The Research Gap Shaping Women's Skin Health Across a Lifetime

Pregnancy, postpartum, and menopause represent some of the most significant hormonal transitions in a woman’s life—yet they remain among the least-studied periods in dermatological research.¹ Doral Fredericks, PharmD, MBA, global vice president of medical affairs and outcomes research at Organon, sat down with Dermatology Times to unpack why these populations have historically been overlooked and what the immunological consequences look like in practice.

The hesitancy to enroll pregnant and postpartum patients in clinical trials is well established, driven by legitimate concerns about fetal exposure and drug transfer through breast milk.² As a result, much of what clinicians know about skin disease in these populations comes from patient registries and longitudinal exposure data rather than controlled trials. But Fredericks argues the research gap runs deeper than safety conservatism.

“Symptoms during pregnancy and menopause are often dismissed as being normal or an inevitable part of aging, and thus reduce clinical urgency to investigate them.”

Compounding the enrollment challenge is the biological complexity of hormonal shifts themselves. Unlike the relatively predictable endocrine changes of puberty or conditions like acne—which affect both sexes and represent a large, more standardizable research population—the hormonal landscape across pregnancy, postpartum, and menopause is heterogeneous and difficult to control for in trial design.

Fredericks also points to a knowledge gap at the provider level. Although many clinicians are well versed in the physiological changes of a normal pregnancy, familiarity with pregnancy-specific dermatoses is less consistent, contributing to patterns of misdiagnosis and underdiagnosis that may not be immediately legible as research failures.³

The immunological implications of these hormonal shifts are consequential and often clinically counterintuitive. Using estrogen as a lens, Fredericks explains how the elevated estrogen of pregnancy drives a Th2-dominant immune shift, worsening conditions like atopic dermatitis while simultaneously improving Th1/Th17-mediated diseases such as psoriasis. In menopause, that dynamic reverses: Sustained low estrogen promotes Th1/Th17 activity, increasing psoriasis flare frequency and severity while simultaneously impairing skin barrier function through reductions in lipid production and hydration.

The result, Fredericks notes, is that conditions like atopic dermatitis can resurface or worsen in older women—particularly on the hands, face, and flexural areas—through a combination of barrier breakdown and immune senescence that is real, clinically meaningful, and still underappreciated in both the research and treatment landscape.

References

1. Dukic J, Johann A, Henninger M, Ehlert U. Estradiol and progesterone from pregnancy to postpartum: a longitudinal latent class analysis. Front Glob Womens Health. 2024;5:1428494. doi:10.3389/fgwh.2024.1428494
2. Jacobson MH, Yost E, Sylvester SV, Renz C, Wyszynski DF, Davis KJ. Understanding willingness and barriers to participate in clinical trials during pregnancy and lactation: findings from a US study. BMC Pregnancy Childbirth. 2024;24(1):504. doi:10.1186/s12884-024-06710-w
3. Vora RV, Gupta R, Mehta MJ, Chaudhari AH, Pilani AP, Patel N. Pregnancy and skin. J Family Med Prim Care. 2014;3(4):318-324. doi:10.4103/2249-4863.148099