The impacts of the exposome on the skin of menopausal women
Today’s report also covers research into omalizumab for urticaria during pregnancy, cosmetic procedures for mothers of brides, and more (1,357 words, 6.5 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
A study published in Surgical and Cosmetic Dermatology (Nov. 2023; 15) explored the impact of hormonal changes and exposure factors, including socio-environmental and lifestyle factors, on the quality of life and the skin of women during menopause. According to the authors, most women are not aware that menopause affects the skin. Some of the most notable changes are an increase in dryness, roughness, sagging, and skin atrophy.
The authors note genetics and exposomal factors influence menopause. These factors fall into three categories: internal, general external, and specific external. When it comes to internal factors, hormonal changes are the most obvious, they write. Menopause is marked by a reduction in estrogen levels, which leads to physiological changes such as decreased collagen production and skin elasticity, increased dryness, wrinkling, and alterations in sebum levels.
As for general external factors, the paper notes that UV radiation can contribute to skin changes during menopause. Higher UV exposure, particularly in tropical countries, is associated with lower estrogen levels, which ultimately impacts skin health. Additionally, environmental pollutants, especially persistent organic pollutants, may interfere with the endocrine system and affect the synthesis of steroid and thyroid hormones, potentially impacting the skin, the authors write. Psychosocial alterations during menopause, such as body image dissatisfaction and changes in interpersonal relationships, can also influence a woman’s quality of life.
When considering specific external factors, the authors note stress and sleep deprivation contribute to a pro-inflammatory state, increased cortisol levels, and disturbances in circadian rhythm leading to skin changes and impairment in collagen fibre production. At the same time, habits such as smoking or a high-sugar diet can increase skin roughness and promote collagen degeneration. Lack of physical activity is also a potential risk factor for facial wrinkles.
The researchers write that it is crucial to promote a healthy lifestyle among menopausal women to increase their quality of life. This includes education on dietary changes, regular physical activity, and habits that contribute to overall well-being. It is also essential for women to pay special attention to their skin during this time. The authors recommend women should use daily sun protection, consume foods rich in antioxidants, and use skin care products that stimulate collagen production, such as retinoids and peptides.
Bottom line
Menopause impacts skin health through hormonal changes and external factors. Estrogen decline leads to collagen loss, reduced elasticity, and wrinkling. Education on menopausal symptoms is vital, emphasizing lifestyle, nutrition, sun protection, and skin care. Physical activity, stress management, and proper skin care contribute to well-being.
Minimally invasive cosmetic procedures for mothers of brides
A study published in the Journal of Cosmetic Dermatology described the role of mothers of brides in wedding celebrations, highlighting the behavioural patterns they have when seeking aesthetic treatments. The researchers suggest personalized strategies for better communication and decision-making based on individual personalities. They also present a specific timeline for the implementation of cosmetic interventions, such as neuromodulators, collagen stimulators, and fillers. They note that financial considerations, often prioritizing wedding costs, influence decision-making. Additionally, they suggest the motivation to look their best for the weddings of their daughters makes them frequent patients in dermatology offices. Understanding the diverse traits and expectations of this demographic is crucial for enhancing patient satisfaction and achieving positive outcomes in the lead-up to significant life events.
Safety of omalizumab for chronic urticaria during pregnancy
Research published in Clinical and Experimental Dermatology assessed the efficacy and safety of omalizumab in patients with severe chronic spontaneous urticaria (CSU) resistant to second-generation H1-antihistamines (sgAHs) who either started the treatment during pregnancy or became pregnant during treatment. The researchers found that using omalizumab to treat CSU in women before or during pregnancy does not seem to have a negative impact on maternal or fetal outcomes.
For this retrospective study, the authors analyzed the data of 29 adult women receiving one or more doses of omalizumab at any point during pregnancy or taking omalizumab at the time of or during the eight weeks before conception. No pregnancy complications or congenital abnormalities were recorded.
Atopic dermatitis: Fertility, pregnancy, and treatment perspectives
A study in the American Journal of Clinical Dermatology assessed the disease course in pregnant women with atopic dermatitis (AD), including challenges in diagnosis, management, and treatments. The researchers found that hormonal and immunologic changes during pregnancy can contribute to dermatoses, with atopic eruption of pregnancy (AEP) being the most common. They also found that about 80% of AD cases during pregnancy are new-onset, while 20% are recurrences or exacerbations of pre-existing disease.
The study also noted a tendency toward undertreatment in pregnant women with AD due to concerns about potential effects on obstetric and fetal outcomes. There is limited evidence regarding the impact of previous AD on fertility.
Nipple-areolar complex conditions in reproductive-aged women
A retrospective cohort study in the Journal of Women’s Health examined and characterized nipple-areolar complex (NAC) conditions in reproductive-age women. The researchers found that nipple pain, dermatitis, and thrush were the most common diagnoses. Additionally, benign breast conditions such as obstructed ductal openings, inverted nipples, and chronic and bacterial infections were present in one-third of all participants.
The study included 407 women of reproductive age who presented with NAC complaints at a large tertiary health centre between 2015 and 2020. The authors collected data on symptoms, diagnoses, medical specialties involved, diagnostic considerations, and treatments. More than 50% of participants reported experiencing nipple pain, dermatitis, or thrush. Most of these complaints were treated by primary care physicians and obstetricians.
VIDEO: Treatment of exogenous hyperpigmentary disorders
Beijing-based dermatologist Dr. Jiayi Feng discusses the treatment of exogenous hyperpigmentary disorders following silver ion-related chemical exposure with a 1,064nm Q-switched laser.
A case of recurrent cheilitis revealing contact allergy to a lipstick
A case study published in the Journal of Cosmetic Dermatology described a 22-year-old woman who presented with a four-month history of recurring lip erythema and blistering. Her lip inflammation was initially misdiagnosed as herpes labialis and was unsuccessfully treated with oral acyclovir. A physical examination revealed blistering and crusting, mainly on the border of the lips and extending to the surrounding skin. The patient attributed the lip inflammation to lipstick use. Patch tests revealed an allergic reaction to a Gallate mix and the patient’s lipstick, which contained propyl gallate. The patient’s lesions completely disappeared after avoiding products containing propyl gallate.
Registration is open for the 2023 Indigenous Skin Spectrum Summit
First held in 2021, the Indigenous Skin Spectrum Summit is a special session of the Skin Spectrum Summit addressing specific challenges in treating Canada’s Indigenous community. This year’s virtual meeting will be held on November 25, 2023.
“When we are using aesthetic injectable tools, we are not trying to change that person’s face, but we’re trying to highlight, define and refine their underlying ethnic features. Ultimately, if we are using combination approaches, we can help our patients age gracefully, and we can treat them as a whole.”
—Dr. Monica Li, a dermatologist based in Vancouver, speaking at the 9th annual Skin Spectrum Summit in October, 2023.
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