Background The cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported. Objective To evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease. Methods Patients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms. Results Data from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more. Limitations The recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities. Conclusion The severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset ( 12 weeks) telogen effluvium.

Trichodynia and telogen effluvium in COVID-19 patients - results of an international expert opinion survey on diagnosis and management.

Background COVID-19 is a febrile, infectious illness that has previously been associated with telogen effluvium (TE). However, to date, no study has been conducted to determine the incidence of TE in those who have had COVID-19. Aims To assess the frequency of TE in post COVID-19 patients and the correlation between the development of TE and the severity of COVID-19, to understand whether emotional stress or medications are responsible for the development of TE. Patients/methods Totally 204 patients with a history of SARS-CoV-2 infection in the last 3 months were included in the study. The diagnosis of TE was made by history of excessive hair shedding, hair pull test, diffuse or bitemporal thinning, and absence of anisotrichosis in trichoscopy. Patients who did not have any TE cause other than COVID-19 and whose hair loss started after COVID-19 were considered as "COVID-19 associated TE (CATE)". Results We found TE in 75 (36.7%) cases and AGA in 85 (41.7%) cases. CATE was present in 27.9% of cases and developed on average 53.76 (± 23,772) days after COVID-19 RT-PCR positivity. The proportion of patients with CATE was numerically higher in hospitalized patients compared to outpatients (31,7% vs. 24,3%; p=0,238); and significantly higher in women compared to men (42,3% vs. 6,2%; p Conclusion Telogen effluvium developed in approximately one-quarter of people who have had COVID-19, and our study is the first to detect it. The time to onset of CATE, which was 7-8 weeks after the SARS-CoV-2 RT-PCR positivity, was not much different from post-infectious TE. Patients with severe COVID-19 seem to be more prone to develop TE. The presence of AGA is associated with a more severe COVID-19. During the pandemic, clinicians should consider a previous SARS-CoV-2 infection in patients presenting with hair loss.

COVID-19 induced telogen effluvium.

Objective:Health-care workers (HCWs) in Indonesia have been participating in the war against the coronavirus disease-2019 since March 2020. Ever since HCWs were exposed to the regular use of personal protective equipment (PPE) with varying levels and maintain hand hygiene more as recommended by the World Health Organization. Adverse skin reactions to PPE in Indonesia has yet to be acknowledged. This study aimed to study the prevalence and characteristics-, possible risk factors-, and suggest possible solutions towards adverse skin reactions to PPE among HCWs in a multi-center setting of Indonesia.Methods:A cross-sectional survey was conducted online among HCWs in the Siloam Hospitals Group of Banten province. HCWs of Banten Province were surveyed from June 1 to August 31, 2020. The data was obtained using avalidated online survey questionnaire including (1) demographic characteristics;(2) occupational-related characteristics;(3) adverse skin reactions.Results:A response rate of 40.2% was obtained and 200 valid respondents were yielded. The mean age of respondents was (26.94±7.23) years old. Adverse skin reactions (66.5%) were reported primarily in female (73.7%) working as doctors (82.7%) of a non-referral center for coronavirus disease-2019 (60.2%) wearing level 2 and 3 PPE (43.6% and 37.6%, respectively). The cheeks and chin was the most common site involved (69.9%) with dryness/tightness (63.9%) and acne (77.4%) as the highest symptoms and signs reported. Sex, age group classification, level of PPE worn, hand hygiene frequency, and duration of PPE worn daily were factors considerably associated with adverse skin reactions to PPE (P<0.05).Conclusions:Adverse skin reactions to PPE are common among HCWs in Indonesia. Comprehensive strengthening of the skin condition and awareness on adverse skin reactions should be advocated. Copyright © 2021 Journal of Physical Chemistry. All rights reserved.

