The position of a gynecologist in the framework of the interdisciplinary treatment of skin diseases

Despite the significant progress in acne treatment recently achieved, the problem of improving the treatment of acne, as well as further study of the causes of the disease, remains very relevant. The frequency of diagnosing severe forms of acne and iatrogenic complications from external influences and inadequately used systemic pharmacotherapy is increasing.

estet-portal.com is the information partner of the interdisciplinary conference «Hormones– health, aging, beauty", where the main topic is to increase the effectiveness of the treatment of dermatological diseases, in particular the treatment of acne and acne.

Find out in this article the opinion of a gynecologist, Ph.D. ; skin.

The position of a gynecologist in the treatment of dermatological diseases

A.G.: Any gynecological disease may be accompanied sooner or later by various changes in the skin.  A gynecologist, like a dermatologist, views the skin as an organ. And this is not accidental, since the skin – it is the "largest organ" (the skin has a fairly large area). As they say: "Eyes" minus; it is a mirror of the soul, and the skin − it is a mirror of the state of all internal organs.”

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It is no coincidence that a lot of receptors, acupuncture points are concentrated on the skin, Zakharyin-Ged sensitivity zones are located (areas of the skin in which, in diseases of certain internal organs, reflected pain occurs, as well as pain and temperature hypersensitivity). And therefore, the appearance of certain changes on the skin in certain areas indicates a violation in the functioning of organs and systems.  Many gynecological diseases can have skin manifestations.

In some situations, these skin changes do not affect the woman's quality of life, and they may not seek help, while in others – can lead to psycho-emotional experiences and a significant impairment of the quality of life.  

Approaches to the treatment of severe acne

It is essential that a gynecologist always evaluate the condition of the skin, for example, the presence of hemangiomas − this is already a signal, since there may be hemangiomas of the liver, and a special choice is needed in diagnosis, therapy (the metabolism of many drugs depends directly on the state of the liver), hyperpigmentation, acne – a consequence of hormonal disorders. Special attitude to neoplasms on the skin.

There are a lot of such examples, therefore it is recommended for all diseases, including gynecological ones, to assess the condition of the skin.

So, in the practice of a gynecologist, when a skin pathology is detected, it is imperative to refer a woman for a consultation to related specialists: a dermatovenereologist, an endocrinologist, an oncologist (if a malignant process is suspected).  I also always advise women to undergo dermatoscopy once a year, before and after traveling to regions with high insolation. This is necessary to accurately determine the nature of changes in the skin, to exclude or confirm the degeneration of benign neoplasms.

Comorbidity with dermatological diseases in the practice of a gynecologist

А.G.: Unfortunately, at the moment there are a lot of patients with polycystic ovary syndrome and other endocrinopathies, which are accompanied by hyperandrogenism or hypercortisolism. Violation of the metabolism of androgens and cortisol is very often accompanied by changes in the skin. Treatment of skin manifestations is impossible without identifying the underlying cause and prescribing appropriate treatment.

The main body – these are patients of adolescence and post-pubertal age, when dermatological diseases are common, as a result of the formation of reproductive function or gynecological diseases.

The most common gynecological patients in the practice are patients with dermatological diseases such as acne, in particular earlier acne, alopecia and hirsutism. In adolescence and post-puberty, the cause of acne may be the formation of reproductive function, accompanied by menstrual irregularities. Therefore, adolescents most often turn primarily to gynecologists with menstrual irregularities. In the reproductive age, the comorbidity of dermatological and gynecological diseases is also traced. 

However, women, first of all, turn to dermatologists for help, since these disorders are observed against the background of a regular menstrual cycle, i.e. women without visible clinical manifestations of hormonal disorders and do not see the need to seek help from a gynecologist. That is why the commonwealth in the work of gynecologists, dermatologists and endocrinologists is very important.

Monotherapy with COCs in the treatment of acne

A.G.: It is impossible to cure this disease with one pill. Of course, there are clinical indications when the appointment of combined oral contraceptives are effective as monotherapy in the treatment of acne. However, all studies on COC therapy show that this category of women always has specially prescribed skin care, there is a topical acne treatment.

Therefore, I am not a supporter of the use of COCs as monotherapy in the treatment of acne, after all, we perceive acne as a dermatological diagnosis and can only use an interdisciplinary approach in the treatment of this pathology, involving a gynecologist, dermatologist, nutritionist and endocrinologist.

Acne pathogenesis depending on the age period of the patient

Age-related acne in the practice of a gynecologist

A.G.: Age-related acne – it is also a dermatological diagnosis. And the main cause of this pathology – This is a restructuring of the hormonal background of a woman in the reproductive and premenopausal period. It is the change in the ratio of hormones that has a direct effect on the skin.

But it must also be taken into account that the hormonal background is a rather arbitrary concept, since the level of hormones – this is the average data. And, therefore, the gynecologist can determine the necessary plan for examination and treatment. Acne treatment in this age group of patients also requires an integrated approach from both a dermatologist and a gynecologist.

Need to consult a gynecologist for dermatological diseases

A.G.: Every therapy must be justified. And if the specialist sees that the prescribed treatment, and especially acne treatment, is not effective, the prescribed treatment should be re-considered and switched to other groups of drugs after joint consultation with a dermatologist. The ineffectiveness of therapy for a dermatological disease should alert the doctor, in this case, an alternative opinion and an interdisciplinary approach are needed.

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