Background:. Women in medicine often delay childbearing due to the competing priorities of training, finding a partner, and waiting for the “right time.” Unfortunately, the steep decline in female fertility during a woman’s mid to late 30s also often coincides with the completion of residency and/or fellowship training. Data show that women in medicine elect to have children later in life and that at least 1 in 4 female physicians suffer from infertility, a higher rate than in nonphysicians. It is essential to escalate the dialogue regarding family planning for female physicians and trainees. Objective:. In this review, we discuss markers currently used to evaluate ovarian reserve, including anti-Müllerian hormone. We also discuss common methods for fertility preservation, including egg/oocyte and embryo cryopreservation, and unique logistical challenges this population faces in family planning. Methods:. Narrative review of literature regarding fertility, markers of ovarian reserve, fertility preservation options, and family-planning challenges, particularly pertaining to the population of women in medicine. Results:. Women in medicine experience higher rates of infertility compared with the general population and frequently delay childbearing due to training and career demands. Limitations:. This is a narrative review and is limited by the available published literature, including a relative paucity of data surrounding fertility and fertility preservation outcomes among female physicians and trainees. Conclusions:. Women in medicine must be viewed as a critical at-risk population for infertility with unique and multifactorial family-building challenges. This underrecognized group deserves heightened attention, with a special emphasis on the key elements of education, mentorship, and support.
Linear morphea is the most prevalent subtype of morphea in pediatric patients and poses a significant clinical concern because of its potential to involve deeper tissues, including muscle, fascia, and bone. If not identified and treated promptly, this can result in long-term complications such as joint contractures, limb length discrepancies, and functional impairment. Diagnosing and managing morphea in children with skin of color presents unique challenges, as hallmark inflammatory signs like erythema may be less visible or absent altogether, leading to delays in diagnosis and difficulties in monitoring disease activity. In darker skin tones, active lesions may instead present as hyperpigmented or hypopigmented patches, which can mimic other common pediatric dermatoses. These diagnostic limitations underscore the need for heightened clinical suspicion and tailored diagnostic strategies in this population. While consensus-based treatment algorithms exist for pediatric morphea, these guidelines are largely derived from studies in lighter skin types and do not address diagnostic and monitoring challenges unique to patients with skin of color. Additional research is needed to develop inclusive guidelines that address these gaps and improve long-term disease control. Herein, we present the case of linear morphea in a 5-year-old African American child, highlighting the diagnostic, therapeutic, and monitoring challenges specific to pediatric patients with skin of color.
Background:. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by painful nodules and abscesses in intertriginous areas, predominantly affecting women. Persistent systemic inflammation and hormonal changes may contribute to reduced bone health and an increased risk of osteoporosis in this population. Objective:. To highlight osteoporosis as an underrecognized comorbidity in women with HS and discuss contributing inflammatory, hormonal, and lifestyle-related risk factors that may predispose patients to bone compromise. Methods:. A narrative review of the literature was conducted examining the relationship between HS, chronic inflammation, menopause-related estrogen decline, and osteoporosis risk. Additional contributory factors commonly associated with HS, including tobacco use, vitamin D deficiency, obesity, physical inactivity, and repeated corticosteroid exposure, were evaluated. Results:. Systemic inflammation, hormonal decline, corticosteroid exposure, vitamin D deficiency, and reduced activity may contribute to increased osteoporosis risk in women with HS. Limitations:. Current evidence evaluating osteoporosis risk specifically in patients with HS remains limited, and additional prospective studies are needed to better characterize prevalence, mechanisms, and screening recommendations. Conclusion:. Bone health should be considered in women with HS, particularly those with severe or longstanding disease.
Objective:. To evaluate the safety of alopecia treatments during pregnancy, in-vitro fertilization (IVF), and polycystic ovary syndrome (PCOS) workup, with a focus on potential maternal and fetal risks. Data sources:. A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus from November 2024 to December 2024. Search terms included medication names in combination with “pregnancy,” “IVF,” “in-vitro fertilization,” and “PCOS.” Study selection:. Peer-reviewed studies addressing the use of therapies for androgenetic alopecia, alopecia areata, and scarring alopecias in the contexts of pregnancy, IVF, and PCOS were included. Articles evaluating maternal safety, fetal risks, and treatment timing were prioritized. Only English-language publications were reviewed. Results:. Despite increasing therapeutic options for alopecia, significant knowledge gaps remain regarding their safety during pregnancy. Pregnant women are often excluded from clinical trials, leading to a reliance on older treatments with limited data on dosing or pharmacokinetics in the pregnant population. Unfortunately, there are few alopecia medications with robust safety data in pregnancy, and many medications are contraindicated during this period. Some medications may be used with caution, while others require additional investigation. During IVF, there are alopecia medications with potential benefit in women experiencing implantation failure or PCOS. For patients undergoing PCOS workup, some alopecia medications may impact hormonal labs or mask PCOS symptoms. Conclusion:. There is a critical need for more targeted research on alopecia treatments in pregnancy, IVF, and PCOS contexts. This review provides current evidence to guide clinicians and support informed, individualized treatment decisions during this vulnerable period.
