The efficacy of 5-aminolevulinic acid photodynamic therapy for VLS
Today’s report also covers research into the psychological influence of acne vulgaris on female university students, low serum ferritin and diffuse hair loss, and more (Issue #95, 1,225 words, 6 mins)
Good morning, and welcome to the Women in Dermatology 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 in the Journal of Dermatological Treatment (March 12, 2025; 36(1): e2497362) evaluated the efficacy and durability of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for treating vulvar lichen sclerosus (VLS) in women of childbearing age. The researchers found that ALA-PDT therapy significantly improved symptoms of vulvar lichen sclerosus, with most patients showing improvement after six months. The treatment also demonstrated durable results, with near-complete symptom resolution at the six-month follow-up.
For this study, the authors used patient records from 55 women with VLS enrolled at a dermatology clinic in Northwest China. All had poor responses to prior topical treatments. Exclusion criteria included concurrent vulvar disorders, autoimmune diseases, or photosensitivity. The PDT protocol involved four treatment sessions spaced seven to 10 days apart.
Each session was conducted shortly after menstruation and included cleansing of the vulvar area, application of 20% ALA cream, and occlusion for three hours, followed by 20 minutes of LED-based irradiation. After each session, patients were also instructed to apply a topical epidermal growth factor gel to relieve discomfort. Standardized photographs were taken before and after treatment to track clinical progress. The efficacy was measured using the Cattaneo clinical score, which evaluates symptoms, and the Dermatology Life Quality Index (DLQI) at baseline, post-treatment, and three and six-month follow-ups.
The results showed significant symptom improvement and DLQI scores for pruritus, fissuring, and pain during intercourse decreased by up to 67% post-treatment, with near-complete resolution at six months. The Cattaneo score also showed progressive lesion repair. The efficacy rates were 81.8% for pruritus relief, 67.3% for skin elasticity restoration, 63.6% for skin colour improvement, and 72.7% for lesion area reduction. Only 3.6% of participants experienced treatment failure by the six-month follow-up.
All patients reported some degree of burning pain during treatment, which was tolerable and resolved gradually after completing the four-session course. No severe adverse reactions were noted, and the treatment protocol was adjusted to individual pain thresholds to enhance tolerability. The authors note that these findings support ALA-PDT as an effective, safe, and durable treatment option for refractory VLS in women of childbearing age.
The Takeaway: The study found that ALA-PDT led to significant improvement in pruritus, fissuring, and dyspareunia. Many patients also experienced an increased quality of life. Improvements were also seen in skin elasticity, skin colour, and lesion area. Most patients achieved near-complete symptom resolution and sustained improvement through the six-month follow-up. The findings suggest that ALA-PDT is a viable option for refractory VLS in women of childbearing age, offering durable symptom relief and cosmetic benefits.
Hormone therapy and increased risk of psoriasis in reproductive-age and postmenopausal women
A nationwide cohort study in the British Journal of Dermatology assessed the link between hormonal therapy and psoriasis risk in reproductive-age and postmenopausal women in Taiwan. The researchers found that hormonal therapy significantly increased the risk of developing psoriasis, with a stronger association observed in reproductive-age women than in postmenopausal women.
For this study, the authors used Taiwan’s National Health Insurance Database from 2001 to 2021. They included women older than 20 years of age without a history of psoriasis, ovarian cancer, or breast cancer, dividing them into reproductive-age and postmenopausal groups. They compared women on hormone therapy to nonusers, and the primary outcome was psoriasis incidence over five years. The results showed that hormonal therapy was linked to a higher risk of psoriasis in both age groups. The risk was higher in reproductive-age women and was especially high in those who used hormonal therapy consistently.
How do facial dermatological diseases affect the quality of life in adult female patients?
A research letter published in the International Journal of Women’s Dermatology explored how different facial dermatoses affect the quality of life in women, challenging the assumption that pigmentary changes are the most impactful. The researchers found that red, inflammatory facial dermatoses, such as rosacea, eczema, psoriasis, and demodicosis, were associated with significantly worse quality of life scores than acne, melasma, and vitiligo.
For this study, the authors assessed 626 adult Caucasian women with facial skin conditions using the Dermatology Life Quality Index and compared results with 113 controls. The results showed that inflammatory conditions causing red lesions affected quality of life the most. Forehead, scalp, and ear involvement further worsened quality of life scores, particularly affecting symptoms, daily activities, relationships, and disease burden.
Evaluation of serum ferritin in diffuse hair loss among women
A cross-sectional study published in AlQalam Journal of Medical and Applied Sciences assessed the relationship between low iron levels and chronic diffuse hair loss in women. The authors found low serum ferritin levels were common among women with hair loss, but there was no clear link between iron deficiency and chronic diffuse hair loss.
The study included 50 female patients diagnosed with either female-pattern hair loss or chronic telogen effluvium. The researchers measured serum ferritin levels to assess tissue iron stores. The results found that only 2% of participants had ferritin within the recommended range, but no clear association between low iron levels and chronic diffuse hair loss.
The psychological influence of acne vulgaris among Pakistani female university students
Research in the Journal of Bioresource Management assessed the prevalence of acne vulgaris among female students at the University of Poonch, Rawalakot, and its impact on their quality of life. The researchers found that acne vulgaris had significant psychological and social implications for female university students’ lives.
For this study, 400 participants completed the Dermatology Life Quality Index (DLQI) questionnaire to evaluate the psychological and social effects of acne. The authors assessed its impact on daily life, including social activities, emotional well-being, academic performance, clothing choices, and interpersonal relationships. The results showed that 76% of participants experienced painful and itchy sores, while 78.5% felt embarrassed about their appearance. The study also revealed that acne affected social interactions, clothing choices, and emotional well-being. DLQI scores showed varying degrees of impact on quality of life, with 20% of participants reporting a significant impact.
VIDEO: Exploring Urticaria from SF Derm Society 2024 | The Future of Dermatology Podcast
Portland, Ore.-based dermatologist Dr. Jason Hawkes discusses the complexities of urticaria during the 2024 San Francisco Dermatological Society’s Annual Conference. He reviews the definitions and types of urticaria, the role of mast cells, and the differences between acute and chronic forms of the condition.
A case of multiple warty dyskeratomas overexpressing SERCA2 in acantholytic cells
A case report in the Journal of Dermatology described a 60-year-old Japanese woman with a long-standing history of acne-like rashes and pruritus that began in her 20s. At age 49, she sought treatment for worsening lesions, which continued to progress despite the use of topical steroids and oral cyclosporine. A clinical exam revealed red, thickened nodules with visible keratin plugs on dermoscopy. Histopathology revealed cell separation above the basal layer and abnormal skin cells, including grains and corps ronds. Although initial suspicion included Darier’s disease, genetic testing ruled Darier’s out by identifying a non-pathogenic ATP2A2 variant. Further immunohistochemical testing revealed overexpression of SERCA2, leading to a diagnosis of warty dyskeratomas.
“When it comes to melanoma, early detection truly saves lives.”
— Dr Helen Robertshaw, a Bournemouth, U.K.-based dermatologist in an interview with Daily Echo.
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