Skin Diseases in Females

Contents
Contributors
Part I: Clinical Dermatology
Chapter 1: Physiology of Skin: Gender-Based Differences
1.1 Introduction
1.2 Hormonal Influence on Skin
1.3 Facial and Body Hair
1.4 Skin Thickness and Elasticity
1.5 Sebum
1.6 Sweat
1.7 Surface pH
1.8 Skin Tone
1.9 Muscle Mass and Body Fat
1.10 Cutaneous Vasculature
1.11 Skin Sensorial Properties
1.12 Response to Exogenous Triggers
1.13 Immune System and Skin Cancer
1.14 Cosmetic and Dermatological Implications of Gender-Based Differences in Skin
1.15 Skin Changes in Females at Puberty
1.16 Hormonal Control of Puberty
1.17 Önset of Puberty in Girls
1.18 Skin Changes in Puberty
1.18.1 Skin Pigmentation
1.18.2 Hair Distribution
1.18.3 Skin Microbiome
1.19 Dermatological Problems Associated with Puberty
References
Chapter 2: Pregnancy-Specific Dermatoses
2.1 Atopic Eruption of Pregnancy
2.1.1 Introduction
2.1.2 Etiopathogenesis
2.1.3 Clinical Features
2.1.4 Pathology
2.1.5 Treatment
2.2 Polymorphic Eruption of Pregnancy
2.2.1 Introduction
2.2.2 Etiopathogenesis
2.2.3 Clinical Features
2.2.4 Pathology
2.2.5 Treatment
2.3 Intrahepatic Cholestasis of Pregnancy
2.3.1 Introduction
2.3.2 Etiopathogenesis
2.3.3 Clinical Features
2.3.4 Pathology and Investigations
2.3.5 Treatment
2.4 Pemphigoid Gestationis
2.4.1 Introduction
2.4.2 Etiopathogenesis
2.4.3 Clinical Features
2.4.4 Pathology
2.4.5 Treatment
2.5 Pustular Psoriasis of Pregnancy
2.5.1 Introduction
2.5.2 Etiopathogenesis
2.5.3 Clinical Features
2.5.4 Pathology
2.5.5 Treatment
References
Chapter 3: Skin in Pregnancy
3.1 Physiological Skin Changes in Pregnancy
3.1.1 Introduction
3.1.2 Pigmentation
3.1.2.1 Melasma
3.1.3 Vascular Changes
3.1.3.1 Varicosities
3.1.3.2 Edema of Pregnancy
3.1.3.3 Spider Angioma
3.1.3.4 Palmar Erythema
3.1.4 Connective Tissue Changes
3.1.4.1 Striae Distensae
3.1.5 Glandular Activity
3.1.5.1 Eccrine Glands
3.1.5.2 Sebaceous Glands
3.1.5.3 Apocrine Glands
3.1.6 Hair Changes
3.1.6.1 Hirsutism
3.1.7 Nail Changes
3.1.8 Breast
3.1.9 Mucosa
3.2 Dermatologic Drugs in Pregnancy
3.2.1 Topical Dermatology Drugs in Pregnancy
3.3 Systemic Dermatologic Drugs in Pregnancy
3.3.1 Safety of Systemic Drugs in Pregnancy is Described in Table 3.4
3.3.1.1 Biologicals in Pregnancy (Table 3.5)
3.3.2 Cosmetic Procedures in Pregnancy: Table 3.6 [76]
References
Chapter 4: Skin Changes in Menopause
4.1 Introduction
4.2 Physiological Changes
4.2.1 Collagen
4.2.2 Elastin
4.2.3 Elasticity
4.2.4 Water
4.2.5 Thickness of Skin
4.2.6 Blood Flow
4.3 Sebaceous Glands and Hair
4.4 Wound Healing
4.5 Skin Thickness
4.6 Elasticity and Distensibility
4.7 Wrinkles
4.8 Blood Flow
4.9 Estrogen-Deficient Skin: Role of Topical Estrogen
4.9.1 Topical Estrogen
4.10 Cutaneous complication of Hormone Replacement Therapy
References
Chapter 5: Acne in Women
5.1 Introduction
5.2 Adult Female Acne (AFA)
5.2.1 Definition
5.2.2 Clinical Presentation
5.2.3 Etiology
5.2.3.1 Genetics
5.2.3.2 Hormones
5.2.3.3 Other Factors
5.2.3.3.1 Epidermal Barrier Function
5.2.3.3.2 Diet
5.2.3.3.3 Drugs
5.2.3.3.4 Stress
5.2.3.3.5 Cosmetics
5.2.3.3.6 Tobacco
