The emotional impact of allergies during pregnancy
Today’s report also covers research into the cutaneous manifestations of hormonal changes, the potential connection between vitiligo and Covid-19, and more (1530 words, 7 minutes 40 seconds)
The Women in Dermatology e-newsletter is supported by an unrestricted grant from Galderma Canada.
Good morning and welcome to the Women in Dermatology e-newsletter from Chronicle Companies. We are pleased to have you join us. This bulletin 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.
Pregnant women with allergies face specific challenges since they tend to avoid using medication for symptom relief during their pregnancies. Additionally, some women experience exacerbations of their symptoms when they are pregnant. These issues may have a significant negative impact on their mental health.
A recent study published in the International Journal of Women's Dermatology (Mar. 2022; 8 (1): p e002) examined the factors that influence allergy exacerbations during pregnancy and analyzed the effects of allergy symptoms on pregnant women's mental health.
The authors conducted a cross-sectional study using web-based research in March 2020, during the Covid-19 pandemic in Japan. Women who were pregnant between Mar. 18th, 2020, and Mar. 26th, 2020, met the inclusion criteria. After selecting the participants, the researchers divided them into three study groups: atopic dermatitis (AD), allergic rhinitis, or no allergies. In total, 411 women were recruited. Mental health was evaluated using the Kessler Psychological Distress Scale (K6), and health-related quality of life was evaluated using the Short Form-8 questionnaire.
The researchers found that 49.1% of the pregnant women included had depressive symptoms, with 10.9% experiencing severe depressive symptoms. They also found that women with allergies had significantly worse mental health than those without allergies. Among AD patients, 30.3% experienced disease exacerbation during pregnancy, and 30.6% with worsening disease did not consult a specialist and endured the exacerbation on their own. There was a significant association between severe pre-pregnancy AD symptoms, employment status, coping with AD symptoms during pregnancy, and AD exacerbation.
In the case of rhinitis patients, 17.1% experienced rhinitis exacerbation during pregnancy.
Bottom line
The authors conclude that pregnant women with allergies tend to have higher rates of depressive symptoms. Therefore, perinatal care experts and allergists should consider the psychological aspects of pregnant women with AD or allergic rhinitis when caring for them. Particular attention should be focused on the kind of condition and the severity of the symptoms. For example, if a pregnant patient has severe AD, more attention should be paid to symptoms of depression.
As part of Rosacea Awareness Month and to support the rosacea community, Galderma has created an online platform called Rosacea Space for rosacea sufferers and their friends and family to share their rosacea experiences via selfies, artwork, photography, poems and videos, and to provide educational information on the condition. Rosacea Space is an immersive experience for rosacea communities worldwide to be seen, heard and felt and to showcase how their rosacea goes #BeyondTheVisible.
Galderma invites you to join the Rosacea Space community and encourage your patients to submit their creations.
From the literature on women in dermatology
Skin, hair and beyond: The impact of menopause
A review published in the journal Climacteric described the manifestations of menopause and perimenopause in the skin and mucosa and hair changes in women. This review aimed to explain which hormones play a role in these changes and how their clinical consequences can be prevented or managed. The researchers found that most previous studies on menopause, its physiologic changes, and various treatments lacked information on the function of sex steroids and their replacement from a dermatologic standpoint. They also noted that although hormone replacement therapy (HRT) is not indicated for skin and hair symptoms alone, a better understanding of skin, hair and mucosal changes at menopause will improve women’s well-being and quality of life at this stage in their lives.
According to the study’s abstract, skin and mucosal menopausal symptoms include dryness and pruritus, thinning and atrophy, wrinkles and sagging, poor wound healing and reduced vascularity. Hair menopausal symptoms include reduced hair growth and density on the scalp, altered hair quality and structure, and increased unwanted hair growth on facial areas.
Cutaneous manifestations and hormonal changes among polycystic ovary syndrome patients
An article published in the Cureus Journal of Medical Science estimated the prevalence of dermatologic manifestations and their association with hormonal changes in polycystic ovary syndrome (PCOS) patients. The authors found that the incidence of cutaneous manifestations among PCOS patients is relatively high and plays a significant role in making the diagnosis. For this reason, the researchers conclude that physicians across various specialties need to be more aware of the full spectrum of PCOS presentations.