Adverse Skin Reactions to Personal Protective Equipment among Health-Care Workers during COVID-19 Pandemic: A Multicenter Cross-sectional Study in Indonesia

Background Mask use can lead to facial dermatoses due to factors, such as hyperhydration, seborrhea, high humidity caused by sweating, and the occlusive effect of the mask. Aim We investigated mask-related facial dermatoses in healthcare personnel who, since the beginning of the COVID-19 pandemic, had to wear a mask for long hours. Methods In this study, healthcare professionals working at Medipol Mega University Hospital since the beginning of the pandemic were screened for facial dermatoses between December 2020 and February 2021 with a dermatological examination and interview. Results Of the 101 healthcare professionals, 51 (50.5%) were doctors and 50 (49.5%) nurses, and 36 (35.6%) were male and 65 (64.4%) were female. All the participants had been actively working at the hospital for 35-46 weeks since the beginning of the pandemic and wearing N95 or surgical masks for an average of 6-13 h a day. During the dermatological examination, the most common facial dermatosis was acne, which was observed in 55.4% (n = 56) of the cases. Of the 56 acne cases, 41.1% (n = 23) had acne in their history, while 58.9% (n = 33) had new-onset acne. Being female, using a N95 surgical mask compared to surgical mask, and the daily average duration of mask use were determined as risk factors for acne development due to mask use. Conclusions The use of masks, more frequently N95, caused both an increase in existing acne and the development of new acne.

Occupational facial dermatoses related to mask use in healthcare professionals.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jdv.17546

Dermatoses caused by face mask wearing during the COVID-19 pandemic.

Although the COVID-19 outbreak has decreased dermatology outpatient clinic visits, acne remains the most common condition among patients requesting an appointment. The widespread use of face masks may be a contributing factor to acne mechanica and folliculitis mechanica, where stopping the mechanical insult is essential to treatment. However, COVID-19 poses a unique challenge as mask wearing is crucial to limiting viral exposure. Although reported cases of mask-associated facial dermatoses are largely documented in healthcare workers, the general population is being affected by “maskne”. Pathogenesis and treatment options are discussed and the importance of counseling patients on proper skin hygiene is highlighted. As mask use increases, dermatologists should anticipate this trend in acne flare-ups.

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Maskne: Exacerbation or Eruption of Acne During the COVID-19 Pandemic

Topical corticosteroid phobia may lead to poor adherence, resulting in persistent disease and escalation to systemic agents. The aim of this paper was to review current literature to assess topical steroid phobia prevalence, populations most at risk, reasons behind steroid phobia, and interventions to reduce it. A systematic search of PubMed, Ovid (Journals@Ovid, MEDLINE), ScienceDirect, and Web of Science was performed. Studies ranged from May 2000 to February 2021. In total, 37 articles met the inclusion criteria. There was inter-study variation in the way steroid phobia is defined, from concern to irrational fear. The worldwide prevalence of topical steroid phobia ranges from 31 to 95.7% and does not differ with patient race/ethnicity or dermatological condition. Female patients and caregivers, and those who have experienced side effects of topical corticosteroids are most likely to express steroid phobia. Reasons for steroid phobia include lack of education, fear of side effects, polypharmacy, misinformation, negative experience with topical steroids, and frequently changing of clinics. Successful interventions to address steroid phobia include patient education in the form of educational videos followed by individualized oral education based on concerns, and demonstrations of application of topical steroids. Multiple interventions address topical corticosteroid phobia and improve adherence of topical corticosteroids in the management of dermatological conditions. Providers should screen patients for steroid phobia, especially in populations particularly at risk. Interventions using patient education should be individualized based on concerns expressed during screening. Further research should investigate if reducing steroid phobia can in fact improve long-term adherence.

Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions.

A surge in the incidence of telogen effluvium in minority predominant communities heavily impacted by COVID-19.

As time progresses, more patients with skin of color will be seen by dermatologists. To meet the needs of the ever-changing population, medical education needs to analyze how residents are trained in recognizing dermatological disorders in patients with skin of color. The aim of this study was to analyze dermatology textbooks to evaluate how well skin of color patients are represented compared to the current national distributions. The most common skin types depicted in the textbooks were Fitzpatrick skin types II and III, whereas the least common skin types depicted were skin types V and VI. There was a significant difference between a national distribution of skin types when compared to photographs in each of the textbooks (P<0.001). These findings emphasize the need to better represent patients with skin of color in medical textbooks.

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Abigail Cline

Papers

Maskne: Exacerbation or Eruption of Acne During the COVID-19 Pandemic

Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions.

A surge in the incidence of telogen effluvium in minority predominant communities heavily impacted by COVID-19.

Representation of Fitzpatrick skin type in dermatology textbooks compared with national percentiles.

Sustained reduction in no-show rate with the integration of teledermatology in a Federally Qualified Health Center.