5.2.3.3.7 Endocrine Diseases
5.2.4 Role of Polycystic Ovary Syndrome (PCOS)
5.2.4.1 Definition
5.2.4.2 Epidemiology
5.2.4.3 Manifestations and Pathophysiology
5.2.4.4 Evaluation Considerations
5.2.4.5 Laboratory Investigations
5.2.4.6 Treatment
5.2.4.6.1 Nonhormonal
5.2.4.6.2 Hormonal*
5.2.4.6.3 Other Drugs
Metformin
Thiazolidinediones
5.2.4.7 Prognosis
5.2.5 Role of Hormonal Treatment in Women
5.2.5.1 The Hormones Implicated in Acne Pathogenesis
5.2.5.2 Endocrinal Evaluation in Patients with Suspected Hormonal Acne
5.2.5.3 Laboratory Tests in Patients with Suspected Hormonal Acne
5.2.5.4 Hormonal Agents
5.2.5.4.1 Combination Oral Contraceptive Pills (COC)
5.2.5.4.2 Spironolactone
5.2.5.4.3 Flutamide
5.2.5.4.4 Prednisone
5.2.5.4.5 Cyproterone Acetate (CPA)
5.2.5.4.6 Drospirenone
5.2.5.4.7 GRH Agonists
5.2.5.4.8 Cortexolone 17α-Propionate
5.3 Acne in Pregnancy
5.3.1 Epidemiology
5.3.1.1 Factors to Consider Among Pregnant Women with Acne
5.3.1.1.1 Previous History of Pre-pregnancy Acne
5.3.1.1.2 Menstrual Cycle History
5.3.1.1.3 Age of Pregnant Women with Acne
5.3.1.1.4 Gravidity/Parity
5.3.1.1.5 Distribution of Acne Lesions
5.3.1.1.6 Severity of Acne Lesions
5.3.1.1.7 Medical Conditions
5.3.1.1.8 Smoking/Alcohol Consumption Continued While Pregnant
5.3.1.1.9 Effect of Previous Medications on Acne in Pregnancy
5.3.2 Pathogenesis
5.3.2.1 Gestational Hormone Status
5.3.3 Management of Acne in Pregnancy
5.3.3.1 Topical Agents
5.3.3.1.1 Maybe Recommended Are the Following
Azelaic Acid
Benzoyl Peroxide
Salicylic Acid
Sodium Sulfacetamide
Topical Antibiotics—Erythromycin and Clindamycin
5.3.3.1.2 To Be Used with Caution
Topical Dapsone
5.3.3.1.3 Not Recommended Are the Following
Topical Retinoids (Tretinoin, Adapalene, Tazarotene)
Tretinoin
Adapalene
Tazarotene
5.3.3.1.4 No Pregnancy/Lactation Rating
Clascoterone
5.3.3.2 Systemic Agents
5.3.3.2.1 May Be Given, as the Situation Calls for
Oral Antibiotics
Macrolide Erythromycin (250 mg-500 mg, 2-4× a day)
Macrolide Azithromycin (Variable Dosing; 250 mg 3× a Day)
Beta-Lactam Amoxicillin (250–500 mg 2× a Day)
Beta-Lactam Cephalexin (500 mg 2× a Day)
Nitroimidazole Metronidazole (250 mg 2× a Day)
Trimethoprim-Sulfamethoxazole (TMP/SMX) (160/800 mg 2× a Day)
5.3.3.2.2 Oral Corticosteroids
Prednisone (≤20 mg/day for not more than 4 Weeks)
5.3.3.2.3 Supplements
Zinc (Zn Gluconate < 75 mg/Day)
5.3.3.2.4 Contraindicated
Tetracyclines
Spironolactone
Isotretinoin*
5.3.3.3 Procedural Options
5.3.3.3.1 Intralesional Steroid Injection for Cystic Acne Lesions
5.3.3.3.2 Chemical Peels
Glycolic Acid
Lactic Acid
Salicylic Acid
Jessner’s Solution
Trichloroacetic acid (TCA)
5.3.3.3.3 Photodynamic Therapy (PDT)
Aminolevulinic acid (ALA)
Narrowband Ultraviolet B Phototherapy
5.4 Isotretinoin in Women
5.4.1 What Pharmacokinetics Tell us
5.4.2 Where Isotretinoin Stands in the Management of Acne Vulgaris
5.4.3 Opening the Doors to Other Modes of Dosaging
5.4.4 The Need for Monitoring Laboratory Parameters
5.4.5 Dealing with Pertinent Concerns when Taking Isotretinoin
5.4.5.1 Pregnancy
5.4.5.2 Adverse Effects
