The impact of hormones in autoimmune cutaneous diseases.

INTRODUCTION: Dermatomyositis, systemic and cutaneous lupus erythematosus have a significantly higher prevalence in women than men, emphasizing the relevance of exploring the relationship between sex hormones and autoimmune skin diseases. This review analyzes the interplay between sex hormones and these two skin diseases. MATERIALS AND METHODS: We performed an extensive literature search using the PubMed database from July to August 2023. Search terms included 'contraceptives', 'pregnancy', 'hormone replacement', 'tamoxifen', and 'aromatase inhibitors'. RESULTS AND DISCUSSION: This comprehensive literature review shows that there remains considerable debate regarding the use of hormonal contraceptives and hormonal replacement therapy in individuals with autoimmune skin conditions. Nonetheless, it is well established that their use is contraindicated in patients with antiphospholipid syndrome or when antiphospholipid antibodies are positive. Individuals experiencing disease flares and uncontrolled symptoms should also avoid these interventions. Pregnancy planning should be timed to coincide with well-managed disease states to minimize obstetric and neonatal complications. Hormonal breast cancer treatment requires close skin monitoring. CONCLUSION: Pregnancy, menopause, contraceptive use, hormone replacement therapy, and breast cancer treatment drugs result in substantial shifts in hormone levels. Additionally, hormone levels are altered by aromatase inhibitors and anti-estrogen medications. These fluctuations can modulate mechanisms influencing autoimmune skin abnormalities.

Perceptions of Infection Risk With Immunomodulatory Medications.

OBJECTIVES: Physicians of many specialties encounter patients treated with immunomodulatory medications and must weigh the risk of infection when making medical decisions. We explored how physician perceptions of the infection risk of immunomodulatory medications differ by specialty and level of experience. METHODS: A survey was distributed to physicians from the internal medicine, family medicine, emergency medicine, rheumatology, dermatology, and infectious disease departments at 1 tertiary care institution. Physicians scored their level of concern for the risk of infection of 15 commonly used immunomodulatory medications hypothetically taken for 1 year. RESULTS: The survey was distributed to 634 people; 197 physicians completed the survey. Opinion of the risk of infection differed significantly by specialty for 8 of 15 medications. Experienced providers rated risk of infection differently from less experienced providers for prednisone 10 to 20 mg (P = 0.046), hydroxychloroquine (P = 0.013), dapsone (P = 0.029), and anti-tumor necrosis factor (TNF) therapy (P = 0.027). Most experienced physicians regarded dapsone (95%) and hydroxychloroquine (93%) as low risk, whereas many less experienced physicians scored them as medium- or high-risk medications. In contrast, experienced physicians were more likely to rate prednisone 10 to 20 mg as medium or high risk. Most less experienced physicians (55%) identified anti-TNF therapy as high risk, whereas experienced physicians were split evenly among low, medium, and high risk. CONCLUSIONS: There is substantial variability in physician perception of the risk of infection of many immunomodulatory medications. Experienced physicians are more concerned than peers about the risk of infection of intermediate doses of prednisone. Opinions regarding anti-TNF therapy range broadly even among experienced providers.