Showing papers in "Clinical and Experimental Dermatology in 2021"
University of Padua1, Boston Children's Hospital2, François Rabelais University3, University of Barcelona4, International University Of Catalonia5, Great Ormond Street Hospital for Children NHS Foundation Trust6, University of Lausanne7, Jawaharlal Institute of Postgraduate Medical Education and Research8, Erasmus University Rotterdam9, Carol Davila University of Medicine and Pharmacy10
TL;DR: This review summarizes the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe.
Abstract: The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestation of COVID-19, chilblain-like lesions. In Part 2, we review other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome, while in Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children, for both COVID-19 and any other pre-existing conditions.
61 citations
TL;DR: A 60-year-old male presented with complaints of fever, oral ulceration and skin rash three days after the first dose of COVID-19 vaccine, for which he visited a local physician and was prescribed paracetamol and levocetrizine, inspite of which the symptoms were not controlled and gradually the rashes became generalised in distribution as discussed by the authors.
Abstract: Steven-Johnson syndrome (SJS) is a severe cutaneous adverse drug reaction. Its occurrence due to vaccines is scant.1 We report a case of SJS caused by COVID-19 vaccine in an adult. A 60-year-old male presented with complaints of fever, oral ulceration and skin rash three days after the first dose of COVID-19 vaccine, for which he visited a local physician and was prescribed paracetamol and levocetrizine, inspite of which the symptoms were not controlled and gradually the rashes became generalised in distribution.
55 citations
TL;DR: Surprisingly, skin cancer waiting times were also reduced in the COVID period compared to the pre‐COVID period (median of 8 and 12 days, respectively; P < 0.001).
Abstract: The UK healthcare system, including skin cancer departments, has been profoundly affected by the COVID-19 pandemic. Despite service capacity and a worldwide increase in incidence, anecdotal reports suggest a decline in skin cancer diagnoses following COVID-19. To determine if there has been a decrease in skin cancer diagnosis in the UK in the COVID-19 era, we analysed data from the Northern Cancer Network from 23 March 2020 to 23 June 2020 and compared it with the same period in 2019 (pre-COVID). In the COVID period, there was a decrease of 68.61% in skin cancer diagnoses, from 3619 to 1136 (P < 0.01). Surprisingly, skin cancer waiting times were also reduced in the COVID period compared to the pre-COVID period (median of 8 and 12 days, respectively; P < 0.001). Collectively, these data highlight a statistically significant reduction in both skin cancer diagnoses and waiting times during the COVID period.
47 citations
TL;DR: In this paper, the safety and efficacy of three anti-interleukin (IL)-23 drugs, namely, guselkumab, risankizumab and tildrakizumaab, were evaluated in elderly patients with plaque psoriasis.
Abstract: BACKGROUND Elderly patients (aged ≥ 65 years) represent an increasing proportion of patients with psoriasis and 15% of these have moderate to severe disease. Biologics are being used frequently in this group of patients even though safety and efficacy data are limited. In addition, owing to anti-interleukin (IL)-23 therapies being a relatively recent option, no data have been reported about their use in elderly patients with psoriasis. AIM To evaluate and compare the safety and efficacy of guselkumab, risankizumab and tildrakizumab in real-world practice in elderly patients. METHODS This was a single-centre retrospective study that enrolled patients aged ≥ 65 years with moderate to severe plaque psoriasis, treated with guselkumab, risankizumab or tildrakizumab. The length of the study for each group depended on the drug (44 weeks for risankisumab, 40 weeks for guselkumab and 28 weeks for tildrakizumab, owing to its more recent availability in Italy). RESULTS In total, 34 patients were enrolled (n = 20 on guselkumab; n = 8 on risankizumab; n = 6 on tildrakizumab). At Week 4, 29.4% reached 90% improvement in Psoriasis Area and Severity Index (PASI90) and 8.8% reached 100% improvement in PASI (PASI100); at Week 28, PASI90 and PASI100 was reached by 58.8% and 29.4%, respectively. At the final follow-up (Week 40 or 44, depending on drug), data were available only for the risankizumab (Week 40) and guselkumab (Week 44) and groups, and showed that 71.4% of patients had reached PASI90 and 53.5% had reached PASI100. Four patients (11.7%) discontinued treatment. No significant differences were found between the three groups. The limitations of the study included its retrospective nature of the study, small sample size, and different numbers of patients and follow-up duration for the different groups (highest for guselkumab, lowest for tildrakizumab). CONCLUSION The three anti-IL-23 therapies assessed are promising, safe and effective options in elderly patients, and there was no significant difference between them. However, more data are needed to confirm our results and to understand their role in the management of this group of patients.