5.4.5.3 Acne Flare
5.4.5.4 Dermatological Procedures while on Isotretinoin
5.4.5.5 Depression
5.4.5.6 Inflammatory Bowel Disease [IBD]
5.4.6 Isotretinoin May Not be for Acne Management Alone
5.4.7 Life with Isotretinoin Intake
References
Chapter 6: Topical Steroid Damaged Face in Females with Skin of Colour
6.1 Introduction
6.2 Epidemiology
6.3 Pathogenesis
6.4 Clinical Presentation
6.5 Management
6.6 Conclusion
References
Chapter 7: Rosacea
7.1 Introduction
7.2 Epidemiology
7.3 Clinical Presentation
7.4 Trigger Factors
7.5 Dermoscopy and Histopathology
7.6 Rosacea Fulminans
7.7 Acquired Forms of Rosacea
7.8 Treatment
7.8.1 Erythema
7.8.2 Telangiectasia
7.8.3 Papules and Pustules
7.8.4 Phymas
7.9 Associated Conditions
7.10 Conclusion
References
Chapter 8: Hidradenitis Suppurativa
8.1 Introduction
8.2 Aetiopathogenesis [5–11]
8.3 Factors Involved in Immune Pathogenesis of HS
8.3.1 Genetics [12]
8.3.2 Microbiome: Role of Antimicrobial Peptides (AMP), Pathogen Recognition Receptors (PRR) and Biofilm [13]
8.3.2.1 AMP—Antimicrobial Peptide [14]
8.3.2.2 PRR—Pathogen Recognition Receptors
8.3.2.3 Biofilm formation [5]
8.3.3 Smoking [14–16]
8.3.4 Obesity, Hormones and Insulin Resistance [17–22]
8.3.5 Sphingolipids [23]
8.3.6 Keratin Defects
8.4 Diagrammatic Representation
8.5 Stages in Development of HS (Figs. 8.1, 8.2, and 8.3) [24]
8.6 Factors Playing Role in Immune Pathogenesis [25–27]
8.6.1 Receptors
8.6.2 Cytokines, Complement and Inflammasomes in HS
8.6.3 Inflammatory Cells Recruited at Site
8.6.4 Net Effect
8.7 Immunopathogenesis of HS [28, 29]
8.8 Comorbid Conditions Associated with HS [30–33]
8.9 Follicular Occlusion Triad, Tetrad and Other Syndromes Associated with HS
8.10 Investigations [36]
8.11 Sonographic Staging [37]
8.12 Other Investigations [38]
8.13 Clinical Features [38]
8.14 Distribution [38]
8.15 Other Staging Systems [40–44]
8.16 Differential Diagnosis [38]
8.17 Management [45–48]
8.18 General Care [38, 49]
8.19 Medical Management [38, 49, 50]
8.19.1 Therapeutic Targets
8.19.2 Antibiotics
8.19.3 Other Antibiotics
8.19.4 Antibiotic Strategies
8.19.5 Antibiotic Resistance in HS
8.19.6 Anti-Inflammatory Agents
8.19.7 Pros and Cons of Immunosuppressive Therapy
8.19.8 Hormonal Therapy [51]
8.19.9 Pros and Cons of Hormonal Therapy
8.19.10 Retinoids
8.19.11 Pros and Cons of Retinoid Therapy
8.19.12 Antidiabetics
8.19.13 Other Therapies
8.19.14 Biologics [45, 46]
8.19.15 Adalimumab
8.19.16 TB Screening Guidelines [47]
8.19.17 Interpretation of Results
8.19.18 Dosing Schedule of Adalimumab
8.19.19 Other Biologics and Small Molecules
8.19.20 Laser and Light-Based Devices in HS [48–54]
8.19.21 Surgical Treatment In HS [55, 56]
8.20 Conclusion
References
Chapter 9: Pigmentary Disorders in Women
9.1 Vitiligo
9.1.1 Epidemiology
9.1.2 Clinical Features
9.1.3 Pathogenesis
9.1.4 Vitiligo and Pregnancy
9.1.5 Investigations
9.1.6 Treatment
9.1.6.1 Topical
9.1.6.1.1 Topical Corticosteroids (TCS)
9.1.6.1.2 Topical Immunomodulators
9.1.6.1.3 Topical Calcipotriol
9.1.6.2 Systemic
9.1.6.2.1 Systemic Steroids
9.1.6.2.2 Systemic Immunosuppressants
