Pub Date : 2022-11-21eCollection Date: 2022-12-01DOI: 10.1097/JW9.0000000000000064
Rahul Masson, Terri Shih, Devea R De, Sarah Park, Ram Parvataneni, Aaron Goldberg, Christopher J Sayed, Vivian Y Shi, Jennifer L Hsiao
Obstetricians-gynecologists (OB-GYNs) are key front-line providers for hidradenitis suppurativa (HS), especially since HS disproportionately affects women of child-bearing age.1 Herein, we explored the perspectives of OB-GYN providers regarding HS care to elicit any knowledge and practice gaps. An anonymous survey was distributed online between May and July 2022 through OB-GYN organizational listservs and in-person at the 2022 Annual American College of OB-GYN Meeting. OB-GYN providers over the age of 18 were eligible to participate. T-tests were used for comparative statistics between provider type and survey responses. A P value of <.05 was considered significant. The study is IRB exempt at the University of California, Los Angeles. Demographics of the 104 respondents are summarized in Table 1. Less than 20% of respondents felt confident managing patients with moderate-severe HS (17/104, 16.3%), discussing how pregnancy/postpartum may affect HS (18/103, 17.5%), or managing HS in pregnancy (20/102, 19.6%) (Fig. 1). Compared to nonphysician providers, physicians were more confident in managing HS during pregnancy (P = .03) and discussing how pregnancy and the postpartum period may affect HS symptoms (P = .046). Attending physicians (11.5 mean years of practice) were more confident than other providers in all queried domains (P < .05). Top treatments prescribed “often”/“sometimes” include oral contraceptives (OCPs) (67.6%, 50/74), topical antibiotics (60.3%, 44/73), oral antibiotics (58.1%, 43/74), and spironolactone (51.4%, 38/74). The majority (91.9%, 68/74) had never prescribed biologics. Procedural treatments were infrequently performed for HS. The majority of respondents “often”/“sometimes” referred patients to dermatology (89.3%, 67/75) and general surgery (46.6%, 34/73), followed by mental health specialists (22.2%, 16/72), HS support groups (19.2%, 14/73), and nutritionists (17.6%, 13/74). Respondents mainly preferred internet-based educational resources (99.0%, 101/102) and peer-reviewed papers (93.1%, 95/102) to learn more about HS. Overall, we found that OB-GYNs were not confident in managing moderate-severe HS, and rarely prescribed biologic agents or performed procedures for HS. This highlights the importance of educating OB-GYNs regarding early referral of patients with HS to dermatologists for appropriate management. Our results show that nearly one-fourth of respondents did not feel confident in diagnosing HS and almost half were not confident in managing mild HS. Important educational areas for OB-GYNs include earlier HS diagnosis, especially given the prevalence of misdiagnosis of HS,2 and management of mild HS. One German study found that approximately 30% of patients had consulted gynecologists for HS symptoms, but only around 5% were ultimately diagnosed by gynecologists.3 An additional high-yield management area to target for OB-GYNs is use of OCPs and spironolactone to help women who have hormone-related HS exacerbations.4 O
{"title":"Perspectives of obstetricians/gynecologists on hidradenitis suppurativa care: a survey study.","authors":"Rahul Masson, Terri Shih, Devea R De, Sarah Park, Ram Parvataneni, Aaron Goldberg, Christopher J Sayed, Vivian Y Shi, Jennifer L Hsiao","doi":"10.1097/JW9.0000000000000064","DOIUrl":"https://doi.org/10.1097/JW9.0000000000000064","url":null,"abstract":"Obstetricians-gynecologists (OB-GYNs) are key front-line providers for hidradenitis suppurativa (HS), especially since HS disproportionately affects women of child-bearing age.1 Herein, we explored the perspectives of OB-GYN providers regarding HS care to elicit any knowledge and practice gaps. An anonymous survey was distributed online between May and July 2022 through OB-GYN organizational listservs and in-person at the 2022 Annual American College of OB-GYN Meeting. OB-GYN providers over the age of 18 were eligible to participate. T-tests were used for comparative statistics between provider type and survey responses. A P value of <.05 was considered significant. The study is IRB exempt at the University of California, Los Angeles. Demographics of the 104 respondents are summarized in Table 1. Less than 20% of respondents felt confident managing patients with moderate-severe HS (17/104, 16.3%), discussing how pregnancy/postpartum may affect HS (18/103, 17.5%), or managing HS in pregnancy (20/102, 19.6%) (Fig. 1). Compared to nonphysician providers, physicians were more confident in managing HS during