The role of OB-GYNs in hidradenitis suppurativa care
Today’s report also covers research into methyl estradiolpropanoate for postmenopausal women, the connection between immune-mediated diseases and alopecia areata, and more (1,330 words, 6 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
Good morning and welcome to this edition of 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.
Hidradenitis suppurativa (HS) is a complex skin condition that disproportionately affects women of reproductive age. While dermatologists are often at the front line of HS patient care, obstetricians-gynecologists (OB-GYNs) also play an essential role. A study published in the International Journal of Women’s Dermatology (Dec. 2022; 8(4):p e e064) explored the perspectives of OB-GYNs regarding HS care to identify any practice gaps.
The authors distributed an anonymous online survey between May and July 2022 through OB-GYN organization lists and in-person to OB-GYNs attending the American College of Obstetricians and Gynecologists (ACOG) 2022 Annual Clinical & Scientific Meeting. A total of 104 OB-GYN providers answered the survey. Fewer than 20% of respondents felt confident treating patients with moderate to severe HS, discussing how pregnancy and delivery may affect HS or managing HS during pregnancy. At the same time, physicians expressed a higher confidence level in managing HS than non-physician OB-GYN providers. Additionally, attending physicians reported being more confident than other providers in treating HS.
As for treatment options, the authors found the top treatments prescribed by respondents include oral contraceptives, topical and oral antibiotics, and spironolactone. Approximately 92% of providers stated they had never prescribed biologics, and procedural treatments were uncommon. Most also reported “often” and “sometimes” referring their HS patients to dermatology and general surgery, followed by mental health professionals, HS support groups, and dieticians.
Finally, the study’s findings show a gap in knowledge regarding HS management during pregnancy and the post-delivery period. Most participants preferred online educational resources and peer-reviewed papers to learn more about HS. The authors emphasize the importance of expanding educational resources for OB-GYNs and promoting care coordination between OB-GYNs and dermatologists to enhance HS management. Early referral may be essential to receiving optimal HS care.
Bottom line
HS can significantly affect a patient’s quality of life. Future treatments should prioritize mental health to serve patients better. Patients’ experiences with healthcare providers can also affect their quality of life, and physicians must provide optimal care. Finally, a multidisciplinary approach is recommended for the treatment of HS.
The periorbital skin rejuvenation efficacy of methyl estradiolpropanoate in women with estrogen-deficient skin
An open-label study published in the Journal of Drugs in Dermatology assessed the efficacy of a methyl estradiolpropanoate (MEP) cream in rejuvenating the periorbital area in women with estrogen-deficient skin (EDS). The authors found that the MEP eye cream was safe and effective.
For this study, the researchers recruited 31 female participants who had not menstruated for at least one year. According to the results, 26 participants showed improvement in the periorbital area after using the MEP cream. The authors also reported that compared to before treatment, the participants were 47% more satisfied with their periorbital appearance.
A rejuvenating treatment targeting “tech neck” lines and wrinkles in Chinese women
A study published in the Journal of Cosmetic Dermatology evaluated the safety and efficacy of a topical anti-aging neck treatment (TNT) in a group of Chinese women with mild to moderate signs of aging on the neck and jawline. The researchers found that TNT was safe and effective. Additionally, they reported that the treatment improved skin radiance, hydration, neck skin elasticity, and the appearance of horizontal neck fold lines.
For this study, the authors recruited 35 Chinese women between 25 and 50 with mild to moderate signs of aging of the neck and jawline. The participants were then asked to apply the TNT to the affected areas twice daily for 84 days.
Effects of physiological skin changes on quality of life during pregnancy
A study published in the Journal of Education and Research in Nursing evaluated physiological skin changes' effects on quality of life during pregnancy. The researchers found that skin changes during pregnancy did not affect overall quality of life. However, pregnant women with stretch marks, itchy skin, enlarged veins, hirsutism, and androgenetic alopecia experienced significant adverse effects on their mental health. These effects impacted their quality of life.
For this cross-sectional study, the authors interviewed 350 pregnant women. The results showed the most common physiological skin changes in pregnant women were melasma, stretch marks, gum changes, and linea nigra, a dark vertical line that can appear on the stomach during pregnancy. The total quality of life score did not vary significantly according to skin changes.
Immune-mediated diseases and the risk of alopecia areata in women
A study in the Archives of Dermatological Research analyzed the connection between immune-mediated diseases and the risk of alopecia areata (AA) in women. The researchers found that personal history of immune-mediated diseases was associated with increased AA risk.
The researchers monitored 63,692 postmenopausal women from 2002 to 2014 to determine if a history of immune-mediated disease was connected to a higher risk of developing AA. During follow-up, the authors identified a total of 133 cases of AA. According to the results, personal history of any immune-mediated disease was associated with a higher likelihood of developing AA. Systemic lupus erythematosus, multiple sclerosis, vitiligo, psoriasis, hypothyroidism, and rheumatoid arthritis were all associated with increased AA risk. In contrast, inflammatory bowel disease, Graves’ disease, and hyperthyroidism were not.
VIDEO: Dermatologist shares skincare ingredients to avoid during pregnancy and ones to try
Dr. Samantha Ellis, a Danville, Calif.-based dermatologist, identifies skincare ingredients women should avoid during pregnancy and which skincare ingredients are considered safe and helpful.
A case of eczema herpeticum and impetigo herpetiformis during pregnancy
A case study published in the Open Access Journal of The European Academy of Dermatology and Venereology reported on a pregnant 30-year-old woman who presented with an itchy, burning rash on her limbs and trunk. She was in her 31st week of gestation and had a history of poorly controlled atopic dermatitis in the same areas as the rash. A skin examination revealed generalized skin xerosis with clustered blisters. The patient was later diagnosed with eczema herpeticum (EH), a skin infection caused by herpes simplex virus type 1. She was prescribed oral antiviral therapy, and her lesions resolved.
The patient reported difficulty breathing and lower leg pain one week after discharge. She also presented with a skin rash and discolouration. After a biopsy, the patient was diagnosed with impetigo herpetiformis (IH), a rare variant of pustular psoriasis that typically appears during the third trimester of pregnancy. The patient was treated with topical steroids, and her symptoms resolved a few weeks later. The authors suggest a possible connection between EH and IH.
“My parents are first-generation Indian immigrants, and my father is a surgeon; I have always been passionate about science and caring for others, especially those in underserved communities. While in medical school, I was fascinated by the broad scope of issues that fall within the umbrella of dermatology — any health conditions that appear on the skin qualify! — as well as all the diagnostic possibilities. The specialty of dermatology is highly competitive in Canada and typically, only 25 spots are available. I was fortunate to get placed and train in Toronto. Every day, I'm motivated to provide my patients with the utmost care and help them look and feel like the very best versions of themselves. Not everyone knows how to take care of their skin — I consider it a privilege to help guide my patients on their self-care journeys.”
— Dr. Geeta Yadav, a Toronto-based dermatologist, in an interview with the business and entrepreneurship portal Go Solo.
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