46 citations
TL;DR: A single‐centre, cross‐sectional study of HCWs from an Irish hospital was undertaken to evaluate the degree of COVID‐19‐related irritant contact dermatitis between April and May 2020.
Abstract: COVID-19 healthcare workers (HCWs) require frequent handwashing and use of personal protective equipment (PPE) to prevent infection. However, evidence is emerging that these practices are causing adverse effects on their skin integrity. A single-centre, cross-sectional study of HCWs from an Irish hospital was undertaken to evaluate the degree of COVID-19-related irritant contact dermatitis (ICD) between April and May 2020. Of 270 participants surveyed, 223 (82.6%) reported symptoms of ICD. The hands were the most commonly affected site (76.47%) and the most frequently reported symptom was dry skin (75.37%). Nearly all (268; 99.26%) HCWs had increased hand-washing frequency, but 122 (45.35%) did not use emollients. In the ICD group, 24.7% cited a history of dermatitis compared with 4.3% of unaffected staff (P < 0.001). The ICD group recorded PPE usage for an average of 3.15 h compared with the non-ICD group at 1.97 h (P = 0.21). Promoting awareness of COVID-19-related ICD is vital to highlight prevention and treatment for frontline staff.
44 citations
TL;DR: Since SARS‐COV‐2 pandemic began, frontline healthcare workers demonstrated to develop facial dermatoses, such as acne, rosacea and seborrheic dermatitis, secondary to prolonged use of personal protective equipment (PPE).
Abstract: Since SARS-COV-2 pandemic began, frontline healthcare workers demonstrated to develop facial dermatoses, such as acne, rosacea and seborrheic dermatitis, secondary to prolonged use of personal protective equipment (PPE).
39 citations
TL;DR: The Systemic Immune‐Inflammation Index (SII) (neutrophils × platelets/lymphocytes) has been widely used in oncology since 2014, with promising results.
Abstract: Background Behcet disease (BD) is an immune-mediated vasculitis-like syndrome characterized by recurrent aphthous lesions and various systemic manifestations. Inflammatory markers may be useful to assess disease severity. The Systemic Immune-Inflammation Index (SII) (neutrophils × platelets/lymphocytes) has been widely used in oncology since 2014, with promising results. Aim To assess the efficiency of the SII in determining activity of BD. Methods This retrospective cohort study was conducted on patients with BD who were admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between 1 January 2010 and 31 December 2019. Patients were divided into two groups based on their disease status upon admission: (i) active BD (n = 103), and (ii) inactive BD (n = 63). Clinical characteristics, demographic features, type of medications, full blood count parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin and SII were compared between the groups. Furthermore, receiver operating characteristic curve analysis was performed to assess the performance of the SII in determining disease severity upon admission to hospital. Results Higher numbers of white blood cells, platelets and neutrophils, greater red cell distribution width, higher levels of ESR, CRP and ferritin, and higher SII were observed in the active disease group (P Conclusion The SII may be used as an additional indicator for the assessment of BD status and physicians should be cautious in patients with SII levels of > 552 × 103 /mm3 ) at the initial evaluation of the patients.
