The importance of female-centric medical research
Today’s report covers new research into chemotherapy-induced alopecia in breast cancer survivors, and treatments for HS, urticaria and skin conditions during pregnancy (1260 words, 6 minutes)
Women in Dermatology is supported by an unrestricted grant from Galderma Canada.
Good morning and welcome to the fifth edition of the Women in Dermatology e-newsletter from Chronicle Companies. We are delighted to have you join us. This publication will update you 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
New research suggests that women are two times more likely than men to die after receiving immunotherapy drugs or immune checkpoint inhibitors for cancer. The question is: Are immune-based cancer medications less effective in women?
A recent study published in the Journal of the American Medical Association (JAMA) on Dec. 2, 2021, examined whether cancer immunotherapy effectiveness varies between women and men diagnosed with advanced melanoma when treated with either nivolumab plus ipilimumab combination therapy or anti-programmed cell death protein 1 (PD-1) therapy.
For this study, 1,369 adults over 65 with a melanoma diagnosis from Jan. 1, 1991, to Dec. 31, 2015, were recruited. The study also included patients with stage III or stage IV melanoma with a clinical record that showed nivolumab plus ipilimumab combination treatment or anti–PD-1 therapy as their last type of immune checkpoint inhibitor (ICI) prescribed. For the overall survival analysis, patients were followed until Dec. 31, 2017. A statistical analysis was also conducted from Sept. 19, 2019, through Feb. 20, 2021.
The researchers found that the outcome of nivolumab plus ipilimumab combination therapy among the patients in the study depended significantly on gender. Women who had previously used ipilimumab and were undergoing combination treatment had a mortality hazard ratio 2.06 times greater than men. They also found that for women who had previously used ipilimumab, combination therapy was also linked to 2.82 times greater mortality hazard than anti–PD-1 therapy. There was no statistically significant difference in mortality risk between anti–PD-1 therapy and combination therapy for men.
“This is the first large population-based study that demonstrates a significant difference in outcomes for women treated with two checkpoint inhibitors at the same time,” said senior author Grace Lu-Yao in a press release.
Bottom line:
The study concluded that female patients with advanced melanoma might not benefit as much from combination ICIs as male patients. The researchers also conclude that tumour mutation load or estrogen level may be an essential biomarker for ICI response in metastatic melanoma.
From the literature on women in dermatology
Gender and ethnicity patterns in dermatology leadership
A cross-sectional study published by the International Journal of Women’s Dermatology assessed the gender and ethnicity patterns in leadership in the American Academy of Dermatology (AAD). The researchers obtained leadership and membership information from the AAD for 2010 to 2021. This data showed growth of underrepresented minority representation in both AAD leadership and membership.
The study concludes that this positive trend in growth could be due to dermatology organizations identifying and encouraging opportunities to increase the proportion of board-certified dermatologists that belong to underrepresented minorities, including female dermatologists. However, while the results are encouraging, continued efforts are needed to encourage underrepresented minority dermatologists to both join professional organizations and apply for leadership positions, the authors write.
Characteristics and response to treatment of chemotherapy-induced alopecia in breast cancer survivors
A study published in JAMA Dermatology analyzed the clinicopathologic characteristics and response to treatment of patients with permanent chemotherapy-induced alopecia (pCIA) after receiving chemotherapy for breast cancer. The researchers found that significant regrowth was achieved for many patients with topical or systemic treatments, suggesting that pCIA may be reversible in some cases.
For this study, the authors conducted a retrospective evaluation of patients with pCIA in four hair clinics from Nov. 1, 2011, to Feb. 29, 2020. Clinical, trichoscopic, and histopathologic characteristics and treatment outcomes were analyzed. The study involved 100 patients, 99 of which were women. Most patients presented diffuse nonscarring alopecia, female pattern hair loss or male pattern hair loss. Other types of alopecia were also observed. As for treatments and their effectiveness, topical and oral minoxidil were associated with improved hair growth and density.
Patients with hidradenitis suppurativa may benefit from the Alexandrite hair removal laser
According to a study published in the Journal of the American Academy of Dermatology, combining Alexandrite laser treatment and oral zinc could help decrease the severity of hidradenitis suppurativa in women.
For this study, 20 female patients were given five laser treatments at six-week intervals. Ten of these women were treated in the groin area and 10 in both the groin and armpits areas. A control group of another 20 female patients had no laser therapy but received an antiseptic chlorhexidine wash and 90 mg of oral gluconate zinc.
At week 15, 10 patients in the treatment group and two patients in the control group had achieved clinical response. At week 30, 14 patients in the treatment group had a clinical response, compared with four patients in the control group. Additionally, the treatment group had significant improvements in pain reduction, Dermatology Life Quality Index ratings, and International Hidradenitis Suppurativa Severity Scores.
Assessment and management of itchy skin in pregnancy
A study published in the Australian Journal of General Practice found that rashes or itchy skin are fairly common during pregnancy, with some being dangerous for fetal health. The authors also note that knowledge of the specific dermatoses of pregnancy will assist in diagnosis and management, especially when treating conditions such as pemphigoid gestationis and intrahepatic cholestasis of pregnancy (ICP) that could have harmful effects on the fetus. General practitioners often treat these two conditions in conjunction with dermatologists, obstetric or maternal-fetal medicine teams, which is ideal for optimizing fetal outcomes.
The researchers aimed to provide a diagnostic framework for tackling a pruritic rash during pregnancy, and serve as a valuable overview of pregnancy-specific dermatoses therapy.
VIDEO: Breast Cancer, Hormones, and Hair Loss
Dr. Mary Wendel of Medi Tresse, a company that uses non-surgical treatments for thinning hair, takes a closer look at treating hair loss after cancer treatments.
Case report: A unique presentation of a woman with multiple urticarias
A 63-year-old woman with a medical history of diabetes, hypertension and hypothyroidism developed repeating episodes of an itchy rash on her body following exposure to the sun. She also presented with recurrent erythema on her abdomen that seemed to be heat-activated--it appeared it appeared each time she cooked using a stove. Both skin conditions had been present for three years and were treated with levothyroxine, losartan and metoprolol. Additionally, she started developing hives in sun-exposed areas and in sun-covered areas after being outside.
Correlation of the patient’s clinical history, pathological changes, and laboratory tests established a solar and heat urticaria diagnosis. She was treated with histamine 1 and histamine 2 antihistamines, specifically fexofenadine and famotidine. She was also prescribed hydroxyzine. A follow-up visit revealed that when the patient consistently took her medications her medications, all symptoms and lesions disappeared and did not recur. However, any slight treatment variance resulted in the recurrence of her urticaria.
Coming Up in Women in Derm:
The next two weeks:
Dec. 10 is Human Rights Day
Dec. 20 is International Human Solidarity Day
Something to think about in the week ahead
“There are four key factors to the regular pathogenesis of acne in all skin types. The first is follicular epithelial hyperproliferation which causes follicular plugging and that leads to comedone formation. People with acne tend to have excess sebum production and, this is especially true in skin of colour. There is also the bacteria that colonizes acne lesions. All of this together leads to inflammation from release of the inflammatory mediators that are triggered by this response.”
— Dr. Renita Ahluwalia, a Toronto dermatologist, speaking at the seventh annual Skin Spectrum Summit in November 2021.