Treating acne vulgaris during pregnancy and lactation
Today’s report also covers research into hyperglycemia and voluntary depigmentation, adverse drug reactions that affect the skin, and more (1,230 words, 6 minutes)
The Women in Dermatology e-newsletter is supported without restriction by Galderma Canada
Good morning and welcome to the first edition of the Women in Dermatology e-newsletter from Chronicle Companies for 2023. Thank you for joining 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
Acne vulgaris often affects women during pregnancy and lactation. The hormonal and physical changes that occur during pregnancy can contribute to the exacerbation of existing acne. While there are many effective acne treatments, some are contraindicated during pregnancy or breastfeeding. A study published in Dermatology and Therapy (Nov. 2022; 13: 115-130) summarized the available updated information on the safety and efficacy of acne treatments during pregnancy and lactation.
According to the study’s abstract, acne care during pregnancy and lactation should follow a progressive approach based on severity. The authors add that it is essential to consider the trimester-specific teratogenicity of medications and the medical history of the mother and child.
The researchers write that certain acne medications, such as tetracyclines, prednisone, isotretinoin, and spironolactone require a “detox” period of at least one month before pregnancy to avoid birth defects. All of these drugs are highly teratogenic and should be avoided during pregnancy.
When it comes to lactation, some of the findings are somewhat contradictory.
Certain medications that are safe during pregnancy should not be used while breastfeeding.
Topical retinoids are contraindicated during pregnancy but are acceptable while lactating.
Isotretinoin should still be avoided.
The researchers note that the best acne therapies to use during pregnancy and lactation are topicals. Most are considered to be safe during these periods except for topical salicylic and glycolic acids, retinoids, and clascoterone. The authors also add that breastfeeding patients should avoid using topical clindamycin, erythromycin, and dapsone in the chest area.
The study also found that some systemic treatments can be used safely during pregnancy to treat moderate-to-severe acne that does not respond to topical therapies. Some of the safe systemic treatments are:
Penicillins
Aminopenicillins
Cephalosporins
Macrolides
Finally, light and laser treatments can be helpful for refractory acne. According to the study, light and laser therapies have no known teratogenic effects, but the information is limited. They add there are some case studies that show these methods are safe and effective. Although laser and light treatments in breastfeeding patients have not been studied, they are not considered a cause for concern because of the low systemic absorption during these procedures.
Bottom line
Acne treatment during pregnancy should take a progressive approach and consider acne severity. It should also consider trimester-specific teratogenic risks. The best treatments for mild-to-moderate acne are topicals because most topical therapies are considered to be safe during pregnancy and lactation. For moderate-to-severe acne, some antibiotics are a safe and viable option. Spironolactone and isotretinoin should never be used during pregnancy.
French maritime pine bark extract improves hair density in menopausal women
A study published in Health Science Reports analyzed the effects of oral Pycnogenol on hair density, scalp microcirculation, and a variety of skin physiological parameters in Han Chinese menopausal women. Pycnogenol is a proprietary bark extract from the French maritime pine tree, and the authors found it could reduce hair loss risk in postmenopausal women.
The researchers conducted a single-centre, double-blind, randomized, placebo-controlled study involving 63 female participants. The subjects were divided into an active or a control group and received either 150 mg Pycnogenol or placebo three times a day with meals for six months. The results showed that Pycnogenol significantly increased hair density. This effect was associated with an improvement in microcirculation.
Biochemical and hormonal abnormalities in adult female acne
A study published in the Journal of Cosmetic Dermatology evaluated biochemical and hormonal parameters in women dealing with adult female acne (AFA). The researchers found that most AFA patients had at least one lipid alteration, and 50% had elevated cholesterol. Additionally, they discovered that obesity, stress, PCOS, and insulin resistance increase the risk of AFA.
The authors concluded it is important to examine the lipid profile in AFA patients and to calculate the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index to measure insulin resistance rather than simply measuring serum insulin levels.
Hyperglycemia incidence in women practicing voluntary depigmentation
A study published in Our Dermatology Online evaluated the incidence of hyperglycemia in women who practice voluntary depigmentation. Voluntary depigmentation is a process that aims to lighten the skin for aesthetic purposes and it is a common practice in Black African countries. Some depigmentation methods include the use of products that promise to neutralize melanin, capsules and even injections. The researchers found that voluntary depigmentation increases the risk of hyperglycemia.
The researchers conducted a retrospective cohort study from February to August 2020 in four hospitals in Yaoundé, Cameroon. They recruited 181 women: 60 who practiced voluntary depigmentation and 121 controls. The prevalence of hyperglycemia was 43.3% in the first group and 27.3% in the second.
Dermatological adverse drug reactions more common in women than men
A study in the Asian Journal of Medical Sciences assessed the incidence of adverse drug reactions that affect the skin, including Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The authors found that dermatological adverse drug reactions are significantly more common in women.
The authors conducted a prospective and hospital-based study of hospitalized cases of cutaneous adverse drug reactions. Some of the reported adverse skin reactions were mild rashes, fixed drug eruptions, urticarial rashes, SJS, TEN, urticarial vasculitis, contact dermatitis, and nail pigmentation. The results also showed that anti-seizure medications, such as carbamazepine or lamotrigine, often caused cutaneous reactions. Other medications such as non-steroidal, anti-inflammatory, antibiotic and chemotherapeutic agents were also likely to trigger adverse effects on the skin.
Dr. James O’Donovan, a Newcastle, U.K.-based doctor, explains acne in pregnancy, including tips for patients to manage the condition at home. He also discusses what treatments to consider prescribing as well as those to avoid.
A case of mycosis fungoides rapidly progressing to tumour stage
A case study published in the Annals of Medicine and Surgery reported on a 30-year-old woman who presented with inflamed reddish lumps and tumours on her armpits and abdomen. The lesions had rapidly progressed and enlarged over the course of two months. The tumours and nodes were itchy and mobile, and some were ulcerated. An examination revealed no enlargement of the lymph nodes, liver, or spleen.
After a skin biopsy and histopathological study, the patient was diagnosed with mycosis fungoides (MF). A microscopic examination revealed a large number of malignant T-cells on the skin. The exam also revealed atypical lymphoid cells surrounded by a clear halo in the epidermis. Additionally, an immunohistochemical exam showed that the tumour cells were positive for cancer. The patient was then referred to an oncologist and recommended to initiate chemotherapy.
“I think parents and educators need to show young girls what’s possible—not simply tell them they have potential. There was never a doubt in my mind about whether or not I could succeed, because I was given the tools from very early on. Beyond that, give women the support they need: initial investment, childcare and emotional support. It takes a lot of time, dedication, and support from family and friends to pursue passions and build businesses.”
— Dr. Sandra Lee, a Southern California-based dermatologist, in an interview with Authority Magazine.
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