Addressing the Unique Skin Health Needs of LGBTQ+ Patients

The unique dermatologic needs of LGBTQ+ patients range from skin conditions associated with sexually transmitted infections to acne to hair loss and removal for the alignment of appearance to gender identity.

Over 14 million U.S. adults identifying as according to a new release from the American Academy of Dermatology (AAD) about presentations at its 2024 Annual Meeting in San Diego.¹ As a result, many dermatologists are taking on issues and conditions that disproportionately affect LGBTQ+ individuals.

“LGBTQ+ individuals are at higher risk for STIs than the general public, and it’s important for patients to know that there are new treatments available that can improve their health and quality of life,” said John Zampella, MD, an associate professor of dermatology at New York University (NYU) Grossman School of Medicine in New York. “Dermatologists are the experts in the diagnosis and treatment of many sexually transmitted infections like syphilis, HPV and herpes that often have skin related symptoms.”

John Zampella, MD

The AAD news release mentions HIV preexposure prophylaxis (PrEP) and, more specifically, Apretude (cabotegravir extended-release injectable suspension), the injectable form of the preventive antiviral medication.

Additionally, the news release notes, the Centers for Disease Control and Prevention (CDC) has approved guidelines suggesting that doxycycline, an oral antibiotic which is often used to treat other dermatologic conditions, may be useful for preventing bacterial sexually transmitted infections, such as syphilis, chlamydia and gonorrhea, and can be taken after potential STI exposure.

Both approaches, Zampella remarked in the news release, are important breakthroughs to help minimize infections from HIV and other STIs.

Recent reports are highlighting new types of fungal infections, such as ringworm, that are spreading among gay and bisexual men and may be sexually transmitted. These new types of fungi are resistant to some commonly used antifungal treatments and patients may require a longer period of treatment, noted Zampella. If patients experience a spreading rash in the groin or on the buttocks that is not responding to treatments, patients should consider seeing a board-certified dermatologist for evaluation, the news release said.

Avrom Caplan, MD, a colleague of Zampella’s at NYU, reported the first two cases of ringworm caused by Trichophyton indotineae that are resistant to terbinafine, the standard antifungal treatment of ringworm. After terbinafine, both patients were treated with itraconazole.

The CDC says on a webpage devoted to resistant ringworm that between March and September 2023, Caplan saw 10 patients with confirmed or possible Trichophyton indotineae infections. “Cases have been reported across the United States; the majority associated with international travel to the Indian subcontinent,” says the CDC webpage.²

One of the most common dermatologic conditions Zampella sees in his clinic among his LGBTQ+ patients is acne. Zampella noted in the news release that acne among transgender individuals is often the result of hormone therapy.

Avrom Caplan, MD

“In these patients, the acne can be severe and the hormones lifelong, so these individuals often need the support of a dermatologist," he said. Zampella says he often recommends treating acne that is caused by hormone replacement therapy with isotretinoin, which is sold under brand name Accutane.

To effectively treat acne caused by hormone replacement therapy, Zampella often recommends isotretinoin for severe cases to help clear his patients’ skin.

Another key aspect of transgender patient care is aligning appearance with gender identity, a matching that often involves hair growth and removal.

“Hair growth is often a goal in transgender men and can be challenging to address,” Zampella said. Numerous hair loss treatments are available, but Zampella says dermatologists are finding that using therapies such as oral minoxidil, a common blood pressure medication, are showing potential for improving hair growth.

References

1. American Academy of Dermatology: New treatments for HIV and other STIs provide hope for better quality of life. News release. PR Newswire. March 8, 2024. Accessed March 13, 2024. https://www.prnewswire.com/news-releases/american-academy-of-dermatology-new-treatments-for-hiv-and-other-stis-provide-hope-for-better-quality-of-life-302082474.html
2. The rise of resistant ringworm: Genomic sequencing confirms the first Two reported U.S. cases of Trichophyton indotineae. Centers for Disease Control and Prevention. September 18, 2023. Accessed March 13, 2024. https://www.cdc.gov/amd/whats-new/tindotineae.html

[This article was originally published by our sister publication, Managed Healthcare Executive.]