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Good morning and welcome to this edition of 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.
Psoriasis is often associated with significant comorbidities such as type 2 diabetes. According to recent research, there might be a complex relationship between this skin condition and insulin resistance.
A study published in the journal Archives of Dermatological Research (Nov. 2022; 314:869–880) assessed the relationship between psoriasis and insulin resistance in a large cohort (21,789) of postmenopausal women from the Women’s Health Initiative (WHI). WHI recruited postmenopausal women between 50 and 79 from 40 clinical centres in the U.S. between 1993 and 1998. Participants provided information on their demographics, medical history, and lifestyle through self-questionnaires. Additionally, the staff obtained anthropometric measurements such as height, weight, and waist and hip circumferences.
Unlike previous research, the new study’s authors wanted to determine whether a pre-diabetic condition such as high baseline insulin resistance is a psoriasis predictor.
For primary analyses, the researchers involved in this study examined the association between the baseline homeostasis model assessment of insulin resistance (HOMA-IR) and psoriasis incidence over 21 years. The authors found that participants with higher HOMA-IR scores were likely to have a history of diabetes, hypertension, cardiovascular disease, stroke, liver disease, or rheumatoid arthritis. In contrast, low HOMA-IR was associated with non-melanoma skin cancer. They also found that higher baseline insulin resistance was significantly associated with a greater incidence of psoriasis. These findings support their initial theory that postmenopausal women with pre-diabetic conditions are at greater risk of developing psoriasis.
The authors note that lifestyle changes can reduce the risk of insulin resistance and may also reduce the risk of psoriasis. Women with higher baseline insulin resistance were often overweight, former smokers, and reported lower physical activity levels.
According to the authors, this could be because psoriasis and diabetes share genetic susceptibility regions. While the exact link between psoriasis and insulin resistance is not fully understood yet, immune dysregulation is known to play an essential role in both conditions.
Finally, the researchers report that previous research has identified a possible link between psoriasis and metabolic syndrome, associated with insulin resistance and psoriasis severity. For instance, patients with metabolic syndrome had higher Psoriasis Area Severity Index (PASI) scores than those without metabolic syndrome. At the same time, observational studies have shown that patients with more severe psoriasis have greater odds of developing metabolic syndrome.
Bottom line
Study results suggest a significant relationship between insulin resistance and psoriasis, and psoriasis may result from a pre-diabetic condition. Reducing the risk of insulin resistance with diet and exercise may ultimately reduce the risk of psoriasis. Insulin resistance should be explored as an additional therapeutic target in psoriasis patients.
Dermatologic care of the lesbian, gay, bisexual, and transgender community of India
A study in the Indian Journal of Dermatology, Venereology and Leprology was designed to identify the common dermatological concerns of the LGBTQ+ community of India. The authors found that transgender women have unique cosmetic and treatment concerns during their transition period. Additionally, they discovered that lesbian, gay, bisexual, transgender, and queer people in India have limited access to dermatological services due to fear of discrimination.
The authors conducted a cross-sectional survey of 51 adult participants who self-identified as transgender in India. The majority of the participants (94%) were transgender women. The most common dermatological concerns among all patients were: facial hair distribution, scarring from gender-affirming surgery, androgenetic alopecia, and facial hyperpigmentation. The most common concern among trans women was having access to facial feminization procedures, and the most common among trans men was testosterone-related acne. Additionally, more than 40% of participants reported dissatisfaction with their bodies.
Characterizing nipple skin injuries in postpartum women
A study in the Journal of the American Academy of Dermatology looked to characterize nipple skin injuries in postpartum women to identify contributing factors. The researchers found that the incidence of nipple skin injury was significantly greater in older mothers.
For this retrospective cross-sectional study, the authors distributed an anonymous survey for new and expecting mothers through multiple Facebook groups. The final sample included 391 postpartum women. The incidence of nipple skin injuries in breastfeeding women was 28.97% during the first six months of lactation, 21.33% between six to 12 months, and 38.66% after one year. Mothers older than 35 years had a significantly greater prevalence (39.85%) of nipple skin injuries than mothers younger than 34 (23.81%).
Lifetime sunburn trajectory and associated risks of cutaneous melanoma and squamous cell carcinoma
A study in JAMA Dermatology studied the association between sunburn patterns and the risk of developing cutaneous melanoma (cM) and squamous cell carcinoma (cSCC) in a cohort of Norwegian women. The authors found that an elevated sunburn frequency throughout life was associated with an increased risk of cM and cSCC.
The authors recruited the study’s participants from the Norwegian Women and Cancer Study. Baseline questionnaires were distributed from 1991 to 2007, followed by additional surveys every five to seven years. Participants reported their indoor tanning habits, sunbathing vacations, and changes in pigmentation. They also said their yearly frequency of sunburns during childhood, adolescence, and adulthood.
Women of childbearing age with hidradenitis suppurativa are often prescribed medications dangerous for pregnancy.
A study published in the Journal of the American Academy of Dermatology analyzed the most common treatments used to treat hidradenitis suppurativa (HS) in women of childbearing age. The researchers found that the most commonly prescribed drug was clindamycin, which is not recommended during pregnancy unless necessary due to lack of data. The most widely prescribed drugs were minocycline, doxycycline, and trimethoprim-sulfamethoxazole (TMP-SMX), known teratogens. Finally, acetaminophen-oxycodone, which can cause premature birth, was also commonly prescribed.
The authors reviewed the National Ambulatory Medical Care Survey (NAMCS) from 2007 to 2018.
Minneapolis-based dermatologist Dr. Jenny Liu comments on hormonal acne. She discusses treatment options and solutions dermatologists can provide to their patients to help their skin.
A case of facial rash with exuberant crusting during pregnancy
A case study published in the International Journal of Women’s Dermatology reported the case of a woman in her 20s who developed pruritic, painful facial lesions during her first gestational trimester. She also had a history of systemic lupus erythematosus and frequently wore facemasks. Upon examination, the patient had multiple combined red spots and blisters with yellow-grey crusting around her nose, mouth, and forehead.
A punch biopsy of a blister helped diagnose periorificial pyoderma faciale. The physicians then initiated a three-month course of cephalexin. At the two-month follow-up, most lesions had disappeared.
“Dermatology is what I envisioned medicine to be. We are able to visually diagnose, confirm with a biopsy, see it on the pathology, and watch it improve with the patient. My idea of medicine is not watching a number change or wondering how much of the result was the placebo effect. This combination of readily accessible clinico-pathologic correlation and instant gratification is very unique to dermatology. We also have really good treatments for a multitude of diseases. Sure, there is a lot of corticosteroid medications involved, but treatment response is cherished by patients. Luckily for us, patient satisfaction leads to less physician burnout.”
— Dr. Jenny Liu, a Minneapolis, Minneapolis -based dermatologist, in a commentary published on her personal website.
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