9.1.6.3 Phototherapy
9.1.6.4 Other Therapies
9.1.6.4.1 Antioxidants
9.1.6.4.2 Depigmentation
9.1.6.5 Surgical Management
9.1.6.6 Newer Drugs
9.1.7 Vitiligo and Quality of Life
9.2 Melasma
9.2.1 Epidemiology
9.2.2 Etiology
9.2.3 Pathogenesis
9.2.4 Clinical Features
9.2.5 Dermatoscopy
9.2.6 Histopathology
9.2.7 Treatment
9.2.7.1 Topical Depigmenting Agents
9.2.7.2 Oral Therapy
9.2.7.3 Chemical Peels
9.3 Periocular Hyperpigmentation
9.3.1 Epidemiology
9.3.2 Etiology and Pathogenesis
9.3.3 Clinical Features
9.3.4 Dermatoscopy
9.3.5 Management
9.4 Lichen Planus Pigmentosus
9.4.1 Epidemiology
9.4.2 Etiopathogenesis
9.4.3 Clinical Features
9.4.4 Dermatoscopy
9.4.5 Histopathology
9.4.6 Treatment
9.5 Pigmented Contact Dermatitis
9.5.1 Etiopathogenesis
9.5.2 Clinical Features
9.5.3 Dermatoscopy
9.5.4 Histopathological Findings
9.5.5 Role of Patch Test in PCD
9.5.6 Management
References
Chapter 10: Eczemas in Women
10.1 Atopic Dermatitis (Atopic Eczema)
10.2 Burden of Mothers of Children with AD
10.3 Contact Dermatitis
10.4 Irritant Contact Dermatitis
10.5 Allergic Contact Dermatitis
10.6 Photocontact Dermatitis
10.7 Drug Photosensitivity
10.8 Dyshidrotic Eczema
References
Chapter 11: Metabolic Syndrome: Dermatological Aspects in Women
11.1 Introduction
11.2 Acrochordons
11.3 Acanthosis Nigricans
11.4 Hirsutism
11.5 Hidradenitis Suppurativa
11.6 Androgenetic Alopecia
11.7 Rosacea
11.8 Acne Vulgaris
11.9 Systemic Lupus Erythematosus
11.10 Atopic Dermatitis
11.11 Miscellaneous Dermatoses
11.12 Conclusion
References
Chapter 12: Body Dysmorphic Disorder in Females
12.1 Introduction
12.2 History
12.3 Current Status
12.4 Epidemiology
12.5 Aetiopathogenesis
12.6 Clinical Features
12.7 Areas of Concern in Females
12.8 Differential Diagnosis
12.9 Comorbidities
12.10 Adverse Effects/Complications
12.11 Prognosis
12.12 Diagnosis of BDD
12.13 Management of BDD
12.13.1 Non-pharmacological Management
12.13.2 Motivational Interviewing (MI) [38]
12.13.2.1 Resist the Righting Reflex
12.13.2.2 Understanding the Patient’s Own Motivation
12.13.2.3 Listen with Empathy
12.13.2.4 Empower the Patient
12.14 Psychoeducation
12.15 Exposure and Response Prevention (E/RP) [40]
12.16 Cognitive strategies [46]
12.17 Mirror Retraining and Attention Training
12.18 Medical Management (Pharmacotherapy) of BDD
12.18.1 SSRI Augmentation Therapies
12.18.2 Therapeutic Prognosis
References
Chapter 13: DLQI in Females: Important Disorders with Low DLQI
13.1 Quality-of-Life Instruments in Dermatology
13.2 Dermatology Life Quality Index (DLQI)
13.3 Dermatology Life Quality Index (DLQI) in Women
13.3.1 Psoriasis
13.3.1.1 Psoriasis in Pregnancy
13.3.1.2 Biologic Agents
13.3.2 Hidradenitis Suppurativa
13.3.2.1 Hidradenitis Suppurativa and Quality of Life in Women
13.3.3 Autoimmune Blistering Disorders
13.3.3.1 Pregnancy and AIBD
13.3.4 Vitiligo
13.3.5 Acne Vulgaris
13.3.6 Alopecia
13.3.7 Hirsutism
13.4 Conclusion
References
Chapter 14: Hair Disorders in Females
14.1 Anatomy and Physiology of Hair
14.2 Classification of Hair Disorders in Females
14.2.1 Female Pattern Hair Loss
14.2.1.1 Epidemiology
