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
Keloids are thick, bumpy scars that can develop after cutaneous wounds heal, and may be even larger than the original wound. Research suggests there could be an association between keloids and underlying health issues. A recent study published in The International Journal of Women’s Dermatology (Mar. 2023; 9(1):p e074) assessed whether or not there may be an association between keloids and underlying health conditions in African-American women.
For this study, the researchers conducted a retrospective chart review using patient data from the 2018 U.S. National Inpatient Sample (NIS). They filtered the data looking for patients who were female, African American and had undergone a C-section since the procedure could induce the development of a keloid. C-sections would also be indicators of both age and sex. They identified 301 African-American women with keloids who had undergone C-sections and compared them to a control group of African-American women who had also undergone C-sections but had no history of keloids.
The authors selected 49 conditions as possible comorbidities for keloids. These included anxiety, depression, atopic dermatitis, kidney disease, diabetes, and hypertension. Compared to the control group, patients with keloids had a higher incidence of benign uterine tumours, peritoneal adhesions, digestive system issues that could complicate childbirth, depression, and gestational diabetes. Patients with keloids were also more likely to have skin conditions that could potentially complicate childbirth.
The keloid patients, however, had a lower incidence of fetal heart rate and rhythm abnormalities that could complicate childbirth. According to the authors, this could be explained by the fact that the control group required more emergency C-sections than the African-American keloid patients.
Finally, the authors noted a significant association between keloids and peritoneal adhesions. They say this condition may be more common in keloid patients than in healthy controls because both conditions may share the same pathological process.
Bottom line
The authors concluded that the propensity to develop keloids is associated with several comorbidities. They specifically noted that African-Americans with keloids seem more likely to also develop peritoneal adhesions, which suggests both conditions have similar mechanisms that result in irregular scarring. They also mention that women who form keloids may be more likely to develop cutaneous issues that affect childbirth.
The Cetaphil line of skin care products from Galderma is celebrating the second annual global Sensitive Skin Awareness Month. According to the company, the new campaign, “We Do Skin. You Do You,” seeks to arm consumers with science-backed guidance on identifying and caring for sensitive skin.
Cetaphil will focus on four main themes throughout March: The Science of Sensitive Skin, Protecting Sensitive Skin and Caring for All Skin with a focus on Inclusive Skincare and What Can Be Done with Sensitive Skin. The company says it will collaborate with board-certified dermatologists and skin specialists to share their knowledge of sensitive skin and advice, tips, and recommendations.
Sensitive skin affects nearly 70% of the worldwide population, caused by genetics, the environment, and/or skincare products. Consumers are advised to choose products that help defend against the five signs of skin sensitivity: dryness, itchiness, roughness, tightness, and weakened skin barrier. With this campaign, Cetaphil seeks to provide first-hand access to experts and science-driven recommendations to help improve overall skin quality appearance and comfort of sensitive skin.
From the literature on women in dermatology
Pediatric hidradenitis suppurativa
A study published in Pediatric Dermatology compared the care pediatric hidradenitis suppurativa (HS) patients receive in the emergency department to the current HS and pediatric skin and soft tissue abscess (SSTA) management guidelines. The authors found that young Black girls are more likely to develop HS and SSTA. They also found that the most common treatment for both conditions among pediatric patients was incision and drainage, and oral clindamycin.
For this study, the researchers reviewed the clinical charts of pediatric HS and SSTA patients who presented to a pediatric emergency department. They note that 69.5% of patients were girls and 93.6% of total patients were Black. Additionally, 22.4% of HS and 5.1% of SSTA patients were referred to a dermatologist.
Gender differences in clinical practice and Medicare reimbursement among Mohs surgeons
A review published in Dermatologic Surgery compared the clinical activity and Medicare reimbursement of male and female Mohs dermatologic surgeons in the U.S. The researchers found that 31.5% of physicians who performed Mohs surgery were female, and they were paid significantly less than their male peers. Researchers also found that, on average, female surgeons performed 123 fewer yearly cases than male surgeons. They added that when surgeons were classified by productivity rather than sex, the pay rate was usually the same.
Covid-19 vaccination among patients with cicatricial alopecia
A study in the InternationalJournal of Women’s Dermatology conducted a survey to evaluate the effects of the Covid-19 vaccine in cicatricial alopecia (CA) patients. The researchers found that Covid-19 vaccines are not likely to worsen CA symptoms.
The authors sent an email survey to 5,103 patient members of the Cicatricial Alopecia Research Foundation in April 2021. Close to 1,000 patients opened the survey, and 317 answered it. Of the answering patients, 302 were women, and most were White. Most of the patients were fully vaccinated and 93% had received an mRNA vaccine. Only 4.8% of the patients said to have altered their CA treatments because of the vaccine, and 8% reported increased hair loss related to the vaccine.
Effective use of azelaic acid for the treatment of adult female acne
A study published in Clinical, Cosmetic and Investigational Dermatology presented six successful case studies to demonstrate the efficacy of topical azelaic acid (AZA) for treating adult female acne. The authors concluded that AZA is an effective and well-tolerated non-antimicrobial therapy for patients with mild to moderate adult female acne. They added that AZA aligns with current recommendations for non-antibiotic acne treatments to reduce the development of antimicrobial resistance.
The researchers included six challenging cases of patients with persistent adult female acne. All patients were treated with AZA as monotherapy or in combination with other treatments twice daily for at least four months. Every patient saw improvement within the first three months of treatment, most showing complete resolution by the final follow-up.
Dr. Andrea Suarez, a Houston-based dermatologist, explains how acne, hair loss, and other skin changes can be signs of high testosterone and other hormonal imbalances in women.
A case of extensive alopecia areata after Covid-19 vaccination
A case study published in the Journal of Cutaneous Immunology and Allergy described a 37-year-old woman who presented a persistent low fever 13 days after receiving her first dose of the Pfizer Covid-19 vaccine. The patient also noticed coin-sized hair loss 22 days after vaccination. The hair loss spread across her entire scalp within one week. She reported receiving the second vaccination dose 32 days after the first one. The persistent fever resolved spontaneously, but the hair loss became worse. Physicians examined her 73 days after the initial dose.
A physical examination revealed widespread alopecia. A trichoscopy showed thinning hair, empty hair follicles, black dots, and broken hairs. A skin biopsy revealed a perifollicular lymphocytic infiltrate and multiple telogen hairs. The patient was treated with topical betamethasone butyrate propionate and saw signs of hair regrowth on day 120 after her first vaccine. Most of the patient’s hair regrew 310 days post-vaccination.
“We are exiting the era of marketing-based skincare and entering the era of performance-based skincare. Skincare needs to embrace the individuality and diverse skincare of every consumer.”
— Dr. Barbara Sturm, a German aesthetics physician, on her personal website.
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