Background:. Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region and is associated with significant impairment of quality of life. High-potency topical corticosteroids are the standard of care; however, some patients show inadequate response or experience relapse. Noninvasive physical plasma (NIPP) is an emerging therapeutic modality with antimicrobial and anti-inflammatory properties, but its role in LS remains unclear. Objective:. To evaluate the safety, tolerability, and preliminary efficacy of NIPP as an adjunctive treatment in patients with vulvar LS refractory to topical corticosteroids. Methods:. This prospective single-arm pilot study included 5 women with histologically confirmed LS and/or chronic vulvar inflammation with persistent symptoms despite topical corticosteroid therapy. Patients received at least 3 NIPP sessions (plasma care, terraplasma medical GmbH), each applied for 1 minute over a 4 × 4 cm area at intervals of 4 to 6 weeks, while continuing standard topical treatment. Clinical assessment, photographic documentation, and patient-reported outcomes using a study-specific questionnaire were collected at baseline, at each session, and at follow-up 4 to 6 weeks after the final treatment. Results:. The median age was 46 years, and the median disease duration was 3 years. No consistent improvement in symptoms or clinical findings was observed following NIPP treatment. Three patients indicated willingness to undergo NIPP again, and 1 patient reported improvement in sexual well-being. No severe adverse events occurred. Treatment was generally well tolerated; however, 1 patient discontinued participation due to treatment-related discomfort. Limitations:. The main limitations are small sample size, lack of a control group, and heterogeneity in disease duration and prior/current treatments. Conclusion:. In this pilot study, adjunctive NIPP did not demonstrate consistent clinical benefit in vulvar LS but appeared safe and well-tolerated. Larger controlled studies are required to further assess its therapeutic potential.
Background:. The impact of hidradenitis suppurativa (HS) on sexual health, pregnancy, and breastfeeding in female patients is understudied. Objective:. To characterize the impact of HS on sexual health, barriers to breastfeeding, and barriers to accessing care for HS during breastfeeding and pregnancy. Methods:. A cross-sectional survey of self-identified adult women with HS from June 13, 2021 to June 30, 2021 was performed to assess associations between demographic and clinical factors, including age, gender, race, and ethnicity, disease severity (patient global assessment), and difficulty accessing dermatologic care with the outcomes of sexual health-related quality of life, breastfeeding practices, and barriers to care. Results:. Eight hundred eight eligible female respondents resided in 5 countries. Seventy-four point three percent self-identified as White, 8.3% Black, 2.4% Asian, 5.3% Hispanic, 7.1% Mixed race, and 1.4% Native Hawaiian or other Pacific Islander. Moderate to extreme difficulties with sexual activity and desire were associated with more difficulty accessing dermatologic care and higher patient global assessment scores (P < .01 for all). Depression and anxiety were associated with moderate to extreme difficulties with sexual activity (P < .01). Of the participants who were previously pregnant, 15% (n = 79/526) reported that HS interfered with breastfeeding ability. The top barrier to care was believing nothing could be done for HS during pregnancy and breastfeeding. Limitations:. Diagnosis and disease severity were self-reported and could not be verified. Conclusion:. Impaired sexual health was associated with access to care limitations, increased disease activity, and comorbid depression and anxiety. Our findings underscore the need for guidance on safe HS therapies during pregnancy and breastfeeding.
Objective:. To critically review the current literature on the safety, efficacy, and clinical considerations of rituximab use in pediatric and pregnant patients with autoimmune blistering diseases (AIBD). Data Sources:. A comprehensive literature search was conducted using PubMed and Embase to identify relevant articles, including case reports, case series, observational studies, and systematic reviews. Study Selections:. Studies were selected based on relevance to rituximab use in pediatric and antenatal AIBD, with particular focus on treatment efficacy, adverse outcomes, and long-term immunologic effects. Results:. Rituximab demonstrates promising efficacy in pediatric AIBD, though concerns remain regarding persistent hypogammaglobulinemia and delayed immune reconstitution. In regards to pregnant patients, current data do not suggest a consistent association between rituximab exposure and congenital anomalies or serious neonatal complications, particularly when used preconception or early in gestation. Reported neonatal B-cell depletion has been transient. Multidisciplinary oversight is critical given the clinical complexity of these populations. Conclusion:. Rituximab may be a viable corticosteroid-sparing option for severe or refractory AIBD in children and pregnant women. Its use should be individualized and carefully monitored by experienced multidisciplinary teams. Larger prospective studies are needed to inform evidence-based guidelines.
Background:. Acne is commonly treated with topical agents such as benzoyl peroxide (BP), which is effective but limited by side effects. Topical dapsone may offer a better-tolerated alternative. Objective:. To compare the efficacy and safety of topical 5% dapsone versus 2.5% BP in mild-to-moderate acne. Materials and methods:. Fifty patients with mild-to-moderate acne were enrolled and randomized. Outcomes included reduction in acne lesion count (inflammatory, noninflammatory, and total), Global Acne Assessment Score (GAAS), patient satisfaction, transepidermal water loss, and side effects. Results:. Forty-four patients completed 12 weeks of treatment (20 with 5% dapsone, 24 with 2.5% BP). Both treatments significantly reduced acne lesions and GAAS scores. Dapsone 5% was more effective in reduction of inflammatory lesions, whereas BP 2.5% was more effective for noninflammatory lesions. Dapsone 5% also achieved a faster reduction in total acne lesions and GAAS scores. Transepidermal water loss increased significantly with BP 2.5%, but not with dapsone 5%. Local side effects, particularly pruritus and erythema, were more frequent with BP. Limitations:. Single-center design and short study duration. Conclusion:. Topical 5% dapsone is an effective and well-tolerated option for mild-to-moderate acne, particularly for inflammatory lesions, and may serve as an alternative for patients intolerant to standard therapies.
