Tailoring psoriasis treatment: Crucial guidance for women planning pregnancy
Today’s report also covers research into nonsurgical interventions for facial feminization, AI-powered visual diagnosis of vulvar lichen sclerosus, and more (1,440 words, 7 minutes)
Systemic therapies have transformed psoriasis treatment over the past two decades, but their safety during pregnancy remains a concern, note the authors of a study in the International Journal of Women’s Dermatology (Dec. 2024; 10(4):p e187). Investigators examined the disease burden and treatment approaches. They shared decision-making indicators in women of childbearing age with moderate-to-severe psoriasis, both with and without a current desire for pregnancy. The researchers determined that treatment decisions for women of childbearing age with moderate-to-severe psoriasis were influenced by childbearing wishes, with shared decision-making improving therapeutic alignment with patient preferences.
For this study, conducted at the University Medical Center Hamburg-Eppendorf, the authors surveyed 145 women of childbearing age with psoriasis. Exclusion criteria included age over 45, early menopause, and comorbidities that posed risks. The participants were divided into two groups: those wishing to conceive (CB+) and those not planning to have children (CB−). Patients without childbearing wishes were older and often had children already. They were assessed on disease severity, quality of life, and treatment choices.
The study’s key findings showed differences in treatment choices between the CB+ and CB− groups but no significant differences for most clinical characteristics. As for treatment options, the CB+ group was more likely to be prescribed tumour necrosis factor (TNF) alpha-blockers, such as certolizumab pegol, a medication considered safer in pregnancy. The CB− group was more frequently prescribed non-biologic systemic treatments such as fumaric acid esters. The results also revealed that the desire to have children was significantly associated with the likelihood of receiving TNF alpha blockers, whereas clinical characteristics were not.
Regarding the indicators of shared decision-making for the current treatment, the authors note that less than 50% of patients acknowledged shared therapy goals despite physicians reporting collaborative goal setting. Additionally, patients with pregnancy plans were more likely to report that their childbearing wishes were considered in treatment decisions, and family planning discussions were more frequent in the CB+ group. The study identified effective, shared decision-making as critical for aligning treatment with patient needs and ensuring safe therapy for women of childbearing age with psoriasis.
The Takeaway: Treatment choices for women of childbearing age with moderate-to-severe psoriasis vary based on childbearing intentions, with those wishing to conceive more likely to receive pregnancy-safe TNF alpha-blockers, while others are prescribed non-biologic treatments. Effective shared decision-making plays a crucial role in aligning treatments with patient preferences, but less than 50% of patients reported sharing their therapy goals. Women with pregnancy plans were more likely to have their childbearing wishes considered in treatment decisions, and family planning discussions were more frequent in this group.
The combined impact of ambient temperature and relative humidity on skin aging characteristics
A study in Dermatitis examined the impact of long-term exposure to heat on skin aging in Indian women. The researchers found that prolonged exposure to high heat contributed to increased pigmentation, hyperpigmentation, coarse wrinkles, crow’s feet, and under-eye wrinkles.
For this study, the authors assessed the skin aging phenotypes of 1,510 Indian women using the SCINEXA scoring tool and data on ambient temperature, relative humidity, heat index, solar UVR, and air pollution. The results showed that prolonged exposure to extreme heat contributes to skin aging.
Nonsurgical interventions for gender-affirming facial feminization
A study published in Facial Plastic Surgery & Aesthetic Medicine examined the effectiveness of nonsurgical facial feminization techniques for gender-affirming care. The researchers found that the most used nonsurgical techniques for facial feminization were neurotoxins, fillers, and hair removal. Still, there is a lack of high-quality studies evaluating their effectiveness, outcomes, and safety in transgender patients.
For this study, the authors conducted a medical database search for relevant studies or articles until July 28, 2022. The final review included 20 studies. The results showed that most nonsurgical facial feminization techniques were derived from cisgender cosmetic procedures to achieve feminine qualities. The most common study type was expert opinion or literature reviews. Only two studies quantitatively analyzed nonsurgical facial feminization outcomes, highlighting a gap in measurable data.
Clinical outcomes of hyaluronic acid filler plus lidocaine for hand rejuvenation in middle-aged women
A study in the International Journal of Women’s Dermatology evaluated the safety and efficacy of hyaluronic acid filler injections for hand rejuvenation. It found that these fillers effectively corrected volume loss and improved skin texture on the upper part of the hands, with noticeable enhancements immediately after treatment and further improvements after one month.
For this prospective study, ten healthy female participants with volume loss and visible veins or tendons in their hands received filler injections of 0.5 to 1.0 mL using a blunt cannula in the dorsal superficial lamina. Evaluations with validated aesthetic scales and standardized photographs showed progressive improvements in hand appearance, including significant vein and tendon visibility reductions. The study didn’t report any severe or long-term complications.
AI-powered visual diagnosis of vulvar lichen sclerosus
A study published in the Journal of the European Academy of Dermatology and Venereology evaluated the potential of machine learning for the early detection of vulvar lichen sclerosus (VLS). The researchers found that a machine learning model trained on anogenital skin images could accurately distinguish VLS from non-VLS dermatoses with high recall, precision, and accuracy rates.
For this study, the authors trained a deep convolutional neural network on 775 images of anogenital skin, including 469 with VLS and 306 without VLS, and tested it on 312 images. The machine learning model accurately distinguished VLS from non-VLS cases, suggesting that Artificial Intelligence-based tools could assist clinicians and patients in identifying VLS, but further studies are needed to validate real-world applicability.
VIDEO: Exploring oral metformin's role in treating Central Centrifugal Cicatricial Alopecia
Dr. Jeffrey Donovan, director of the Donovan Hair Academy in Whistler, B.C., discusses a study from JAMA Dermatology that examines the effects of low-dose metformin on central centrifugal cicatricial alopecia (CCCA). The study reveals intriguing changes in gene expression that could offer new insights into treating this underdiagnosed condition, which primarily affects Black women.
A case of psoriasis on the breast of an elderly woman
A case study in SAGE Open Medical Case Reports described a woman in her late 60s with a three-year history of unilateral, painful, ulcerative plaque on her left breast. Her left breast was much warmer to the touch than her right breast, and a previous 3D mammogram and radiograph were normal. She had been treated with antibiotics, steroids, and antifungals in the past, but the treatments were ineffective. Biopsies revealed histopathological findings consistent with psoriasis, including psoriasiform hyperplasia and inflammatory infiltrates. The patient was prescribed risankizumab 150 mg, which led to rapid symptom resolution, with only residual hyperpigmentation after one month. She continued to receive risankizumab 150 mg each quarter without recurrence.
“I think people are desperate to find derms who really understand their skin concerns. Even though [a Latiné patient] might look lighter, [that patient can] still [be] prone to the same things that darker counterparts might be prone to.”
— Dr. Mara Weinstein Velez, a New York-based dermatologist in an interview with Elle Magazine.
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