for general skin lightening. Only 22.6% of skin-lightening users consulted a healthcare professional before using the products, and 45.4% were unaware of the product’s ingredients. Additionally, 82% of skin-lightening agent users were women.
Rosacea and seborrheic dermatitis differentially respond to lactic acid sting and capsaicin tests
A study published in the Journal of Cosmetic Dermatology assessed the skin reactions to the lactic acid sting test (LAST) and capsaicin test (CAT) in a cohort of Chinese women with rosacea compared to women with seborrheic dermatitis. The authors found that women with rosacea tend to have higher LAST and CAT scores, likely due to inferior skin permeability barrier and increased neurovascular sensitivity.
For this study, the researchers recruited 60 patients with rosacea, 20 with seborrheic dermatitis, and 40 healthy controls. The participants were assessed for skin sensitivity to 10% lactic acid or 0.001% capsaicin solution. Patients with rosacea had significantly higher LAST and CAT scores than both groups. Seborrheic dermatitis patients did not have a considerably higher LAST or CAT score than the healthy controls.
Pregnancy, delivery, and postpartum considerations among patients with vulvar lichen sclerosus
A study in the International Journal of Obstetrics & Gynaecology explored the impact of vulvar lichen sclerosus (VLS) on women during pregnancy, childbirth, and postpartum. The researchers found that the symptom severity of VLS remained the same or decreased during pregnancy but increased after childbirth. Additionally, women used fewer topical corticosteroids while pregnant than before or after pregnancy.
The authors distributed a 47-question survey to participants recruited through social media support groups. Out of 204 responses, 134 met the inclusion criteria. Symptoms decreased in 44% of pregnancies but increased after childbirth in 60%. Anxiety about delivery due to VLS symptoms was reported by 50% of participants, and 31% experienced postpartum depression. Furthermore, 60% of participants said they used topical steroids before pregnancy, 40% during pregnancy, and 65% after delivery. Overall, 94% of participants reported receiving insufficient information on the topic.
VIDEO: Women in dermatology and the work-life balance
Nina Copeland, an Advanced Practice Nurse at Johnson Dermatology in Fort Smith, Ark., shares how she balances her personal life with her career working in dermatology.
A case of labia majora reconstruction with neurovascular pedicled pudendal thigh flap post-extensive vulvectomy for extramammary Paget’s disease
A case study published in Clinical Case Reports describes a 68-year-old woman with a five-year history of minor pain and redness in the genital area. A skin biopsy of the lesions revealed abnormal histopathological results, and the patient was diagnosed with primary extramammary Paget’s disease of the labia majora. The physicians performed a radical vulvectomy, which removed all of the lesioned areas but resulted in a sizeable labial tissue defect.
The physicians designed a unilateral pudendal thigh flap with a hidden scar in the midline of the posteriorly-based flap to fill the labial defect and reconstruct the labia majora. The flap’s size matched the defect and was elevated under the deep fascia to include the necessary blood vessels and nerves for sensation and survivability of the flap. The flap was then transposed to repair the area without tension, and the wound was closed with minimal damage.
“I always wanted to have my own private practice and be my own boss. I’ve always inherently had an entrepreneurial streak within me, and I felt cosmetic dermatology is the best field where I can balance being a doctor and an entrepreneur.”
— Dr. Priyanka Reddy, a Bangalore, India-based dermatologist and founder of DNA Skin Clinic in an interview with the website Sugermint.
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