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It’s no secret that women are more likely than men to be misdiagnosed by a medical professional. In fact, as many as 57 per cent of women have reported being wrongly diagnosed by a doctor. In 2016, a study found that women have a 50 per cent higher chance than men of receiving a misdiagnosis after a heart attack, while researchers found in 2014 that 33 per cent of women are more likely than men to be misdiagnosed after a stroke. When it comes to women’s health, an explicit gender bias in medicine can lead to serious and sometimes life-threatening results. That’s why Dr Erin Nance, an orthopaedic hand and wrist surgeon located in New York City, has dedicated the month of October to sharing the most commonly misdiagnosed health conditions that affect women. Her series has since gone viral on TikTok, as she discussed how symptoms of rare autoimmune disorders or infertility can present differently in women, leading to a misdiagnosis. For the first video of the series, Dr Nance revealed how postural orthostatic tachycardia syndrome - also known as POTS - affects more than one million people, but is present in mostly women aged 20 to 50. However, Dr Nance explained that POTS is so difficult to diagnose because “we can’t see it”. “This is the group of women that get written off by doctors because they look healthy. There doesn’t seem to be anything wrong with them,” she said. According to the National Institute of Neurological Disorders and Stroke, POTS is a condition in which a reduced volume of blood returns to the heart after someone stands up from a lying down position. As a result, patients with POTS may experience an increased heart rate, dizziness, or fatigue when they stand up after lying down. @littlemissdiagnosed Day 1: It’s me, POTS, I’m the the problem it’s me #littlemissdiagnosed #31for31lmd #pots ♬ original sound - Dr. Erin Nance 🇺🇸 Dr Nance explained that some other symptoms of POTS include “chronic fatigue, brain fog, total body chronic pain, GI [gastrointestinal] stomach issues, anxiety, headaches, and it can affect any part of your body”. Another difficulty about POTS is that there’s “no specific treatment” to help the condition, Dr Nance said. “We can’t do a biopsy, we can’t do any imaging, there’s no blood test for it,” she added. Instead, doctors may recommend drinking more fluid, exercising regularly, or wearing compression stockings to keep blood flow in the centre of the body. For the 14th day of her video series, Dr Nance received 1.4m views when she spoke about the commonly misdiagnosed symptoms of stroke in women. “Stroke is the third leading cause of death in women,” she began the clip. “Yet, women are over 33 per cent more likely to be misdiagnosed when having an acute stroke.” Dr Nance admitted that most women who experience a stroke are often told by doctors that they simply have anxiety or a migraine. When it comes to the “unique” symptoms of stroke that are present in women, some may experience loss of consciousness or fainting; general weakness; shortness of breath; confusion, unresponsiveness, or disorientation; sudden behavioural change; agitation; hallucination; nausea or vomiting; seizures or even just hiccups. @littlemissdiagnosed Day 14: Stroke is no joke #littlemissdiagnosed #31for31lmd #stroke ♬ original sound - Dr. Erin Nance 🇺🇸 “These unique symptoms are often the ones that are overlooked,” Dr Nance said, before detailing the individual risk factors that can put women at a greater chance of having a stroke. The first on the list of risk factors was taking birth control pills, followed by pregnancy, hormone replacement therapy, and history of suffering from migraines. “The reason why this is so important for everyone - every normal, everyday person - to know this is because the best outcomes are when women are evaluated and treated within three hours of having this symptom,” Dr Nance added. On day 16, the orthopedic surgeon explained how symptoms of a heart attack can also be wrongfully overlooked by doctors. “More women than men die of heart disease every year, yet women have a 59 per cent increased risk of being misdiagnosed with acid reflux, stress, or anxiety,” Dr Nance said. Besides chest pain, a woman may exhibit signs of a heart attack when she experiences unusual fatigue for several days; sleep disturbances; shortness of breath; lightheadedness; nausea or cold sweats; indigestion or gas-like pain; and pain in the arm, neck, jaw, or back. @littlemissdiagnosed Day 16: It’s not always Big on the Peloton #littlemissdiagnosed #31for31lmd #heartattack #womensheart ♬ original sound - Dr. Erin Nance 🇺🇸 When it comes to multiple sclerosis (MS), Dr Nance revealed on day 19 of her video series that women are 83 per cent more likely to be misdiagnosed for MS by a doctor. MS is a disease that affects the “myelin” - the protective sheath covering the brain, nerves, and the spinal cord. According to Dr Nance, some of the often-missed signs of MS include extreme fatigue, confusion, forgetfulness, and mood swings. @littlemissdiagnosed Day 19: You’re gonna be okay #littlemissdiagnosed #31for31lmd #ms #multiplesclerosis ♬ original sound - Dr. Erin Nance 🇺🇸 As for lupus - an autoimmune disease in which the immune system attacks its own tissues, causing inflammation in the body - Dr Nance shared in the 20th video of her series that women between the ages of 15 and 45 are most likely to develop the disorder. “The average time from when you first develop your symptoms to diagnosis is six years,” Dr Nance revealed. @littlemissdiagnosed Day 20: Sneaky little 👿 #littlemissdiagnosed #31for31lmd #lupus ♬ original sound - Dr. Erin Nance 🇺🇸 She claimed that 46 per cent of patients report being misdiagnosed with something other than lupus, while “54 per cent of them were told that either nothing was wrong with them or that their symptoms were psychological.” “The main problem with lupus is that the longer you go undiagnosed and untreated, then the greater risk for end organ damages,” she added. The Independent has contacted Dr Nance for comment. Read More How to optimise your 22 minutes exercise a day according to fitness experts TikTok influencers warn about ‘potent’ steroid cream risks among black women – dermatologist explains the risks Want to be a useful man? Arnold Schwarzenegger is here to tell you how How to optimise your 22 minutes exercise a day according to fitness experts TikTok influencers warn about ‘potent’ steroid cream risks among black women – dermatologist explains the risks Want to be a useful man? Arnold Schwarzenegger is here to tell you how