pregnancy (P = .03) and discussing how pregnancy and the postpartum period may affect HS symptoms (P = .046). Attending physicians (11.5 mean years of practice) were more confident than other providers in all queried domains (P < .05). Top treatments prescribed “often”/“sometimes” include oral contraceptives (OCPs) (67.6%, 50/74), topical antibiotics (60.3%, 44/73), oral antibiotics (58.1%, 43/74), and spironolactone (51.4%, 38/74). The majority (91.9%, 68/74) had never prescribed biologics. Procedural treatments were infrequently performed for HS. The majority of respondents “often”/“sometimes” referred patients to dermatology (89.3%, 67/75) and general surgery (46.6%, 34/73), followed by mental health specialists (22.2%, 16/72), HS support groups (19.2%, 14/73), and nutritionists (17.6%, 13/74). Respondents mainly preferred internet-based educational resources (99.0%, 101/102) and peer-reviewed papers (93.1%, 95/102) to learn more about HS. Overall, we found that OB-GYNs were not confident in managing moderate-severe HS, and rarely prescribed biologic agents or performed procedures for HS. This highlights the importance of educating OB-GYNs regarding early referral of patients with HS to dermatologists for appropriate management. Our results show that nearly one-fourth of respondents did not feel confident in diagnosing HS and almost half were not confident in managing mild HS. Important educational areas for OB-GYNs include earlier HS diagnosis, especially given the prevalence of misdiagnosis of HS,2 and management of mild HS. One German study found that approximately 30% of patients had consulted gynecologists for HS symptoms, but only around 5% were ultimately diagnosed by gynecologists.3 An additional high-yield management area to target for OB-GYNs is use of OCPs and spironolactone to help women who have hormone-related HS exacerbations.4 O","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":" ","pages":"e064"},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/70/jw9-8-e064.PMC9678498.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40702399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-18eCollection Date: 2022-12-01DOI: 10.1097/JW9.0000000000000058
James P Pham, Phoebe Star, Annika Smith
{"title":"Morbilliform eruption and systemic inflammatory response syndrome following mRNA COVID-19 vaccination in a patient receiving penicillamine.","authors":"James P Pham, Phoebe Star, Annika Smith","doi":"10.1097/JW9.0000000000000058","DOIUrl":"https://doi.org/10.1097/JW9.0000000000000058","url":null,"abstract":"","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":" ","pages":"e058"},"PeriodicalIF":0.0,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/fd/jw9-8-e058.PMC9674477.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40506858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-21eCollection Date: 2022-10-01DOI: 10.1097/JW9.0000000000000061
Kelly Z Young, Linna L Guan, Ben J Friedman, Pranita V Rambhatla
{"title":"Recalcitrant vulvar pyoderma gangrenosum successfully treated with mycophenolate mofetil.","authors":"Kelly Z Young, Linna L Guan, Ben J Friedman, Pranita V Rambhatla","doi":"10.1097/JW9.0000000000000061","DOIUrl":"10.1097/JW9.0000000000000061","url":null,"abstract":"","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":" ","pages":"e061"},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/81/jw9-8-e061.PMC9622688.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40450640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-10eCollection Date: 2022-10-01DOI: 10.1097/JW9.0000000000000051
Sara Asbeck, Brittany Smirnov
A 65-year-old African-American female presented to the der- matology clinic complaining of poorly controlled melasma over the past year. Physical examination incidentally revealed bilateral violaceous periorbital erythema and edema, accen-tuated on the left eye, patchy gray to violaceous pigmented patches on forehead and glabella, and flat-topped, hyperkeratotic papules overlying the metacarpophalangeal and proximal interphalangeal joints (Fig. 1). Upon further inspection with capillaroscopy, periungual, dilated, looped telangiectasias were evident (Fig. 2). The patient denied proximal muscle weakness, fatigue, weight loss, shortness of breath, chest pain, or dyspnea on exertion. A punch biopsy above the left metacarpophalangeal joint was taken revealing perivascular lymphocytic infil- trate with epidermal hyperplasia, acanthosis, slight increase of papillary dermal mucin, and mild vacuolar interface at the der- moepidermal junction. Direct immunofluorescence revealed C5b-9 and weak IgM and C3 deposition with cytoid bodies along the epidermal basement membrane.