14.2.1.2 Pathogenesis
14.2.1.3 Clinical Features
14.2.1.4 Associations
14.2.1.5 Investigations
14.2.1.6 Treatment
14.2.2 Telogen Effluvium
14.2.2.1 Etiopathogenesis
14.2.2.1.1 Premature Teloptosis
14.2.2.1.2 Collective Teloptosis
14.2.2.1.3 Premature Entry into Telogen Phase
14.2.2.2 Bedside Tests
14.2.2.3 Investigations
14.2.2.3.1 Acute Telogen Effluvium
14.2.2.3.2 Chronic Telogen Effluvium (CTE)
14.2.2.4 Chronic Diffuse Telogen Hair Loss
14.2.3 Hirsutism
14.2.3.1 Severity Score
14.2.3.2 Investigations (Table 14.3)
14.2.3.3 Treatment
14.2.4 Alopecia Areata
14.2.4.1 Epidemiology
14.2.4.2 Predisposing Factors
14.2.4.3 Pathogenesis
14.2.4.4 Clinical Features
14.2.4.5 Variants of AA
14.2.4.6 Associations
14.2.4.7 Investigations
14.2.4.8 Differential Diagnosis
14.2.4.9 Treatment
14.2.4.10 Prognosis
14.2.5 Lichen Planopilaris
14.2.5.1 Epidemiology
14.2.5.2 Pathogenesis
14.2.5.3 Clinical Features
14.2.5.4 Investigations
14.2.5.5 Treatment
14.3 Hair Loss in Lupus Erythematosus
14.3.1 Pseudopelade of Brocq
14.3.1.1 Epidemiology
14.3.1.2 Etiopathogenesis
14.3.1.3 Clinical Features and Investigations
14.3.1.4 Diagnostic Criteria
14.3.1.5 Prognosis
14.3.1.6 Treatment
14.3.2 Trichotillomania
14.3.2.1 Diagnostic Criteria for Trichotillomania
14.3.2.2 Epidemiology
14.3.2.3 Clinical Features
14.3.2.4 Investigations (Table 14.1)
14.3.3 Traction Alopecia
14.3.3.1 Epidemiology and Pathogenesis
14.3.3.2 Clinical Features and Investigations
14.3.3.3 Treatment
14.3.4 Central Centrifugal Cicatricial Alopecia
14.3.4.1 Epidemiology
14.3.4.2 Pathogenesis
14.3.4.3 Clinical Features and Investigations
14.3.4.4 Treatment
14.4 Hair Shaft Disorders
14.5 Premature Canities
14.6 Pigmentary Disorders
References
Chapter 15: Nail Diseases in Women
15.1 Introduction
15.2 Physiologic Nail Changes in Women
15.3 Nail Cosmetics and Women
15.3.1 Manicure and Pedicure
15.3.2 Nail Polish and Removers
15.3.3 Sculptured/Artificial Nails
15.3.3.1 Gel Nails
15.3.4 Nail Hardeners
15.3.5 Onychocosmeceuticals [46]
15.3.6 Nail Care Oils
15.3.7 Risks to Salon Employees
15.4 Nail Disorders in Women
15.4.1 Brittle Nails
15.4.2 Paronychia
15.4.3 Onycholysis
15.4.4 Nail Tic Disorders
15.4.5 Ingrown Nail
15.4.6 Subungual and Periungual Warts
15.4.7 Onychomycosis
15.4.8 Nail Tumors
15.5 Conclusion
References
Chapter 16: Tropical Diseases in Women
16.1 Introduction
16.2 Leprosy
16.2.1 Epidemiology
16.2.2 Leprosy Transmission
16.2.2.1 Role of Women in Leprosy Transmission
16.2.2.2 Leprosy Spectrum
16.2.3 Pure Neuritic Leprosy
16.2.4 Histoid Leprosy
16.2.5 Lucio Leprosy
16.2.6 Lepra Reaction
16.2.6.1 Type 1 Lepra Reaction
16.2.6.2 Type 2 Lepra Reaction
16.2.7 Lazarine Leprosy
16.2.8 Lucio Phenomenon
16.2.9 Leprosy and Pregnancy
16.2.10 Effect of Leprosy on Fertility Status and Menstrual Cycle
16.2.11 Diagnosis of Leprosy
16.2.12 Investigations
16.2.12.1 Slit Skin Smear and Ziehl–Neelsen Staining
16.2.12.2 Morphological Index (MI)
16.2.12.3 Histopathology of Skin and Nerve
16.2.12.4 FNAC of Skin Lesions and Nerve
16.2.13 Advanced Diagnostic Methods
16.2.13.1 Serological Assay