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According to skin influencers on TikTok, topical steroid creams are being ‘illegally sold’ in some black Afro hair and beauty supply stores, affecting black women in particular. Angela Mavalla, a pharmacist and skincare educator, has been sharing TikTok videos garnering thousands of views, encouraging black women to stop purchasing topical steroid creams from these shops – as they are meant to be prescription-only treatments used with appropriate guidance from a doctor. When used incorrectly, the creams can make potentially make skin symptoms worse and harder to manage. “Though these creams tend to address issues like acne and eczema very quickly, because of their potent nature, the skin becomes addicted to it and will flare up badly once you stop using them,” said Mavalla. “A lot my clients – [who are black women] – that I consult privately, were coming to me with issues relating to topical steroid use, such as having terrible flare-ups because they had stopped using the cream, and needed help with tapering off them. “I began making content based on these creams, mainly to warn people of them, and found that these TikTok’s would go viral in a short space of time, with lots of people relating to it, and giving their own testimonials of how the creams damaged their skin,” Mavalla added. “I have seen instances of accidental skin bleaching, worsened eczema and hyperpigmentation, topical steroidal withdrawal and addiction, and worst of all, a crippling low self-esteem and self image. It’s awful. “The first point of call when it comes to steroidal creams should always be a pharmacy. Pharmacists are always willing to help, advise and where necessary, signpost to the most appropriate medical profession, such as a dermatologist.” Dr Unnati Desai, the national GP lead, as well as safeguarding lead for GP services and dermatology lead at Nuffield Health, acknowledged that it can take sometimes take time to correctly diagnose these conditions, and might require a biopsy. It might also take a longer period of time to get symptoms under control, as skin conditions may require trying multiple different treatment regimes to find the one that suits each individual person, as well as getting to grips with individual triggers. What are topical steroid creams and what should they be used for? Doctors prescribe topical steroid creams to treat a wide range of skin complaints – but it’s important to have proper assessments first. “They are topical medications (synthetic corticosteroids) that have an anti-inflammatory action on the skin, by suppressing the skin immune system and constricting the blood vessels of the skin where applied,” Desai told the PA news agency. “They are used for dermatological conditions that result in inflamed, itchy or irritated skin – e.g. eczema, psoriasis, lichen simplex, lichen planus, lichen sclerosus and other autoimmune dermatoses.” Why do people experience topical steroid withdrawal after using steroid creams? When used incorrectly, topical steroids may have potentially significant side-effects. And as Desai warned: “Stopping any steroid treatment suddenly can often result in a flare-up of the condition, which may be worse than the original presentation.” There are some obvious signs and symptoms to look out for to figure out if you are experiencing topical steroid withdrawal, such as red, burning skin and a lumpy, papulopustular rash. “When using a steroid cream to get a dermatitis flare-up under control, especially when a more potent steroid cream has been used for a prolonged period of time, it is necessary to slowly come off the steroid cream and wean your skin off treatment by either reducing the potency of the cream, or the frequency [of application],” said Desai. “This gives the skin time to adjust to coming off the steroid cream slowly, but also clarifies whether the skin condition is coming under control with treatment. “Sometimes, severe dermatoses require long-term use of a medication to be controlled, in which case your doctor will consider alternative treatment modalities.” What damage can it do to your skin?Desai added: “Long-term use of potent steroid creams is not recommended, as there may be some systemic absorption, which can result in suppression of your body’s natural cortisol hormone at the worst. “In most cases, it is the long-term impact on the skin itself that is the concern, as regular or long-term use of steroid creams can impact the skin integrity and thickness, resulting in thinning of the skin, stretch marks, increased hair at the site of use, enlarged skin blood vessels and bruising. “Using a steroid cream when there is an underlying infection present on the skin will make the infection worse, or using steroid creams on the face can result in other chronic skin conditions, such as perioral dermatitis or other acneiform eruptions. “Occasionally, an allergy can develop to components within the cream that can make the dermatitis worse.” How can people remain safe? Desai stressed the importance of only using topical steroid treatments under the appropriate supervision of a qualified clinician. “In addition, as most chronic inflammatory skin conditions tend to result in drier skin, self-care at home with soap substitutes and emollients is important,” she said. “This includes gently cleansing the skin one to two times daily maximum (over-washing will negatively impact the skin barrier function, as will long hot bubble baths), and using unscented emollients (medical grade skin creams designed to gently hydrate the skin), which will better protect the skin and may, depending on the skin condition, make a flare-up less frequent or less severe. “If a steroid cream is needed, a doctor will recommend the amount of cream to be used according to the size of the area affected. We use the ‘Finger Tip Unit’ (FTU) – one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adult’s fingertip – as a method of advising each patient how much cream they need to use with each application.” Read More House of the Year 2023 shortlist revealed by Royal Institute of British Architects Fatima Whitbread supporting new fostering campaign, as research finds ‘misconceptions put people off’ 5 key coat trends to complete your autumn/winter wardrobe 12 ways to weave some woodland wonder into your home Hibernation mode: 5 small self-care adjustments to make before the clocks change 13 possible cancer symptoms you should get checked out

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