{"title":"Subtle periorbital edema and hyperkeratotic papules in a woman of color.","authors":"Sara Asbeck, Brittany Smirnov","doi":"10.1097/JW9.0000000000000051","DOIUrl":"https://doi.org/10.1097/JW9.0000000000000051","url":null,"abstract":"A 65-year-old African-American female presented to the der- matology clinic complaining of poorly controlled melasma over the past year. Physical examination incidentally revealed bilateral violaceous periorbital erythema and edema, accen-tuated on the left eye, patchy gray to violaceous pigmented patches on forehead and glabella, and flat-topped, hyperkeratotic papules overlying the metacarpophalangeal and proximal interphalangeal joints (Fig. 1). Upon further inspection with capillaroscopy, periungual, dilated, looped telangiectasias were evident (Fig. 2). The patient denied proximal muscle weakness, fatigue, weight loss, shortness of breath, chest pain, or dyspnea on exertion. A punch biopsy above the left metacarpophalangeal joint was taken revealing perivascular lymphocytic infil- trate with epidermal hyperplasia, acanthosis, slight increase of papillary dermal mucin, and mild vacuolar interface at the der- moepidermal junction. Direct immunofluorescence revealed C5b-9 and weak IgM and C3 deposition with cytoid bodies along the epidermal basement membrane.","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":" ","pages":"e051"},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/7d/jw9-8-e051.PMC9553372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33516295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-07eCollection Date: 2022-10-01DOI: 10.1097/JW9.0000000000000053
Meropi Karakioulaki, Dedee F Murrell, Aikaterini Kyriakou, Aikaterini Patsatsi
Autoimmune bullous diseases are a group of skin disorders resulting from an autoimmune reaction against intercellular adhesion molecules or components of the basement membrane of skin and mucosa. Autoimmune disorders often occur in patients with a history of another autoimmune disease and most autoimmune diseases have a striking female predominance. In this review, we aim to analyze the different associations of autoimmune bullous diseases with other autoimmune diseases and highlight the distinctiveness of the female gender in these associations.
{"title":"Investigation of comorbid autoimmune diseases in women with autoimmune bullous diseases: An interplay of autoimmunity and practical implications.","authors":"Meropi Karakioulaki, Dedee F Murrell, Aikaterini Kyriakou, Aikaterini Patsatsi","doi":"10.1097/JW9.0000000000000053","DOIUrl":"https://doi.org/10.1097/JW9.0000000000000053","url":null,"abstract":"<p><p>Autoimmune bullous diseases are a group of skin disorders resulting from an autoimmune reaction against intercellular adhesion molecules or components of the basement membrane of skin and mucosa. Autoimmune disorders often occur in patients with a history of another autoimmune disease and most autoimmune diseases have a striking female predominance. In this review, we aim to analyze the different associations of autoimmune bullous diseases with other autoimmune diseases and highlight the distinctiveness of the female gender in these associations.</p>","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":" ","pages":"e053"},"PeriodicalIF":0.0,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33503998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-07eCollection Date: 2022-10-01DOI: 10.1097/JW9.0000000000000049
Natalie Ingraham, Lena R Hann, J Austin Williamson, Caleb Drew
Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease that impacts an estimated 1 to 4% of the population; women are twice as likely to be diagnosed as men. There is no cure for HS, and many patients face a lifetime of various healthcare appointments, medical interventions, and personal experiences living with the disease.
Objective: This study aimed to explore social, emotional, and medical experiences for individuals with HS, and to understand connections between those experiences and quality of life.
Methods: Participants (n = 243) in the community-based convenience sample completed a cross-sectional survey about their experiences and quality of life and reported high rates of anxiety, embarrassment, and depressed mood. These and other negative emotions were commonly experienced during interactions with healthcare providers and romantic partners.
Results: Participants who had more negative interactions with providers and partners surrounding their HS tended to experience a lower quality of life.