16.2.14 Polymerase Chain Reaction (PCR)
16.2.14.1 Nerve Conduction Study
16.2.15 High Resolution Ultrasonography (HRUS)
16.2.16 Management of Leprosy
16.2.17 Treatment of Type 1 Lepra Reaction
16.2.17.1 Dose of Steroid in T1R Recommended as per WHO for the Field Purpose
16.2.17.2 Dose of Steroid in T1R at Referral Centres
16.2.18 Treatment of Type 2 Lepra Reaction
16.2.18.1 Severity Grading of T2R (Table 16.5)
16.2.18.2 Deformities in Leprosy in Females
16.2.18.3 WHO Grading of Deformities in Leprosy [66]
16.2.18.4 Leprosy and Stigma in Female
16.3 Cutaneous Tuberculosis
16.3.1 Tuberculosis Verrucosa Cutis (TVC)
16.3.2 Lupus Vulgaris (LV)
16.3.3 Scrofuloderma
16.3.4 Tuberculous Chancre
16.3.5 Tuberculous Gumma
16.3.6 Orificial Tuberculosis
16.3.7 Acute Miliary Tuberculosis
16.3.7.1 Histopathological Findings of Different Types of Cutaneous Tuberculosis
16.3.8 Tuberculids
16.3.8.1 Papulonecrotic Tuberculid
16.3.8.2 Lichen Scrofulosorum
16.3.8.3 Erythema Induratum of Bazin
16.3.9 Treatment of Cutaneous Tuberculosis
16.4 Atypical Mycobacteria
16.4.1 Classification of Atypical Mycobacterium Species [87]
16.4.2 Cutaneous Manifestation of Atypical Mycobacterial Infection (Table 16.11)
16.5 Mycetoma
16.6 Leishmaniasis
16.7 Schistosomiasis
16.8 Dracunculiasis/Guinea Worm
16.9 Onchocerciasis
16.10 Lymphatic Filariasis
References
Chapter 17: Vulvar Disorders
17.1 Clinical Examination
17.2 Investigations
17.3 Normal Variants
17.4 Vulvar Dermatoses
17.5 Infections
17.6 Vulvovaginal Candidiasis
17.7 Bacterial Infections
17.7.1 Contact Dermatitis
17.7.2 Lichen Simplex Chronicus
17.7.3 Lichen Planus
17.7.4 Lichen Sclerosus
17.7.5 Psoriasis
17.7.6 Plasma Cell Vulvitis
17.8 Pigmentary Disorders
17.8.1 Vitiligo
17.8.2 Acanthosis Nigricans
17.8.3 Benign Lesions
17.9 Premalignant Conditions of the Vulva
17.9.1 Vulvar Intraepithelial Neoplasia
17.9.2 Vulvar Paget’s Disease
17.9.3 Squamous Cell Carcinoma
17.10 Miscellaneous Conditions
17.10.1 Vulvar Edema
17.10.2 Vulvodynia
17.10.3 Red Vulva Syndrome
17.11 Summary
References
Chapter 18: Sexually Transmitted Diseases in Females
18.1 Introduction
18.2 Bacterial STDs
18.2.1 Syphilis
18.2.1.1 Epidemiology
18.2.1.2 Clinical Features
18.2.1.3 Diagnosis
18.2.1.4 Treatment
18.2.1.5 Partner Management
18.2.2 Chancroid
18.2.2.1 Epidemiology
18.2.2.2 Clinical Features
18.2.2.3 Diagnosis
18.2.2.4 Management
18.2.3 Lymphogranuloma Venereum (LGV)
18.2.3.1 Epidemiology
18.2.3.2 Clinical Features
18.2.3.3 Diagnosis
18.2.3.4 Management
18.2.4 Donovanosis
18.2.4.1 Epidemiology
18.2.4.2 Clinical Features
18.2.4.3 Diagnosis
18.2.4.4 Management
18.2.5 Gonorrhoea and Chlamydia
18.2.5.1 Epidemiology
18.2.5.2 Clinical Features
18.2.5.3 Diagnosis
18.2.5.3.1 Gonorrhoea
18.2.5.3.2 Chlamydia
18.2.5.4 Management
18.2.6 Bacterial Vaginosis (BV)
18.2.6.1 Epidemiology
18.2.6.2 Clinical Features
18.2.6.3 Diagnosis
18.2.6.4 Management
18.3 Viral STDs
18.3.1 Herpes Genitalis
18.3.1.1 Epidemiology
18.3.1.2 Clinical Features
18.3.1.3 Diagnosis
18.3.1.4 Management
18.3.2 Genital Warts
18.3.2.1 Epidemiology
18.3.2.2 Clinical Features
18.3.2.3 Diagnosis
