editorial women s skin throughout...

EditorialWomen’s Skin throughout Lifetime

Gérald E. Piérard,1 Corinne Charlier,2 Philippe Delvenne,3

Philippe Humbert,4,5 and Claudine Piérard-Franchimont6,7

1 Laboratory of Skin Bioengineering and Imaging (LABIC), Department of Clinical Sciences, Liege University, 4000 Liege, Belgium2Department of Clinical Toxicology, University Hospital of Liege, 4000 Liege, Belgium3Department of Pathology, Unilab Lg, University Hospital of Liege, 4000 Liege, Belgium4Department of Dermatology, University Hospital Saint-Jacques, 25030 Besancon, France5 Inserm U645 Research Unit IFR133, 25030 Besancon, France6Department of Dermatopathology, Unilab Lg, University Hospital of Liege, 4000 Liege, Belgium7Department of Dermatology, Regional Hospital of Huy, 4500 Huy, Belgium

Correspondence should be addressed to Gerald E. Pierard; [email protected]

Received 11 February 2014; Accepted 11 February 2014; Published 13 April 2014

Copyright © 2014 Gerald E. Pierard et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

The distinction between skin of men and women stemsas much from biologic differences as from their differentsocial roles and status in various societies. Currently, there isagreement among clinicians and researcher scientists to dis-tinguish between different episodes in female life according totheir hormonal status.They influence the skin physiology andthe risk of diseases and possibly alter the quality of life. Thepresent special issue contains ten papers focused on recentdevelopments in the field of women’s skin and mucosae.Two papers deal with physiological aspects of breasts priorto surgical intervention, as well as the skin response toseasonal environmental changes. One paper is focused onnew developments in toxicological aspects related to selectedhormone disruptors. Seven other papers focus on peculiaraspects of a series of skin disorders developed in women.

The paper entitled “A methodological evaluation of vol-umetric measurement techniques including three-dimensionalimaging in breast surgery,” by H. Hoeffelin et al., describesobjective and noninvasive methods for assessing breast vol-ume. The 3D LifeViz system (Quantificare) was used invarious settings (in situ on corpse dissection, on controlprostheses, and in clinical conditions). Such a system wascompared to other methods (CT scanning and Archimedes’principle) under the same conditions. The parameters of

feasibility, safety, portability, minimal patient stress, and limi-tations (underestimation of the in situ volume, subjectivity ofcontouring, and patient selection) of the LifeViz 3D systemindicate similar benefits compared to other measurementmethods. The prospects of this method appear promising fora series of applications in clinical practice in order to limit thesubjectivity of breast surgery.

The paper entitled “The weather-beaten dorsal handclinical rating, shadow casting optical profilometry, and skincapacitance mapping,” by M. Delvenne et al., is an originalwork about a common condition linked to seasonal skinpresentation associated with environmental changes. Thewithered skin surface changes were assessed during thefour seasons. Among 47 menopausal women completing thestudy, 31 volunteers were on hormone replacement therapy(HRT) and 16 did not use HRT. Skin xerosis and scalinesswere rated following clinical assessments. In addition, skinwithering of the dorsal hands was assessed by computer-ized shadow casting optical profilometry. Skin capacitancemapping was also performed. Marked changes over theseasons were recorded corresponding to the combinationof patchy heterogeneous stratum corneum hydration andheterogeneous skin surface roughness. These features likelyresulted from variations in the environmental temperature

Hindawi Publishing CorporationBioMed Research InternationalVolume 2014, Article ID 328981, 3 pageshttp://dx.doi.org/10.1155/2014/328981

2 BioMed Research International

and moisture. Daily stress due to alternate outdoor andindoor conditions was possibly involved in the skin condi-tion. The severity of changes revealed by clinical inspectionwas not supported by similar directions of fluctuations inthe instrumental assessments. Such contradiction was infact due to different levels of scale observation. The clinicalcentimetric scale and the instrumental inframillimetric scalepossibly provided distinct aspects of the biological impact.

The paper entitled “Measurement of urinary biomarkersof parabens, phthalates, and benzophenone-3 in a Belgianpopulation,” by L. Dewalque et al., addresses the con-cerns about hormone disruptors. Phthalates, parabens, andbenzophenone-3 (BP3) are commonly present in plasticiz-ers, antimicrobial conservatives, and UV-filters, respectively.They exhibit endocrine disrupting properties yielding, forinstance, to skin malignant melanoma. Humans are exposedto such chemicals through different sources like food, per-sonal care preparations, and cosmetics. In this study, theexposure to five phthalates, four parabens, and BP3 wasassessed by measuring urinary levels of their biomarkers insamples collected from 261 volunteers living in the Liegeregion of Belgium. The analyses were carried out by liquidchromatography tandem mass spectrometry (LC-MS/MS)with deuterated standards. The phthalate metabolites, BP3,and most of the parabens were detected in 82.8 to 100.0%of the samples. For most of these chemicals, the exposurepatterns seemed to differ between children and adults. Inaddition, differences were perceived between males andfemales, especially with significantly higher concentrations ofparabens in females. If a correlation was established betweenthe incidence of some cutaneous pathologies, for example,malignant melanoma, and the presence of endocrine dis-rupting chemicals in biological samples, the present resultsare puzzling. Further studies on the subject are necessary toclarify this relationship.