Limitations: Limited generalizability due to convenience sampling.
Conclusion: Providers should consider how patients experience patient -provider communication about HS, and how this communication impacts other areas of patients' lives, including quality of life, mental health, and romantic relationships. Future care approaches should prioritize mental health strategies in HS patients' care plans, and establish partnerships between dermatology practices and mental health professionals to aid in the multidisciplinary approach recommended for the treatment of HS.
{"title":"Communicating with health providers and romantic partners: The impact of negative emotions on quality of life for individuals with hidradenitis suppurativa.","authors":"Natalie Ingraham, Lena R Hann, J Austin Williamson, Caleb Drew","doi":"10.1097/JW9.0000000000000049","DOIUrl":"https://doi.org/10.1097/JW9.0000000000000049","url":null,"abstract":"<p><p>Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease that impacts an estimated 1 to 4% of the population; women are twice as likely to be diagnosed as men. There is no cure for HS, and many patients face a lifetime of various healthcare appointments, medical interventions, and personal experiences living with the disease.</p><p><strong>Objective: </strong>This study aimed to explore social, emotional, and medical experiences for individuals with HS, and to understand connections between those experiences and quality of life.</p><p><strong>Methods: </strong>Participants (n = 243) in the community-based convenience sample completed a cross-sectional survey about their experiences and quality of life and reported high rates of anxiety, embarrassment, and depressed mood. These and other negative emotions were commonly experienced during interactions with healthcare providers and romantic partners.</p><p><strong>Results: </strong>Participants who had more negative interactions with providers and partners surrounding their HS tended to experience a lower quality of life.</p><p><strong>Limitations: </strong>Limited generalizability due to convenience sampling.</p><p><strong>Conclusion: </strong>Providers should consider how patients experience patient -provider communication about HS, and how this communication impacts other areas of patients' lives, including quality of life, mental health, and romantic relationships. Future care approaches should prioritize mental health strategies in HS patients' care plans, and establish partnerships between dermatology practices and mental health professionals to aid in the multidisciplinary approach recommended for the treatment of HS.</p>","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":" ","pages":"e049"},"PeriodicalIF":0.0,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/47/jw9-8-e049.PMC9542567.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33503997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pemphigus vulgaris is a chronic autoimmune mucocutaneous blistering disorder. Apart from the disease itself, other aspects of patients' life, including psychological, social, and financial, can be affected. Women are particularly more disposed to the impact of the disease due to their physiological characteristics, the specific periods of pregnancy and lactation as well as their social and familial role. In this review, we summarized the burden of pemphigus vulgaris on various aspects of women's lives. It is essential to understand these problems and provide appropriate support for patients with such a burdensome disease.
{"title":"Burden of pemphigus vulgaris with a particular focus on women: A review.","authors":"Nika Kianfar, Shayan Dasdar, Hamidreza Mahmoudi, Maryam Daneshpazhooh","doi":"10.1097/JW9.0000000000000056","DOIUrl":"10.1097/JW9.0000000000000056","url":null,"abstract":"<p><p>Pemphigus vulgaris is a chronic autoimmune mucocutaneous blistering disorder. Apart from the disease itself, other aspects of patients' life, including psychological, social, and financial, can be affected. Women are particularly more disposed to the impact of the disease due to their physiological characteristics, the specific periods of pregnancy and lactation as well as their social and familial role. In this review, we summarized the burden of pemphigus vulgaris on various aspects of women's lives. It is essential to understand these problems and provide appropriate support for patients with such a burdensome disease.</p>","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":"8 3","pages":"e056"},"PeriodicalIF":0.0,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9529034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9548678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.1097/JW9.0000000000000033
Devon E Cross, James Garritano, Amanda E Zubek, Alicia J Little
{"title":"Pruritic annular erythematous eruption after receiving the COVID-19 vaccine.","authors":"Devon E Cross, James Garritano, Amanda E Zubek, Alicia J Little","doi":"10.1097/JW9.0000000000000033","DOIUrl":"https://doi.org/10.1097/JW9.0000000000000033","url":null,"abstract":"","PeriodicalId":53478,"journal":{"name":"International Journal of Women''s Dermatology","volume":"8 3","pages":"e033"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/e7/jw9-8-e033.PMC9276362.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9177326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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