The connection between the skin and pregnancy
New research into the effects of stretch marks on female mental health; how pregnancy can impact different chronic skin conditions, and more (1145 words, 5 minutes 45 seconds)
Women in Dermatology is supported by an unrestricted grant from Galderma Canada.
Good morning and welcome to the fourth edition of the Women in Dermatology e-newsletter from Chronicle Companies. We are delighted to have you join us. This publication will provide you with updates on new findings regarding dermatologic issues that affect women and the female dermatologists who care for them every two weeks. 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
Many women around the world live with chronic dermatologic conditions. While most of these disorders generally do not affect survival, they can harm quality of life, especially during pregnancy. Even women without any skin disease often see significant changes in their skin during pregnancy. These changes include acne, dark spots, melasma and striae gravidarum, also known as stretch marks.
The University of Michigan conducted a study to understand the emotional impact of pregnancy-related stretch marks on women. The researchers surveyed 116 pregnant patients with stretch marks. Approximately 75 per cent of the participants reported having moderately or prominently noticeable stretch marks, and more than one-third reported significant or moderate embarrassment related to the marks. Lesion severity was directly associated with the degree of embarrassment and self-consciousness and the impact of stretch marks on quality of life, clothing choice, self-image, self-esteem, anxiety, depression, and social life.
“Women were very concerned about the permanency of lesions, which are often met with negative feelings and self-consciousness,” said Dr. Frank Wang in a press release. Dr. Wang is the paper's senior author and the William B. Taylor Endowed Professor of Clinical Dermatology at Michigan Medicine. “The women who reported feeling embarrassed were also more likely to report the lesions impacting other parts of their lives like social activities, self-esteem and clothing choice,” he added.
According to Dr. Wang, while there are clinical methods to reduce the appearance, colour and texture of stretch marks, there is little scientific evidence that any treatment fully prevents or even treats the lesions.
The researchers also found that close to one-quarter of the participants felt that the emotional distress related to stretch marks was similar or more than that caused by other skin problems, such as acne, psoriasis, or eczema.
Bottom line
Striae gravidarum are linked to several negative emotions, including embarrassment, emotional distress and decreased quality of life. These outcomes may aggravate the mental stress of pregnancy, requiring psychological support in conjunction with proper dermatologic care.
From the literature on women in dermatology
The viability of montelukast versus finasteride for the treatment of moderate acne in women
A randomized, single-blinded, prospective clinical trial published in the Journal of Cosmetic Dermatology compared the efficacy, tolerability and safety of montelukast versus finasteride in treating moderate acne in adult women. The researchers found that both montelukast and finasteride have good efficacy in treating acne, but that finasteride is more effective.
The trial recruited 65 female subjects with moderate acne vulgaris to be evaluated over 12 weeks. One group (30) received oral montelukast (10 mg daily), while the second group (25) received oral finasteride (2.5 mg daily) in combination with topical clindamycin. Lesion count and acne severity were evaluated.
Prevalence of hirsutism among reproductive-aged African American women
A study published in the Journal of Women’s Health aimed to analyze the prevalence of hirsutism, the most common clinical symptom of hyperandrogenism, among a large sample of Black women. The researchers found hirsutism associated with polycystic ovary syndrome (PCOS), severe acne, and irregular menstrual cycles.
The researchers conducted a prospective community-based cohort study of African American women, which involved 1,568 participants. Some 37 per cent reported being bothered by excess hair, and 10% met the criterion for hirsutism. A history of severe facial acne was associated with this condition, as was a diagnosis of PCOS.
The impact of pregnancy on hidradenitis suppurativa
According to a systematic review and meta-analysis conducted by researchers from the University of California, Los Angeles, female patients with hidradenitis suppurativa (HS) are more likely to experience a stable or worsened disease course during pregnancy. They also found that more than half of these patients tend to experience a postpartum HS flare.
The researchers systematically searched medical databases for relevant articles published up until Nov. 22, 2020. There were 672 cases where data on the patient’s HS disease history during pregnancy was available, and 164 cases where data on the patient’s postpartum flare was available.
In the meta-analyses, the rate of HS disease improvement was 24 per cent, while the rate of HS disease worsening was 20 per cent. A postpartum flare was experienced by 60 per cent of patients.
Lesbian, gay, bisexual, and transgender identity and disclosure among U.S. dermatologists
A study published in JAMA Dermatology assessed LGBT identity and disclosure among dermatologists in the United States. The researchers conducted a secondary analysis of the American Academy of Dermatology (AAD) 2020 Member Satisfaction Survey. They found that LGBT dermatologists who are open about their sexual orientation are more likely to be male.
This was a cross-sectional survey distributed in print and electronically to 10,060 dermatologists between Jan. 3 and Jan. 31, 2020. Out of 1,339 survey respondents, 47 identified as LGBT. Of those 47 individuals, 40 were male, and seven were female. The researchers also found that LGBT dermatologists tended to be open about their sexuality with colleagues and family but not with their patients.
VIDEO: Ending AIDS by 2025: The role of dermatologists, by Dr. Manjula Rajapakshe
This presentation by Professor Lidia Rudnicka focuses on drugs under development for the treatment of psoriasis (editors’ note: this video, available on YouTube, is age-restricted.)
CASE REPORT: Rosacea fulminans in pregnancy
A 32-year-old pregnant woman in her tenth week of pregnancy developed a severe inflammatory condition of the face. The lesions appeared three weeks after starting progesterone therapy for polycystic ovary syndrome-related infertility. Despite stopping progesterone for one month, her lesions had considerably worsened.
A physical examination revealed erythematous nodules and pustules all over the face, merging into extensive thick plaques on the right cheek and chin. She was then treated with empiric cephalosporin therapy, intralesional triamcinolone injections, blue light treatments and prednisone throughout her pregnancy. Isotretinoin was also prescribed three months after delivery and upon nursing cessation. While the patient showed some improvement after specific treatments, her skin did not completely clear after eight months postpartum. Her doctors found isotretinoin to be the most effective treatment.
Coming Up in Women in Derm:
The next two weeks:
November is Woman Abuse Prevention Month
Nov. 25 is International Day for the Elimination of Violence against Women
Something to think about in the week ahead
“Wear sunscreen. It’s been drilled into us, and we have it in our makeup, we put it on in the day, but I think one of the biggest mistakes we make is not applying it throughout the day. If you are driving home in the afternoon and the sun is directly on your face, you don’t have sunscreen on. If you put it on in the morning, it’s not there anymore, you’ve wiped it off, or if it’s a chemical sunscreen, it’s worn off or deactivated, so to speak.”
— Dr. Sandra Lee (aka “Dr. Pimple Popper”), Dermatologist, Upland, Calif.