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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.
A study published in the International Journal of Women’s Dermatology (Oct. 2022; 8(3):p e056) summarized the burden of pemphigus vulgaris (PV) in female patients. PV is a chronic autoimmune blistering disorder that can severely affect a patient’s life. In addition to uncomfortable and often painful symptoms, the condition can significantly impact a patient’s finances, social life, and mental health. According to the abstract, women can be more susceptible to the impact of the disease. It has also been reported that PV affects women more frequently.
There are multiple treatment options for the management of PV. The authors write that corticosteroids (CSs), often oral prednisone, are usually advised as an initial treatment. Recommended adjuvant therapies include immunosuppressive agents, such as azathioprine, mycophenolate mofetil (MMF), cyclophosphamide, and rituximab (RTX). However, CSs can improve PV symptoms but have adverse effects, especially in women. For example, CSs can increase the risk of osteoporosis in postmenopausal women. The chronic use of CSs can also affect the female reproductive cycle. Patients may experience postmenopausal bleeding or even the complete absence of menstruation.
The authors add that pregnancy can also be complicated for PV patients. PV symptoms may worsen during pregnancy and after delivery, as in other autoimmune conditions. The hormonal changes that occur during pregnancy trigger this disease exacerbation. Although CSs are generally considered safe during pregnancy, a woman's adherence to PV treatment may be influenced by their concern about the harm these medications may have on their pregnancies. Some women may even develop new lesions triggered by breastfeeding and C-sections. Poor control of gestational PV can also result in adverse pregnancy outcomes, such as premature birth, spontaneous abortion, stillbirth, and neonatal PV. However, if the disease is well-controlled, most women with PV will likely deliver a healthy baby. PV can have a significant impact on a patient's mental health, according to the researchers. They add that women appear to be at a higher risk of developing depression and anxiety comorbidities than men. The high prevalence of depression and anxiety in female PV patients is believed to be linked to the changes the condition can cause in a person’s appearance. At the same time, the authors write that long-term immunosuppressive therapy with CSs can cause disturbances in psychiatric health, such as depression, mania, and even cognitive impairment.
PV can also pose an economic burden on patients. A study cited by the authors tracked the inpatient financial burden of PV and found that the mean annual cost for patients with a primary diagnosis was US$14,520. Furthermore, the cited study found that non-White, poor, and uninsured patients had higher hospitalization rates with more extended stays and higher costs.
Finally, a timely diagnosis is essential to improve symptoms and stop disease progression. However, many patients experience delays in diagnosis. A lack of knowledge about PV among healthcare providers may be responsible for this delay. The long wait times for a dermatologic consultation that many patients experience also contribute to delays. According to the authors, there is an average six-month lag from the first disease manifestation to a final diagnosis.
Bottom line
Pemphigus vulgaris can affect different aspects of a patient’s life. Other than the disease itself, some of the main issues are related to mental health. Many of these problems are connected and can directly impact other issues. Women are more susceptible to experiencing mental health issues triggered by PV and need intensive disease monitoring during pregnancy. Finally, getting access to a prompt diagnosis is essential for proper disease management.
Improvements in skin quality parameters in postmenopausal women after topical growth factor serum
A study published in the Journal of Cosmetic Dermatology assessed the efficacy of topical combination-treatment hypoxic growth factor serum (TNS A+) in postmenopausal women with moderate to severe facial photodamage. The researchers found that the TNS A+ treatment was safe and significantly improved skin quality in the target population.
For this open-label, single-centre study, 17 participants used a TNS A+ serum twice daily for 12 weeks. The treatment demonstrated significant improvements in fine lines and wrinkles at weeks six and 12. The therapy also positively impacted overall photodamage, skin tone evenness, and tactile roughness. Most participants stated that TNS A+ improved skin texture, made lines and wrinkles less noticeable, and made their skin look and feel smooth, soft, and rejuvenated.
Adult female acne in a multiracial Asian population
A study in the Journal of the American Academy of Dermatology evaluated the clinical characteristics, comorbidities, and quality of life in adult Asian women diagnosed with acne. The researchers found the only significant difference between women with and without predominantly jawline acne was older. These results are opposite to those from studies performed in Western populations.
For this prospective observational study, the authors evaluated the clinical history of 169 patients at a tertiary referral center from April 2015 to July 2021. Most patients had mild acne in multiple facial zones and reported premenstrual acne flares. Patients with acne, primarily on the jawline, were often older. There was a negative relationship between acne on the torso and cheek acne. Patients with darker skin types had higher rates of scarring and post-inflammatory hyperpigmentation. Additionally, acne severity had a significant impact on quality of life.
Research published in the journal Brazilian Annals of Dermatology describes the current management of vulvar dermatosis. The authors found that vulvar diseases are common and associated with high morbidity.
This retrospective observational study involved 148 female patients who attended consultations for vulvar issues over five years. The most common vulvar dermatosis was lichen sclerosus, followed by irritative eczema of the vulva. Most patients reported anogenital itching or pain. Additionally, patients with lichen sclerosus were significantly older than those with any other vulvar disease.
Comparison of survival in women with melanoma by race and ethnicity
A study published in the Journal of the American Academy of Dermatology analyzed the impact of race and ethnicity on melanoma survival among women. The researchers found that Black women tend to be diagnosed later, leading to lower survival rates.
The authors consulted the National Cancer Database for cases of invasive melanoma in women between 2004 and 2018. Hispanic women were diagnosed at the lowest median age, followed by Asian women. The five-year overall survival was the highest for White women, followed by Hispanic women. Black women had the highest rates of distant metastasis. Additionally, race and ethnicity were associated with disease stage at diagnosis, with a higher rate of White women diagnosed at stage I.
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A case of clinically amyopathic dermatomyositis
A case study published in the International Journal of Rheumatic Diseases reported on a 59-year-old Filipino woman who presented with a purple rash, muscle weakness, red and scaly spots on the knuckles, and widespread redness on her back and shoulders. By the time of the visit, the patient had had the symptoms for two years. She was previously treated for systemic lupus erythematosus and had responded well to corticosteroids.
The patient was later admitted due to a mass at the base of her spine that grew progressively over one month. The mass was eventually determined to be an abscess. The diagnosis was clinically amyopathic dermatomyositis (CADM) with interstitial lung disease (ILD). She was treated with corticosteroids and received a cycle of cyclophosphamide infusion before being discharged.
“The biggest mistake is improperly removing makeup, meaning leaving residue on the face and smeared into pores. The ingredients in makeup can be inflammatory and can trap dirt and oil in the skin. So it is imperative that all traces of makeup be removed before heading off to bed.”
— Joyce Park, a California-based dermatologist, in an interview with the HuffPost.
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