Faculty Bibliography

Hidradenitis suppurativa (HS) is a prevalent, debilitating disease affecting ~1% of the population, with limited therapeutic options and poor long-term remission rates. HS arises from inflammation and destruction of apocrine-bearing hair follicles, suggesting a multifactorial pathology involving immune dysregulation and follicular dysfunction. Emerging treatment strategies largely center on immune suppression, with three FDA-approved therapies targeting inflammatory pathways. However, most patients fail to achieve durable remission. Genetic evidence increasingly implicates the hair follicle as a key contributor to HS pathogenesis. For example, genes that cause ectodermal dysplasias (EDs) have been implicated by common risk variants identified in genome-wide association studies (GWAS) and by rare variants in sequencing studies of rare ED syndromes that co-present with HS. EDs are Mendelian (i.e., single-gene) disorders that disrupt the development of ectodermal derivatives, including hair follicles and sweat glands. The enrichment of ED-associated genes in HS genetic studies, together with HS phenotypes observed in ED patients, supports a critical role for aberrant follicular development in HS pathogenesis. We propose that HS represents a spectrum of related diseases entities spanning immune dysregulation and hair follicle pathology, underscoring the need for biomarkers and refined disease classification to tailor treatment strategies. This perspective argues for broadening drug-development programs and insurance coverage for therapeutic strategies beyond immunomodulation to include follicle-targeted approaches.

The skin synthesizes hormones and expresses hormone receptors. Androgens are steroid hormones that interact with the skin and play a role in the development of acne, hirsutism, and hair loss. Estrogens and progestogens are steroid hormones found in the skin that may affect sebum production and hair growth by lowering androgen levels, as well as incompletely understood interactions with the skin's structures. Thus, oral contraceptive pills (OCPs) containing estrogen and progestogen have potential benefits in treating conditions commonly seen by dermatologists. In part 1 of this continuing medical education article (CME), we discuss the effects of androgens, estrogens, and progestogens on the skin and hair and characterize available hormonal oral contraceptives, their routes of administration, hormonal compositions, and potential adverse effects. This two-part CME is intended to serve as a guide to dermatologists for both selecting among OCPs and further understanding their interactions with the skin and hair.

Combined oral contraceptives (COC) decrease androgen levels by inhibiting androgen production and increasing sex hormone binding globulin. COC can therefore be used in the treatment of androgen-mediated dermatologic conditions. Hormonal contraceptives may also contribute to some dermatologic diseases through interactions with estrogen and/or progesterone receptors. In part two of this continuing medical education article, we discuss evidence regarding the mechanism and efficacy of hormonal contraceptives as therapeutics for acne, hirsutism, and hair loss, and review potential dermatologic SE of hormonal contraceptives to guide dermatologists in utilizing this therapy in their practices.

The vulvar dermatologic examination is a crucial component of gynecologic and dermatologic practice, requiring a thorough understanding of normal anatomy and physiologic variations, and common pathologic conditions. This review outlines key elements of the history-taking process, including demographic factors, symptoms, product use, and relevant medical history, which help guide diagnostic evaluation. A structured approach to distinguishing normal anatomic variations from disease is emphasized, including the identification of physiological changes across the lifespan and common benign lesions that may mimic pathology. Proper vulvar hygiene and personal care habits play a significant role in maintaining vulvar health and preventing irritant or allergic reactions. We review evidence-based recommendations on cleansing practices, product selection, and environmental factors that contribute to vulvar irritation, as well as common allergens and irritants implicated in contact dermatitis. In addition, we discuss the indications for vulvar biopsy, emphasizing its role in distinguishing benign inflammatory conditions from premalignant or malignant processes. Specific biopsy techniques and procedural considerations are highlighted to ensure accurate histopathologic diagnosis and optimal patient outcomes. This guide provides clinicians with a practical framework for evaluating the vulva, integrating history-taking, physical examination, patient education, and diagnostic interventions to improve care for individuals presenting with vulvar complaints.