37 citations
University of Padua1, Boston Children's Hospital2, François Rabelais University3, University of Barcelona4, International University Of Catalonia5, Great Ormond Street Hospital for Children NHS Foundation Trust6, University of Lausanne7, Jawaharlal Institute of Postgraduate Medical Education and Research8, Erasmus University Rotterdam9, Carol Davila University of Medicine and Pharmacy10
TL;DR: This review summarizes the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe.
Abstract: The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults, as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discussed one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions. In this part of the review, we describe other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.
36 citations
TL;DR: A case of subacute cutaneous lupus erythematosus (SCLE) following mRNA vaccination with the Pfizer mRNA vaccine BNT162b2 was reported in this paper.
Abstract: Evidence is accumulating that COVID-19 vaccines might induce or exacerbate autoimmune rheumatic diseases. The currently available COVID-19 vaccines include mRNA and recombinant adenoviral vector vaccines, both encoding SARS-CoV-2 spike protein production as the primary target for neutralizing antibodies. We report a case of subacute cutaneous lupus erythematosus (SCLE) following mRNA vaccination with the Pfizer mRNA vaccine BNT162b2, and summarize the current literature on CLE occurring after COVID-19 vaccination.
35 citations
TL;DR: The COVID-19 outbreak had drastically modified the treatment of chronic inflammatory diseases (i.e. psoriasis) in terms of drug delivery, visits booking and patients adherence.
Abstract: COVID‐19 outbreak had drastically modified the treatment of chronic inflammatory diseases (i.e. psoriasis) in terms of drug delivery, visits booking and patients’ adherence. Furthermore, during lockdown several patients modified or even discontinued their anti‐psoriatic treatments due to misinformation, COVID‐phobia or even cabin fever syndrome experiencing a psoriatic flare and decreasing the overall daily functionality and quality of life.
34 citations
TL;DR: In this paper, a de novo generalized pustular psoriasis following the first dose of COVID-19 vaccine was reported in a patient with no pre-existing Psoriasis or any previous dermatological issue.
Abstract: We present an interesting and novel case of a de novo generalized pustular psoriasis following administration of first dose of Oxford-AstraZeneca COVID-19 vaccine in a patient with no pre-existing psoriasis or any previous dermatological issue.
TL;DR: In this paper, the authors report five cases of heterogeneous rare, severe cutaneous conditions arising in close connection with Covid-19 vaccination (Table 1) and conclude that vaccines may carry a small risk of adverse reactions, especially when used on large populations outside the highly controlled phase 3 clinical trials setting.
Abstract: Developing and manufacturing effective vaccines against Coronavirus Disease 2019 (COVID-19) have been epic achievements in record time. We believe that the vaccine will help stop the pandemic due to the SARS-CoV-2 virus. As for other medical interventions, vaccines may carry a small risk of adverse reactions, especially when used on large populations outside the highly controlled phase 3 clinical trials setting. We herein report five cases of heterogeneous rare, severe cutaneous conditions arising in close connection with Covid-19 vaccination (Table 1).
TL;DR: This review provides a concise update on current understanding of M. pneumoniae‐induced rash and mucositis and other reactive infectious mucocutaneous eruptions.
Abstract: Mycoplasma pneumoniae-induced rash and mucositis is the most accurate diagnosis for patients with blistering mucocutaneous disease provoked by an infection. Recent literature suggests expansion of the name is required, as other infections have caused a clinically similar presentation. This review provides a concise update on current understanding of M. pneumoniae-induced rash and mucositis and other reactive infectious mucocutaneous eruptions.
TL;DR: In this paper, the conserved Janus kinase (JAK) signalling pathway represents a promising therapeutic avenue to reduce the activation of multiple proinflammatory mediators involved in AD pathogenesis.
