BC01 (P44): Dermatological issues in the transgender population: a review of the literature
A. Coulton1 and M. Devkota2
1Portsmouth Hospitals NHS Trust, Portsmouth, UK and 2King’s College Hospital NHS Foundation Trust, London, UK
Transgender patients represent a growing proportion of the dermatology patient population owing to the consequences of hormonal treatments and unique complications from surgical and aesthetic interventions. This review serves to outline dermatological conditions reported in the literature within the transgender patient population and to raise awareness of this specific patient demographic. Patients who have transitioned, or are transitioning, often suffer skin disorders, whether attributable to or independent of their treatment for gender reassignment. Additionally, there can be both physiological and psychological complexities that require a holistic approach to treatment, and which may deem usual treatment options inappropriate; hormonal acne treatment targeting testosterone in female-to-male persons will be counterintuitive and contraindicated. Therefore, management of skin conditions in transgender patients often requires an alternate approach to conventional treatment, and it is pertinent that practitioner awareness is raised in order to continue to deliver appropriate care. A PubMed search using the term “transgender AND (skin OR dermato*)” returned 196 papers. These were reviewed for relevance with regard to dermatological issues and conditions in transgender patients; 67 of the 196 papers were deemed relevant. These were reviewed, and skin conditions and pathology reported within the literature were recorded. Medical concerns identified centred primarily around the impact of hormonal therapy. In female-to-male patients undergoing testosterone therapy, the following were noted: androgenic alopecia, acne, brittle nails, xerosis and eczema. In male-to-female patients undergoing oestrogen therapy and testosterone blockade melasma, lichen planus, systemic sclerosis, hormone-resistant hirsutism, pseudofolliculitis barbae, eczema and xerosis were noted. Several papers discussed limitations in treatment options for hormonal acne and that isotretinoin may need to be used with caution, or with increased surveillance, in those with a significant mental health background. Complications arising from gender reassignment surgery included infection, Koebnerization of pre-existing skin conditions such as psoriasis and lichen planus to surgical scars, hypertrophic and keloid scarring, and squamous cell carcinoma of surgically formed genitalia and within the neovaginal canal. Other conditions relating to aesthetic intervention included infection, siliconomas and granulomas associated with silicone injectables, lymphoedema due to lymphatic silicone migration, and adverse effects of chest binding such as miliaria, acne and dermatitis. Also noted was an increased requirement for hair-removal therapies due to dissatisfaction with hormonally driven hair loss. The burden of dermatological disease in the transgender population is unique and likely substantial, with cases reported in the literature only a small representation of reality. Further research into this emerging area is valuable to further understand the prevalence of dermatological disease within the transgender population. It is vital for practitioners to appreciate the demographic-specific concerns, treatment nuances and necessary holistic approach required to manage the dermatological concerns of this growing patient population.
