The historical stigma of spironolactone use in breast cancer survivors with alopecia
womeninderm.substack.com
The historical stigma of spironolactone use in breast cancer survivors with alopecia
Today’s report also covers research into female sexual health and vulvar lichen sclerosus, the effects of early discharge on wound healing, and more (1,240 words, 6 minutes)
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
According to an editorial in the International Journal of Women’s Dermatology (June 2023; 9(2):p e e083), spironolactone is often used off-label to treat androgenetic alopecia in women. However, some clinicians are concerned that its antiandrogenic effects could lead to an increased risk of breast cancer.
The authors say recent research supports the safety of spironolactone for alopecia treatment, but there is still a significant stigma surrounding the use of spironolactone in breast cancer survivors with alopecia. The editorial also reviewed the historical background of the perceived association between spironolactone and breast cancer.
According to the authors, in 1975 a case series reported that five patients developed breast cancer while using spironolactone. However, subsequent research conducted in the same year found that the association between spironolactone and breast cancer was not statistically significant.
The authors write that in the early 1980s, some studies revealed rats exposed to high doses of potassium canrenoate, a metabolite of spironolactone, showed an increased incidence of mammary tumours. However, research conducted in 1988 showed that spironolactone itself does not produce the compounds associated with breast cancer. Since 2018, the U.S. FDA no longer lists breast cancer as an adverse effect of spironolactone, further reinforcing its safety.
The authors emphasize that misinformation around the drug prevents women from receiving effective treatment and contributes to the psychological burden they experience. Additionally, they highlight the importance of considering spironolactone as a viable therapeutic option for androgenetic and hormone-related alopecia in breast cancer patients, without fearing an increased risk of cancer recurrence.
Bottom line
The researchers conclude there is enough evidence to support the notion that spironolactone does not increase the risk of developing breast cancer. Furthermore, they challenge the historical stigma associated with spironolactone and advocate for its use in managing various forms of alopecia in female breast cancer survivors.
The impact of early discharge on wound healing after breast cancer surgery
A study published in the International Wound Journal assessed the effects of early postoperative discharge after breast cancer surgery on wound healing and postoperative complications. The authors found that early discharge, with or without a drain, after breast cancer surgery leads to fewer postoperative wound complications. They also found that it can lead to cost reduction and lower overall complication rates.
For this study, 44 patients who underwent breast cancer surgery at Kocaeli State Hospital in Turkeybetween Dec. 2020 and Jan. 2021 were divided into two groups: an early discharge group (discharged on the day of surgery) and a traditional long-stay group (discharged one day after surgery). The results showed that the early discharge group had lower complication rates, including lower rates of seroma, wound infection, and bleeding, compared to the traditional long-stay group. Patient satisfaction did not differ significantly between the two groups. The study also showed a significant decrease in healthcare expenses in the early discharge group.
Sexual health consequences among women with vulvar lichen sclerosus
Research in the Journal of Sexual Medicine aimed to identify the sexual health consequences of vulvar lichen sclerosus (VLS) among women affected by this condition. The authors discovered that VLS has a significant impact on women's sexual health, leading to decreased sexual frequency and satisfaction, feelings of sexual inadequacy, pain during intercourse, negative genital self-image, low sexual drive, and sexual distress.
For this systematic review, the authors conducted a search on PubMed, MEDLINE, and Scopus to identify relevant literature assessing the impact of VLS on women's sexual health. The final review included 20 studies. The results showed VLS has a negative impact on sexual health, with sexual dysfunction reported in 16 to 60% of affected women and pain during or after intercourse reported by 22 to 56.7%.
Laser and 5-aminolevulinic acid photodynamic therapy shows promising results for treating vulva condyloma acuminatum in Women
A study in the Journal of Obstetrics and Gynaecology Research evaluated the effectiveness of combining a laser with 5-aminolevulinic acid (ALA) photodynamic therapy for treating condyloma acuminatum (genital warts) in the vulva, vagina, and cervix. The researchers found the treatment is safe, effective, and has minimal adverse effects.
For this study, 106 female patients with genital warts were treated with this combined therapy between May 2020 and July 2021. The results showed 84.9% of patients responded positively to the initial ALA-photodynamic treatment. Some patients relapsed throughout the weeks, but after four courses of treatment, the wart clearance rate reached 100% in all 106 patients.
The efficacy of medicinal plant preparations in the alleviation of radiodermatitis in breast cancer patients
A systematic review in Phytotherapy Research evaluated the role of topical and oral herbal medicines in the prevention and treatment of radiodermatitis in patients with breast cancer. The researchers found that henna ointments, silymarin gel, and Juango flower cream can effectively improve radiodermatitis symptoms.
The authors searched Embase, PubMed, Web of Science, and Scopus for studies involving the use of plant medicine in the treatment of radiodermatitis in breast cancer patients. The final review included 35 studies.
Dr. Andrea Suarez, a Houston-based dermatologist, discusses skin signs of yeast overgrowth and discusses optimal treatment.
A case of recalcitrant prurigo nodularis after Covid-19 vaccination
A case study in the Open Access Journal of the European Academy of Dermatology and Venereology described a 57-year-old woman who presented with multiple itchy nodular lesions on the trunk and limbs. The lesions appeared two days after receiving a second dose of the CoronaVac Covid-19 vaccine and persisted for 10 months. She was initially treated with oral cetirizine and topical high-potency steroids, specifically clobetasol propionate, for two months but there was no improvement, and her lesions progressively worsened.
After a series of examinations, the patient was diagnosed with prurigo nodularis (PN) and was prescribed injectable dupilumab. The patient’s lesions started improving after four weeks of dupilumab therapy and were almost completely resolved by week 16. The treatment was eventually discontinued, and the patient did not experience recurrence.
“Skincare companies can offer less promotion and more education based on valid science. Products must be made with ingredients that are safe, sustainable and biodegradable. Packaging should be written in simple language that is easy to understand, with full disclosure and cautions included where appropriate. Marketing must be honest and transparent, straightforward and data driven. There should be an end to over-promising, over-packaging and over-pricing.”
— Dr. Fayne Frey, a West Nyack, N.Y.-based dermatologist in an interview with BookTrib.
You are receiving this newsletter because you subscribe to Women in Dermatology or another Chronicle journal, have attended a Skin Spectrum Summit live event or webinar, or have previously requested a subscription to one of our newsletters. If you no longer wish to subscribe to this newsletter, please email the subject line “Unsubscribe Women in Dermatology” to health@chronicle.org.
Women in Dermatology is published by Chronicle Companies: 1460 The Queensway, Suite 212, Etobicoke, Ont. M8Z 1S4
Mitchell Shannon, Publisher; R. Allan Ryan, Editorial Director; Cristela Tello Ruiz, Client Services; John Evans, Managing Editor; Kylie Rebernik, Jeremy Visser, Editors. Content is copyright (c) 2023, Chronicle LifeSci America Corp, except as indicated. Are you interested in contributing to this newsletter or learning more about Chronicle’s services? Please write to us at health@chronicle.org.