18.3.2.4 Management
18.3.3 Molluscum Contagiosum
18.3.3.1 Epidemiology
18.3.3.2 Clinical Features
18.3.3.3 Diagnosis
18.3.3.4 Management
18.3.4 Hepatitis Virus
18.4 Fungal and Protozoal STDs
18.4.1 Vulvovaginal Candidiasis (VVC)
18.4.1.1 Epidemiology
18.4.1.2 Clinical Features
18.4.1.3 Diagnosis
18.4.1.4 Management
18.4.2 Trichomoniasis
18.4.2.1 Epidemiology
18.4.2.2 Clinical Features
18.4.2.3 Diagnosis
18.4.2.4 Management
18.5 Pelvic Inflammatory Disease
18.5.1 Epidemiology
18.5.2 Clinical Features
18.5.3 Diagnosis
18.5.4 Management
18.6 Conclusion
References
Chapter 19: Challenges faced by women Dermatologists and Training Programs available to them
Part II: Aesthetic Dermatology
Chapter 20: Treatment of the Aging Face
20.1 Introduction
20.2 Pathophysiology of Aging
20.2.1 Anatomy of Aging
20.2.1.1 Bones
20.2.1.1.1 Orbit
20.2.1.1.2 Maxilla
20.2.1.1.3 Mandible
20.2.1.2 Mimetic Muscles and Ligaments
20.2.1.3 Subcutaneous Fat
20.2.2 Clinico-Pathological Features of Aging
20.2.3 Assessment Tools for Objective Improvement of Aging
20.3 Female Facial Esthetics
20.3.1 Signs of Aging
20.4 Preventative Treatment of Aging
20.4.1 Skin Care
20.4.2 Topical Antiaging Agents
20.4.3 Minimally Invasive Antiaging Treatments
20.4.3.1 Treatment of Structural Changes
20.4.3.1.1 Treatment of Wrinkles
20.4.3.1.2 Treatment of Folds
20.4.3.1.3 Volume Restoration
20.4.3.1.4 Treatment of Sagging
20.4.3.2 Laser and Energy-Based Devices
20.5 Conclusion
References
Chapter 21: The Sensitive Skin: Do’s and Don’ts
21.1 Introduction
21.2 Pathophysiology of Sensitive Skin
21.3 General Skin Care of Sensitive Skin
21.4 Step 1: Identify and Avoid the Potential Source
21.5 Step 2: Care of Any Underlying or Accompanying Cutaneous Disorders
21.6 Step 3: Repair the Disrupted Cutaneous Barrier—Moisturizers and Novel Formulations
21.7 Step 4: Restart of Cosmetics (If Needed) and Cosmetics for Sensitive Skin
21.8 Emotional and Psychological Support
21.9 The COVID-19 Pandemic and Care of Sensitive Skin
References
Chapter 22: A Guide to Botulinum Toxin and Fillers
22.1 Introduction
22.2 Botulinum Toxin
22.3 Mechanism of Action
22.4 Handling, Storage and Dilution
22.5 Indications of Use
22.6 Common Indications of Botox
22.7 Side Effects and Contraindications
22.8 Dermal Fillers
22.9 Types of Dermal Fillers
22.10 HA Fillers
22.11 Rheology
22.12 Assessment of the Patient
22.13 Common Indications of HA Fillers
22.14 Complications
22.15 Conclusion
References
Chapter 23: Chemical Peels: Special Considerations
23.1 Introduction
23.2 Male Versus Female Skin: What We Should Know Prior to Peels
23.2.1 Classification
23.2.2 Alpha Hydroxy Acids
23.2.3 Trichloroacetic Acid (TCA)
23.2.3.1 The Baker–Gordon Peel
23.2.3.2 Side Effects: [40]
23.2.4 Peels in Pregnancy: Table 23.7
23.3 Fundamentals of Peeling
23.3.1 Chemical Peel Consultation
23.3.1.1 History
23.3.1.2 Examination: [15, 17]
23.3.1.3 Documentation
23.3.1.4 Pre-peel Priming of Skin
23.3.1.5 Test Spot Testing
23.3.1.6 Steps of Peeling
23.3.1.7 General Considerations
23.3.1.8 Post-Peel
23.4 Conclusion
References
Chapter 24: Lasers: Special Considerations in Women
