Today’s report also covers research into the Impact of low-pH cosmetic products on the skin microbiome, amitriptyline for the treatment of vulvodynia, and more (1,555 words, 7.4 minutes)
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 research in the InternationalJournal of Women’s Dermatology (Mar. 2025; 11(1):p e191), pityriasis rosea (PR) has increased prevalence and potential risks during pregnancy, particularly in early gestation. The study analyzed the relationship between PR and pregnancy outcomes. The researchers found that while most pregnancies affected by PR had favourable outcomes, PR onset before 15 weeks of gestation significantly increased the risk of adverse outcomes, including spontaneous abortion.
Photo by Apostolos Vamvouras
For this study, the authors systematically reviewed literature published between 1950 and 2024 on PubMed, Web of Science, and Directory of Open Access Journals. They used the keywords “pityriasis rosea,” “pityriasis circinate,” “roseola annulate,” “herpes tonsurans maculosus,” “herald patch,” and “pregnancy.” They included studies that reported outcomes data for pregnant patients with established PR, written in or translated into English and published in peer-reviewed journals. After screening and exclusion processes, 11 relevant articles met the selection criteria for this review.
A total of 177 patients with PR during pregnancy were analyzed in the study. Overall, 81% of patients experienced favourable pregnancy outcomes, while 19% faced adverse outcomes, including 8% with spontaneous abortions. The results revealed that PR onset before 15 weeks of gestation carried a significantly higher risk of adverse outcomes, including a high spontaneous abortion rate, compared to later onset, where no spontaneous abortions were reported.
The study's results suggest that gestational timing of PR onset plays a critical role in pregnancy outcomes. Factors such as extensive body surface area involvement, associated systemic symptoms, and higher human herpesvirus 6 viral loads were identified as potential indicators of poor prognosis.
The study found conflicting data regarding the impact of PR on pregnancy outcomes, with varying reports on its influence and many cases of healthy births. The authors note that adverse outcomes appear predominantly associated with early-onset PR and more severe disease presentations. However, limited long-term data on children born to PR-affected mothers suggest that unfavourable outcomes may often be temporary. This underscores the need for further research to clarify the condition’s impact on fetal health and guide treatment approaches.
The study suggests PR may harm pregnancy despite potential data biases. The researchers recommend close follow-up and consideration of antiviral treatment for pregnant PR patients with high-risk factors. Acyclovir and valacyclovir are suggested as treatment options, as they may treat PR and are generally considered safe in pregnancy. Additionally, the study emphasizes the importance of ruling out syphilis in all pregnant women with suspected PR, regardless of severity.
The Takeaway: The study found that pityriasis rosea (PR) during pregnancy may be associated with adverse outcomes, with 19% of patients experiencing unfavorable outcomes, including an 8% rate of spontaneous abortion. The timing of PR onset is crucial, with PR occurring before 15 weeks of gestation linked to a higher risk of unfavorable outcomes. The study recommends close follow-up, consideration of antiviral treatment for high-risk patients, ruling out syphilis in all cases.
A 15-year analysis of hospitalized hidradenitis suppurativa patients with a focus on sex differences
Research in Acta Dermatovenerologica Alpina Pannonica et Adriatica analyzed 15 years of hidradenitis suppurativa (HS) cases in southeastern Europe. The researchers found that women with HS typically experienced disease onset at an earlier age and had a higher prevalence of trunk involvement compared to men.
For this retrospective, cross-sectional study, the authors analyzed data from hospitalized patients with HS at a university dermatology clinic from 2007 to 2022. They collected information on demographics, clinical features, laboratory findings, comorbidities, and treatments from electronic health records and patient histories. Disease severity was assessed using the Hurley classification system, and lesion localization was categorized into specific body areas. The results showed that women had earlier disease onset and hospitalization, whereas men had a higher disease severity. The study also found significant sex-based differences in lesion localization and treatment choices. For example, men were more often treated with rifampicin-clindamycin combinations, and women were more often treated with tetracyclines and systemic steroids.
Impact of low-pH cosmetic products on the skin microbiome
A study in Dermatology and Therapy assessed the effects of skincare products with pH levels lower than five on the skin microbiome. The researchers found that low-pH cosmetic products did not significantly disrupt skin microbiome diversity and may positively impact skin health by reducing specific pathogenic microbial populations.
For this study, the authors evaluated the diversity of the skin microbiome of post-menopausal women after 28 days of using four different low-pH products: vitamin C, resveratrol, a collagen mask, and a native algae mask. The results showed that none of the investigational products caused significant disruption to the skin microbiome diversity. Furthermore, an increased diversity of the skin microbiome was observed throughout the study, with the native algae mask significantly reducing the Corynebacterium genus.
A study in the International Journal of Dermatology evaluated the use of amitriptyline for vulvodynia in 20 women with Vulvar Lichen Sclerosus (VLS). The researchers found that amitriptyline significantly reduced pain and improved quality of life. However, careful management of adverse effects is necessary.
For this study, the authors presented a case series of 20 women treated with amitriptyline for vulvodynia secondary to VLS, along with an extensive literature review. Although amitriptyline effectively treated vulvodynia, the researchers emphasized the need for larger, more extensive trials to validate these findings.
A comprehensive classification and analysis of oily-sensitive facial skin
A study published in Scientific Reports aimed to develop an objective classification system for skin types and subtypes based on biophysical parameters. The researchers found that oily-sensitive skin can be objectively classified into three subtypes: barrier-sensitive, neuro-sensitive, and inflammatory-sensitive.
For this study, the authors collected 104 biophysical facial skin parameters from 200 healthy young female volunteers in Beijing using non-invasive instruments. They used various statistical techniques to categorize skin types and analyze the characteristics of oily-sensitive skin and its subtypes. They identified dry, neutral, and oily skin types based on sebum levels and further categorized oily skin into its subtypes. Furthermore, the results showed that oily sensitive skin exhibits increased sebum, redness, and acne, with distinct subtypes showing specific traits such as high pH, elevated trans epidermal water loss, and low elasticity.
Miami-based dermatologist Dr. Mariya Miteva shares trichoscopy practice pearls for treating scarring alopecia.
A case of recurrent erysipelas
A case study in the Australasian Journal of Dermatology described an 89-year-old woman who presented with acute painful plaques on the buttocks. The patient had experienced five similar episodes over the past year. Examination revealed erythematous, hardened plaques with erosions. A skin biopsy showed papillary dermal edema and a mixed perivascular and interstitial inflammatory infiltrate. Swabs from the erosion showed growth of group C/G streptococcus, which is sensitive to penicillin. The patient was treated with intravenous cefazolin and oral cefalexin, which led to the resolution of the eruption within 14 days. She was then treated with prophylactic penicillin V at follow-up.
“The skin is our largest organ and protects us daily from the elements. It regulates our temperature, keeps us from infection, provides us with sensation and plays a role in our immunity. It is also often an indicator for deeper issues and can offer clues to systemic issues that may be at play. It sometimes allows dermatologists to be the first to detect a patient's deeper health problems. It seems obvious but without our skin, we would not survive.”
— Dr. Kimberly Werner Billet, a Frisco, Texas-based dermatologist in an interview with Community Impact
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