The importance of a female-centric approach in dermatologic care
Today’s report covers new research into the treatment of hidradenitis suppurativa in women, the skin signs of Covid-19 and more. (1,500 words; 7 minutes, 30 seconds reading tie)
The Women in Dermatology e-newsletter is supported by an unrestricted grant from Galderma Canada.
Good morning, and welcome to the first edition of the Women in Dermatology e-newsletter from Chronicle Companies of 2022. We hope you had an enjoyable holiday break. Every two weeks, this publication will provide you with updates 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.
Hidradenitis suppurativa (HS) is a painful inflammatory skin disorder that occurs more frequently in female patients. Although the significance of sex hormones such as estrogen and progesterone in disease activity is not entirely understood, changes in hormone levels may play a role for many patients. Research also suggests that specific clinical considerations should be made for women with HS, particularly in the setting of pregnancy, childbirth, breastfeeding, and menopause.
A recent article published in the International Journal of Women’s Dermatology integrated up-to-date pathogenic and mechanistic insights with evidence-based clinical management, to optimize care for women with HS. The authors analyzed the existing literature involving female patients diagnosed with HS to achieve this.
According to the researchers, while the current evidence for how sex hormones affect HS disease activity is scarce, research suggests a link between the two. They found, for example, that patients with HS have more than three times the crude prevalence of polycystic ovary syndrome (PCOS) compared with patients without HS. Menstruation, pregnancy and childbirth also seem to have a particular effect on HS.
It has been reported that between 43% and 63% of women experience worsening of their HS around menstruation. Multiple women also report worsening of their HS during pregnancy and postpartum. Additionally, HS may present a significant obstacle to breastfeeding.
Bottom line
The researchers concluded that physicians need to consider the unique challenges that female patients may experience when treating women with HS, including menstruation, menopause, pregnancy, breastfeeding, and sexual dysfunction. The authors also note that to optimize patient care and quality of life, it is essential that a multidisciplinary team is involved. This team should include dermatologists, psychiatrists, psychologists, obstetricians, gynecologists, endocrinologists, and sexologists.
A recent study published in the International Journal of Women’s Dermatology noted that while there is research on the identification processes for human trafficking victims, there is no framework detailing the dermatologic patterns of human trafficking survivors. The researchers found that rashes and brandings, such as tattoos, were more likely to be found in survivors of sex trafficking. However, signs of physical torture such as burns, injuries, and deep cuts were more likely to be found in labour-trafficked survivors.
For this study, a comprehensive narrative review was conducted using PubMed and Google Scholar (January 2010–December 2020) to identify relevant articles that included information about the physical signs of human trafficking. After the search, 10 final studies were selected. The researchers also identified significant mental health indicators such as depression, anxiety and low self-esteem.
A recent review published in the International Journal of Women’s Dermatology summarized the existing literature to date regarding the effects of hormone therapy on melanoma in women. The researchers focused on studies investigating the associations between oral contraception, fertility treatments, menopausal hormone therapy (MHT), and melanoma. According to the authors, there does not appear to be a well-established association between exogenous female hormones and melanoma incidence.
However, the researchers note that menopausal hormone therapy practices and formulations are very different from country to country. They also specify that while MHT does not appear to increase melanoma risk in studies from the United States, some conflicting results have been observed in data from Europe. Further research on unopposed estrogen MHT formulations is needed to establish a definite link between hormone therapy and the incidence of melanoma.
Dermatology in a multidisciplinary approach with infectious disease and obstetric medicine against Covid-19
According to a study published in the International Journal of Women’s Dermatology, a wide range of cutaneous symptoms can arise early in Covid-19 infection, making dermatologic identification crucial for early diagnosis. These cutaneous symptoms include maculopapular eruptions, urticaria, vasculitis, livedo-like lesions and even herpes zoster. The researchers also specify that during pregnancy, there is an increased risk for severe illness from Covid-19. The early identification of Covid-19-related skin complications in pregnant women could improve maternal and fetal outcomes during the infection.
The authors conclude that dermatologists should encourage ObGyns and other doctors to monitor and educate pregnant patients about the possibility of skin eruptions as a symptom of Covid-19.
Gender-based differences found in gut microbiota, metabolites in people with acne
A study published in Annals of Dermatology found that male and female patients with acne vulgaris have significantly different dysbiosis of gut microbiota and associated metabolites. According to the study’s authors, these findings corroborate the significance of gender in the pathogenesis of acne vulgaris, but do not establish a causal association between gut microbiota and acne.
The study conducted in China collected and analyzed fecal samples from 43 patients with acne and 43 patients without acne, matched for age and gender. Compared with healthy controls, men had a lower abundance of 18 microbes, including Butyricicoccus, Clostridium sensu stricto, Faecalibaculum, Bacillus, Lactococcus, Blautia, Clostridiales, Lachnospiracea incertae sedis, and Ruminococcus at genus level. Female patients showed increased Clostridium sensu stricto and declined Oscillibacter and Odoribacterin.
Additionally, male patients had a disrupted fatty acid metabolism. In contrast, female patients had a dysbiosis of amino acid metabolism, but there was no significant difference in bacterial diversity and structures across patient subgroups with varying acne severity.
VIDEO: Why skin disease is often misdiagnosed in darker skin tones
Dermatologist Dr. Jenna C. Lester shares her effort to extend medical training beyond its current limited scope and ensure all medical students get trained in the full spectrum of diseases as they appear in all patients, regardless of skin tone.
Case report: A rare, exophytic tumour on the arm of an elderly female
A woman in her early 90s presented with at least a 12-month history of a growing, exophytic tumour on the left lateral arm. She had dementia and was a local extended-care facility resident. In addition to her dementia, her medical history included anxiety and cardiac arrhythmia. Upon presentation, she reported some discomfort at the tumour site but denied any additional symptoms. Her physicians performed a shave biopsy of the lesion.
A histologic examination revealed atypical melanocyte nests with rete ridge bridging, confluence at the dermal-epidermal margin, and individual cell pagetoid spread. Epithelioid cells proliferated with cytologic and nuclear pleomorphism on one side of the lesion, creating keratin pearls. The tumour had a Breslow depth of at least 1.7 mm with no histologic evidence of ulceration and was classified as T2a malignant melanoma (MM). The patient was referred for a biopsy, which was negative for metastatic spread.
“Atopic dermatitis in skin of colour patients represents a number of considerations. One is that there is a diverse cultural practice and context that we have to think about in this patient population in terms of cultural competency.”
— Dr. Marissa Joseph, a Toronto-based dermatologist, speaking at the seventh annual Skin Spectrum Summit in November 2021.
You are receiving this newsletter because you are a subscriber to Women in Dermatology or other 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 send an email with the subject line “Unsubscribe Women in Dermatology” to health@chronicle.org
Women in Dermatology is published by Chronicle Companies: 555 Burnhamthorpe Road, Suite 306, Toronto, Ont. M9C 2Y3
Mitchell Shannon, Publisher; R. Allan Ryan, Editorial Director; Cristela Tello Ruiz, Client Services; John Evans, Managing Editor; Katherine Brenders, Kylie Rebernik, Jeremy Visser, Editors; Catherine Dusome, Operations Manager; Peggy Ahearn, Consultant Content is copyright (c) 2022, Chronicle LifeSci America Corp, except as indicated. Interested in contributing to this newsletter or in learning more about Chronicle’s services? Please write to us at health@chronicle.org
