Gyn meets Derma: When it comes to skin problems, women often seek advice from a gynaecologist. An overview of how both disciplines can complement each other – and which questions you should be prepared for.
Patients with skin problems or abnormalities in body hair often present in the gynecological practice with a not inconsiderable level of suffering. Young women are plagued by facial acne, pregnant women worried regarding sudden skin changes and menopausal patients dissatisfied with their skin and hair. In addition, we gynecologists see a lot of skin from a special perspective during the examination. It is not uncommon for an unusual irritation in the genital area or in the submammary folds to be noticed.
Contraception and hormone replacement therapy
Even if, following more than 60 years, people are becoming increasingly tired of taking the pill, it is still the most popular contraceptive in the industrialized nations. low-dose combination drugs Ethinylestradiol or. Estradiol and a corresponding one depending on the preparation Progestogenare the common entry-level contraceptive, especially for first prescriptions.
In general, a preparation should be used first Levonorgestrel, a progestogen with a comparatively low risk of thrombosis. Younger patients in particular suffer from impure skin and acne on the face, back and décolleté. Combined contraceptives with progestins such as B. Dienogest and chlormadinone acetate have proven to be advantageous here due to their partial anti-androgenic effect. If there are no risk factors in a patient that speak once morest a combined contraceptive, the desire for reliable contraception can be combined with a good effect on the skin or the skin effect can be used exclusively. However, it should always be pointed out that these preparations have a slightly higher risk of thrombosis than levonorgestrel.
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Combination preparations are contraindicated in women who are at risk of thromboembolism or who are breastfeeding. Only progestin preparations are used here. There has been one in Germany since April 2021 Drospirenon-mono preparation (Slinda®), which seems to combine many advantages. It shows a high safety profile in contraception and stabilizes the bleeding pattern better than conventional progestin-only preparations. Furthermore, it has anti-mineral corticosteroid and anti-androgenic effects and has also proven itself in studies in adolescents and overweight women. Especially with androgenization symptoms (acne, Hirsutismus, alopecia) positive effects are described.
Other contraceptive methods that only contain progestins, such as a pill containing desogestrel, a hormone spiral or an implant, tend to favor the tendency to impure skin.
If premenopausal patients report increased menopausal symptoms that are the reason for hormone replacement therapy, preparations with an antiandrogenic effect can be advantageous in the event of additional androgenization symptoms. These include progestins such as dienogest or drospirenone. Due to the physiological hormone deficiency in the Postmenopause the vaginal skin dries out increasingly, becomes thin and vulnerable. Regular local estrogen application in the form of a cream or suppository relieves the symptoms and prevents urinary tract infections.
pregnancy and skin
Typical skin symptoms can occur during pregnancy due to normal hormonal changes:
- Stretch marks (Stretch marks of pregnant women): stretch marks in the skin on the abdomen, buttocks, chest area and extremities. These often fade following birth, but often do not disappear completely.
- Increased pigment formation: dawn line is becoming black line on the abdomen. Nipples, genital region and facial areas (Chloasma) are more heavily pigmented.
On the other hand, there are also pregnancy-specific skin diseases:
- pregnancy cholestasis
If a pregnant woman complains of excruciating itching, often starting on the palms of her hands and feet and later including the trunk and other areas, it may be a pregnancy cholestasis act. The preferred occurrence is the 3rd trimester, with laboratory tests showing elevated transaminases and bile acids. The etiologically unclear clinical picture is rare, but if left untreated it can have fatal consequences for the outcome of the pregnancy. Get therapy right away Ursodeoxycholsäure, the increased rate of premature births and intrauterine fetal death can be significantly reduced. The pregnancy should be closely monitored as it progresses. The clinical picture disappears with childbirth.
- Polymorphic pregnancy dermatosis
Maculo-papular, pruritic erythema of abdomen and extremities with periumbilical recess. Usually occurs in the last weeks of pregnancy or postpartum (15%) with a self-limiting course. Individual risk factors are first and multiple pregnancies and excessive weight gain in the mother. There is no fetal risk.
- Atopic Schwangerschaftsdermatosis
Eczematous, nodular and itchy skin lesions in the case of allergies in the anamnesis, which usually occurs in the 2nd trimester and does not pose a risk to the fetus.
- pregnancy pemphigoid
After the second half of pregnancy or shortly following birth with itching, nodules, plaques and blisters periumbilical and on the extremities. An immunological genesis is suspected; the fetus is usually not directly affected. Preterm birth and fetal retardation are discussed.
Polyzystisches Ovarsyndrom
According to the Rotterdam criteria, two of the three symptoms should be present by definition:
Of a PCOS are 8-13% of all women of reproductive age affected. The clinical picture is very heterogeneous and is 80% the most common cause of menstrual cycle disorders. 70% of patients have one insulin resistance and 60% of European PCOS patients are obese. The risk of depression, cardiovascular disease and Endometrial carcinoma appears to be elevated. Etiology and pathogenesis are not fully understood, genetic and environmental factors are most likely to be assumed. In the case of cutaneous androgenization symptoms, combined oral contraceptives are recommended following unsuccessful topical therapy. Combinations with progestins, which have a partial antiandrogenic effect, are advantageous. In the case of a pure progestin preparation, drospirenone (Slinda®) is an option. Metabolic components and infertility may be involved Metformin and Letrozole be treated in off-label use.
oncology and skin
The annual gynecological cancer check-up includes a thorough inspection of the skin in the genital and breast areas.
Suspicious skin lesions of the breast suspicious of a malignancy such as an inflammatory one breast cancer or one Paget’s disease are require further clarification. After radiation of the breast is rare Angiosarcoma to think.
In the genital area you can see a benign one more often Lichen sclerosus, which covers the vulva with thin, whitish patches of skin. Biopsy, local therapy and regular check-ups are necessary to prevent increased carcinogenesis here. Deposits and ulcer-like depressions can be precursors or manifestations of a For vulvar cancer be.
In the case of suspicious nevi, it is advisable to inform the patient regarding regular dermatological screening. Everywhere, whether genital region, chest area or other skin areas: Conspicuous skin symptoms should be presented in dermatology.
Conclusion
Gynecology and dermatology come into contact in many ways. In acne, alopecia and hirsutism, androgenic laboratory parameters are often elevated. Antiandrogenic hormone therapy can be helpful here. Progestins with partial antiandrogenic effects are administered alone or in combination with an estrogen. This may include oral contraception or hormone replacement therapy.
It is important to differentiate pregnancy cholestasis from other, less threatening skin irritations during pregnancy.
In the case of unusual skin symptoms in the genital and breast areas, gynecologists are well advised to refer generously to their dermatological colleagues.
Image source: Austin Distel, Unsplash