In the paper entitled “Pruritus in female patients,” JMRGLambert reviews the global understanding about pruritusaffecting some women. Pruritus is a frequent symptom in anumber of skin diseases. This review was focused on specificitch problems specific to women, namely, pruritic vulvardermatoses, and specific pruritic dermatoses of pregnancy.The characteristics of the vulva and the hormonal changesduring the different age periods make these dermatosesvery particular. It seems that vulvar diseases remain under-diagnosed and undertreated. Pruritic vulvar diseases have asevere impact on quality of life. The most common pruriticdiseases concern atopic and contact dermatitis, psoriasis,lichen sclerosus, lichen planus, and infectious vulvovaginitis.The diagnostic issues of these diseases are discussed and thegeneral principles of therapy are covered.

In the paper entitled “The female pattern hair loss in2013: Review of etiopathogenesis and diagnosis,” A. Vujovicand V. Del Marmol review concepts regarding female pat-tern hair loss (FPHL), representing the most common hairloss disorder in women. Initial signs possibly develop inteenagers leading to a progressive hair loss with a charac-teristic distribution pattern. The condition is characterizedby progressive replacement of terminal hair follicles overthe frontal and vertex regions by miniaturized follicles. This

evolution leads progressively to a perceptible reduction inhair density. Women diagnosed with FPHL may undergosignificant impairment of quality of life. FPHL diagnosis ismostly clinical. Depending on patient history and clinicalevaluation, further diagnostic testing is occasionally useful.

In the paper entitled “Female gender and acne disease arejointly and independently associated with the risk of majordepression and suicide: a national population-based study,”Y. C. Yang et al. address the association of acne, poor self-esteem, and social phobia in Taiwanese people. Previousstudies based on questionnaires from several thousand ado-lescents had showed that acne was particularly associatedwith major depression and suicide. Using a 2006 databasefrom the National Health Insurance in Taiwan, patientswith acne, major depression, and suicide were considered.A total of 51689 patients with acne were identified (17974males and 33715 females) from 1 million subjects. The youths(7–12 years) had the highest prevalence of acne (15.87%).Major depression was more common in patients with acne(0.76%) than in controls (0.56%, 𝑃 < 0.0001) regardlessof gender. Multiple logistic regressions showed an increasedrisk to major depression in women without acne. The riskwas further increased in women with acne. Similar increasedrisk of suicide was noticed in acneic women. In conclusion,acne and gender, independently and jointly, are associatedwith major depression and suicide. Special medical supportshould bewarranted in females with acne for the risk ofmajordepression and suicide.

The paper entitled “Psoriasis: female skin changes invarious hormonal stages throughout life—puberty, pregnancy,and menopause,” by R. Ceovic et al., discusses the fateof psoriasis in women. Stress greatly affects both the hor-mone and immune systems. The severity of psoriasis oftenfluctuates or is influenced with each hormonal phase inwomen and this relationship affects some disease frequenciespeaking at puberty, during postpartum, and menopause,while symptoms improve during pregnancy.

The paper entitled “Vulvar skin disorders throughoutlifetime: main dermatoses,” by J. Doyen et al., addresses fourrepresentative vulvar dermatoses. Lichen simplex chronicusis a pathological condition related to friction. Such detri-mental effects in the presence of other dermatoses have tobe considered when therapeutic responses are unsatisfactory.Lichen sclerosus is a common vulvar dermatosis particularlyin the elderly. Lichen planus is a distinct entity. Paget’sdisease, although a rare condition, represents a clinical andtherapeutic challenge.

The paper entitled “A clinical and pathological overviewof vulvar condyloma acuminatum, intraepithelial lesions, andsquamous cell carcinoma,” by B. Leonard et al., is focused onsome vulvar epithelial neoplasms. Condyloma acuminatum,intraepithelial neoplasia, and squamous cell carcinoma arethree common vulvar lesions. Condyloma acuminatum isinduced by low risk genotypes of human papillomavirus(HPV). Vulvar intraepithelial neoplasia (VIN) and squamouscell carcinoma have different etiopathogenic pathways andare related or not with high risk HPV types. This articlereviews the main pathological and clinical features of these

BioMed Research International 3

lesions. A special attention is paid to epidemiology, patholog-ical classification, and clinical implications of these diseases.

The paper entitled “Streamlining cutaneous melanomas inyoung women of the Belgian Mosan region,” by T. Hermanns-Le and S. Pierard, is a review article focused on sporadiccutaneous melanomas (SCM) developing in women duringtheir childbearing age.This neoplasmhas shown an increasedincidence over the past few decades. The vast majority ofthese SCM were of the superficial type without any obviousrelationship with a large number of melanocytic nevi. Signsof frequent and intense sunlight exposure were not disclosedby the extent in the mosaic subclinical melanoderma. Aseries of investigations point to a possible relationship linkingthe development of some of these SCM with the womenhormonal status including the effect of hormonal disruptors.These aspects remain, however, unsettled and controversial.It is possible to differentiate and clearly quantify the SCMshape, size, scalloped border, and variegated pigmentationusing computerized morphometry as well as fractal andmultifractal methods.

We hope this special issue will not only help to under-stand and diagnose some skin disorders typically foundin women, but also reinforce the development of bettermanagement modalities for these women skin disorders.

Gerald E. PierardCorinne CharlierPhilippe DelvennePhilippe Humbert

Claudine Pierard-Franchimont

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