24.1 Rosacea
24.2 Melasma
24.3 Hirsutism
24.4 Lichen Sclerosus
24.5 Connective Tissue Diseases
24.6 Syringomas
24.7 Acne and Post-acne Scars
24.8 Notalgia Paresthetica
24.9 Lasers During Pregnancy and Lactation
References
Chapter 25: Treatment of Cellulite
25.1 Introduction
25.2 Histopathology
25.3 Pathophysiology
25.4 Etiopathogenesis
25.4.1 Anatomical and Hormonal Alterations
25.4.2 Vascular Alterations
25.4.3 Inflammatory Factors
25.5 Differential Diagnosis
25.6 Classification
25.7 Treatment
25.7.1 Past Treatment Modalities for Cellulite
25.7.2 Noninvasive Treatments Without the Use of Biologically Active Substances
25.7.3 Noninvasive Treatments with Biologically Active Substances
25.7.4 Invasive Treatments with Biologically Active Substances
25.7.5 Invasive Treatments Without Biologically Active Substances
25.8 Conclusion
References
Chapter 26: Breast Augmentation: Cutaneous Aspects and Complications
26.1 Introduction
26.2 Anatomy of the Breast and the Effects of Ageing
26.2.1 Anatomy of the Breast and Its Practical Implications
26.2.2 Age-Related Changes
26.2.2.1 Caudal Nipple Deviation
26.2.2.2 Volume of the Breast
26.2.2.3 Ptosis
26.2.2.4 Changes in the Skin Overlying the Breast
26.2.2.4.1 Autologous Fat Grafting
26.3 Surgical Breast Augmentation
26.3.1 Indications for Breast Augmentation
26.3.1.1 Surgical Implantation
26.3.1.2 Autologous Fat Grafting
26.3.2 Complications
26.3.2.1 Surgical Breast Lift/Mastopexy
26.4 Non-surgical Breast Augmentation and Breast Lift
26.4.1 Non-surgical Procedures for Breast Firmness and Lift
26.4.1.1 Radiofrequency Type Devices
26.4.1.1.1 Indications
26.4.1.1.2 Contraindications
26.4.1.1.3 Principle
26.4.1.1.4 Types
Bipolar Radiofrequency Device
Monopolar Radiofrequency Device
26.4.1.1.5 Procedure
Results
26.4.1.1.6 Complications
26.4.1.2 Threads
26.4.1.2.1 Principle
26.4.1.2.2 Indications
26.4.1.2.3 Contraindications and Precautions
26.4.1.2.4 Procedure
26.4.1.2.5 Results
26.4.1.2.6 Advantages
26.4.1.2.7 Complications
26.4.1.3 Other Modalities for Breast Lift and Firmness
26.4.2 Non-surgical Procedures for Breast Augmentation
26.4.2.1 Breast Fillers
26.4.2.1.1 Principle
26.4.2.1.2 Indications
26.4.2.1.3 Contraindications and Precautions
26.4.2.1.4 Procedure
26.4.2.1.5 Results
26.4.2.1.6 Complications (Table 26.7)
26.5 Conclusion
References
Chapter 27: Vaginal Rejuvenation
27.1 Introduction
27.2 Anatomy of the Female Genitalia and Age-Related Changes
27.3 Vaginal Rejuvenation
27.3.1 Surgical Vaginal Rejuvenation and Female Genital Cosmetic Surgery
27.3.2 Nonsurgical Vulvovaginal Rejuvenation
27.3.3 Concerns Regarding Safety
27.3.4 Patient Evaluation
27.3.5 Techniques for Nonsurgical Vaginal Rejuvenation
27.3.5.1 Energy-Based Devices
27.3.5.1.1 Radiofrequency Devices
Principle
Technique
Results
Complications
27.3.5.1.2 Lasers
CO2 Laser (Ablative)
Principle
Technique
Results
Side Effects and Complications
Er-YAG Laser (Nonablative)
Principle
Technique
Results
Side Effects and Complications
Hybrid Fractional Lasers
27.3.5.1.3 Other Modalities for NVR
27.4 Conclusion
References