Dermatologists warned their colleagues to be aware of the special dangers facing the LGBTQ community: an increased risk of skin cancer among gay men, possibly due to over-exposure to ultraviolet light, and acne in transgender people, especially vulnerable to acne due to hormone therapy.
Sexual minority identities “have a significant influence on many facets of health,” explains the dermatologist Matthew Mansh, MD, of the University of Minnesota, Minneapolis, said in a presentation to the Experience of virtual meetings of the American Academy of Dermatology.
As for skin cancer, he said, “there appear to be consistently higher rates of skin cancer and certain preventable risk behaviors, such as tanning inside, among men of sexual minorities.”
Mansh, co-director of the University of Minnesota High-Risk Non-Melanoma Skin Cancer Clinic, highlighted report, published in JAMA Dermatology in 2020, which used data from the 2014-2018 U.S. survey of more than 870,000 adults to examine the association between sexual orientation and the prevalence of skin cancer in life. The researchers found that gay and bisexual men had a higher prevalence of skin cancer in life compared to heterosexual men (adjusted probability) [aOR], 1.25; 95% confidence interval, 1.03-1.50; Pg = 0.02; and aOR, 1.46; 95% CI: 1.01-2.10; Pg = 0.04; for gay and bisexual men, respectively).
Compared with heterosexual women, the risk among bisexual women was lower (AOR, 0.75; 95% CI, 0.60-0.95; Pg = 0.02), but not among lesbian women (AOR, 1.01; 95% CI: 0.77-1.33; Pg = .95, respectively).
Other studies have reached similar conclusions, Mansh said, although there has been quite a bit of research in this area. What could explain these differences? Factors such as smoking, age and alcohol consumption said they affect the risk of skin cancer, but these studies control these variables. Instead, he noted, it is useful to examine studies on ultraviolet exposure.
For example, he highlighted a to study published in JAMA Dermatology in 2015, which examined tanning rates within 12 months and the prevalence of skin cancer by sexual orientation, using data from California and national health surveys. The study found that, compared to heterosexual men, “men of sexual minorities had higher rates of inner tanning about three to six times,” said Mansh, the lead author. “And that was among respondents who were adults over the age of 18. People between the ages of 18 and 34 are important from a skin cancer standpoint, as it’s well established that exposure to tanning beds at younger ages it is more associated with an increased risk of skin cancer. “
Men of sexual minorities were also significantly more likely to report having skin cancer, compared to heterosexual men.
In the study, women from sexual minorities were about half as likely to engage in inner tanning compared to heterosexual women and were less likely to report that they had been diagnosed with non-melanoma skin cancer, she added.
Other studies suggest gay and bisexual men live in neighborhoods with more indoor tanning salons and may also spend more time in the sun outside, he said. Some research suggests the motivations for tanning include social pressure and a desire to improve appearance, he added.
Overall, “we may be able to use this data to add more appropriate evidence and recommendations for these patients, who are severely lacking in dermatology,” and to design specific behavioral interventions, said Mansh, co-director of the Gender Care Clinic. the dermatology of the University. of Minnesota.
What can dermatologists do now? In an interview, dermatologist Jon Klint Peebles, MD, from the Mid-Atlantic Permanent Medical Group in Largo, Md, suggested colleagues ask patients questions about the frequency of indoor tanning, motivations for tanning, exposure to outdoor ultraviolet radiation, sunscreen use and use of sunscreen.
Hormone therapy and acne
In a presentation related to the meeting, Howa Yeung, MD, from the dermatology department at Emory University in Atlanta, said that in transgender people, estrogen therapy it can actually reduce sebum production and often improve acne testosterone therapy often has the opposite effect.
“We’ve seen some pretty difficult cases of acne in transmasculine patients in my practice,” said Yeung, who highlighted a recent post to study who followed up 988 transgender patients in Boston who underwent testosterone therapy. Nearly a third were diagnosed with acne, compared with 6% before hormone therapy, and those at higher risk were between 18 and 21 years old.
The prevalence of acne was 25% 2 years after the start of hormone therapy. “Acne remains a very common problem and not just at the beginning of treatment,” he said.
In 2020, Yeung and his colleagues reported the results of a survey of 696 transgender patients in California and Georgia; most were treated with hormone therapy. They found that 14% of transmasculine patients reported having moderate to severe acne diagnosed by a doctor, compared to 1% of transfeminine patients.
Yeung pointed to another poll of transmasculine people who had received testosterone found that those with moderate to severe acne were more likely to suffer depression and anxiety than those who had never had acne (AOR, 2.4; 95% CI, 1.1-5.4; Pg = 0.001, for depression; and aOR, 2.7; 95% CI: 1.2-6.3; Pg = .002, for anxiety).
Acne treatments in transmasculine patients are complicated by the fact that hormonal treatments for acne can have feminizing effects, Yeung said, adding that it is unclear how clascoterone, a new antiandrogen therapy for acne, will affect them. For now, many patients will require it isotretinoin to treat acne.
Peebles warned him with isotretinoin“We do not yet have solid data on the optimal dosage or duration in the context of testosterone-induced acne, as well as what individual factors may predict the success or failure of treatment. It is also important to be aware of any surgical procedures.” whether as part of gender-affirming treatments or not, as some surgeons may view isotretinoin as a barrier to some procedures, despite limited data supporting it. “
Both Peebles and Yeung pointed out that the iPledge the risk management program for isotretinoin patients who may become pregnant is problematic. “A trans man who is assigned a woman at birth and identified as a man and has a uterus and ovaries must be registered as a woman with reproductive potential,” Yeung said.
“While the program remains intrinsically discriminatory, it is important to maintain an honest conversation with patients about these issues in a sensitive manner,” Peebles noted. “Fortunately, there is a strong push in modifying iPLEDGE to become more inclusive. While the mechanics are complicated and involve various advocacy entities and initiatives, we are optimistic that there will be major changes in the process.”
Mansh, Yeung and Peebles did not report any disclosures.
This article originally appeared on MDedge.com, which is part of the Medscape professional network.