All PCOS patients who attended King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia, from 2016 to 2021 were included for this cross-sectional study. A total of 447 female patients were diagnosed with PCOS. The prevalence of cutaneous manifestations among patients was 68%, and hirsutism, acne vulgaris, and androgenic alopecia were the most common cutaneous manifestations. Additionally, obesity, infertility, and dyslipidemia were the most common comorbidities in the sample.
Influence of narrowband ultraviolet B phototherapy on serum folate levels in women with skin of colour
A recent study published in the International Journal of Women’s Dermatology compared the serum folate levels of women with skin of colour and dermatologic conditions treated with narrowband (NB-UVB) phototherapy and healthy white women of childbearing age to evaluate the effect of NB-UVB on serum folate levels in darker skin phenotypes. According to the abstract, recently published data showed that NB-UVB might decrease serum folate levels in Fitzpatrick skin phenotype I–III, which could predispose newborns to neural tube defects. The authors found that cumulative NB-UVB exposure is not associated with a statistically significant difference in serum folate level in females of childbearing age with skin of colour compared to age-, gender-, and skin phenotype-matched healthy females, even at relatively higher cumulative doses that have been shown to reduce serum folate levels in lighter skin phenotypes.
For this multicentre cross-sectional study, 30 female participants were recruited. Out of the total, 15 patients underwent NB-UVB phototherapy for vitiligo, psoriasis, atopic dermatitis, mycosis fungoides, or lichen planus. The other 15 participants were part of the control sample. Blood samples were taken from both groups and analyzed. According to the researchers, serum folate levels were within the normal range in both groups. No statistically significant difference was found between them.
Most common physiologic and pathologic cutaneous manifestations during pregnancy
A systematic review published in the Cureus Journal of Medical Science assessed the most common cutaneous changes and conditions during pregnancy. The authors found that pregnant women are more prone to several dermatologic conditions during pregnancy and that these were primarily physiological such as hyperpigmentation. However, pathological pregnancy-specific skin conditions and exacerbations of pre-existing dermatoses such as atopic eruptions were also reported and should not be excluded.
For this review, relevant medical literature was searched using the PubMed and Google scholar databases. The eligible research articles between 2015 and 2021 were selected. The final study included 11 articles that met the eligibility criteria and were published between 2015 and 2021.
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New-onset vitiligo following Covid-19
A report published in the journal Skin Health and Disease presented the case of a 45-year-old woman who developed vitiligo two weeks after being diagnosed with Covid-19. The patient presented sharply demarcated milky-white spots on her limbs, face and trunk. Initially, she barely noticed the hypopigmented lesions as she was more concerned about Covid-19 symptoms. However, during the summer, skin lesions had spread over her upper limbs, trunk, face, groin, and lower limbs, becoming increasingly evident in contrast to the patient’s tanned skin. The well-defined hypopigmented spots were consistent with non-segmental stable vitiligo at clinical examination. The patient’s skin lesions stabilized after one month of the initial spreading, and it was recommended that she undergo NB-UVB phototherapy to stimulate repigmentation.
According to the report’s abstract, new onset of vitiligo and hypopigmentation has been described as a possible side effect of Covid-19 vaccination, but never after Covid-19 infection. The authors state that physicians should be aware of this possible autoimmune cutaneous reaction to Covid-19. However, they also express that this particular case could be coincidental. More studies are necessary before determining whether vitiligo can be a consequence of Covid-19 infection.
“Dermatology was considered a luxury and Blacks simply did not have access to it. So as a result of not having access, when a Black person finally did see a dermatologist, usually a White one, the [White dermatologist] wasn't even trained appropriately on our hair and skin. And even to this day, there's inappropriate treatment of skin of color. Then Black people get the sense that, well, they don't really know my hair, they don't really know my skin.”
— Dr. Chesahna Kindred, a Columbia, Md.-based dermatologist in an interview with Allure Magazine.
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