Abstract: Atopic dermatitis (AD) is chronic, pruritic, inflammatory skin disease that affects a significant portion of the population in industrialized nations. For nonresponders to conventional therapies, AD can significantly reduce sleep quality and quality of life. AD pathogenesis is multifactorial and involves multiple immune pathways, with recent evidence of T helper (Th)2, Th17 and Th22 axis attenuation in various AD endotypes and racial subtypes. Inhibition of the conserved Janus kinase (JAK) signalling pathway represents a promising therapeutic avenue to reduce the activation of multiple proinflammatory mediators involved in AD pathogenesis. JAK inhibitors exist in both oral and topical forms with variable specificity for the receptor tyrosine kinases JAK1, JAK2, JAK3 and tyrosine kinase 2. Oral formulations include abrocitinib, upadacitinib, baricitinib and gusacitinib, and are most appropriate for patients with moderate to severe AD. Emerging topical formulation in development include ruxolitinib and deglocitinib, which may be used in patients with localized AD and also adjunctively with systemic therapy in patients with more severe disease. With observed rapidity in itch relief and accompanying dramatic reduction in inflammatory lesion count, JAK inhibitors represent a promising new treatment to revolutionize the management of AD.
TL;DR: In this paper, the authors discuss conventional drugs, other treatments, including newer options such as immunotherapy and immunochemotherapy, and future prospects for leishmaniasis treatment, and discuss the potential of these treatments.
Abstract: Leishmaniasis is broadly classified into three types: cutaneous, mucocutaneous and visceral. The visceral form is most dangerous and can result in death. Although leishmaniasis is an ancient disease, its treatment is still challenging. Several drugs, differing in their cost, toxicity, treatment duration and emergence of drug resistance, are used for different types of leishmaniasis. To overcome these limitations, the search for newer drugs and other treatments continues. In this article, we discuss conventional drugs, other treatments, including newer options such as immunotherapy and immunochemotherapy, and future prospects for leishmaniasis treatment.
TL;DR: The emergency use authorisation of COVID-19 vaccinations in December 2020 has led to renewed optimism of reducing the prevalence and burden on healthcare systems as mentioned in this paper, and three vaccinations have now been granted temporary authorisation in the United Kingdom: BNT162b2, ChAdOx1 and mRNA-1273.
Abstract: The coronavirus disease (COVID)-19 pandemic has resulted in significant morbidity and mortality worldwide. The emergency use authorisation of COVID-19 vaccinations in December 2020 has led to renewed optimism of reducing the prevalence and burden on healthcare systems. Three vaccinations have now been granted temporary authorisation in the United Kingdom: BNT162b2, ChAdOx1 and mRNA-1273.
TL;DR: COVID-19 mRNA vaccines might differently stimulate myeloid or plasmacytoid dendritic cells, generating an imbalance in the downstream cytokine pathways that play a crucial role in autoimmunity and autoinflammation.
Abstract: COVID-19 vaccines are proving to be the most important medical tool to prevent and control the current pandemic (1). The skin is reported as the target organ where post-vaccination adverse reactions are frequently detected (2). The potential for vaccines to act as triggers of autoimmune reactions is a well-known adverse effect. COVID-19 mRNA vaccines might differently stimulate myeloid or plasmacytoid dendritic cells, generating an imbalance in the downstream cytokine pathways that play a crucial role in autoimmunity and autoinflammation (3).
University of Padua1, Boston Children's Hospital2, François Rabelais University3, University of Barcelona4, International University Of Catalonia5, Great Ormond Street Hospital for Children NHS Foundation Trust6, University of Lausanne7, Jawaharlal Institute of Postgraduate Medical Education and Research8, Erasmus University Rotterdam9, Carol Davila University of Medicine and Pharmacy10
TL;DR: This review summarizes the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe.
Abstract: The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.
TL;DR: In this article, a retrospective observational multicenter study was conducted to identify and describe LC-OCT criteria associated with SCC and actinic keratosis (AK) and to compare the findings in these tumours.
Abstract: Background Early and accurate diagnosis of cutaneous squamous cell carcinoma (SCC) and actinic keratosis (AK) is fundamental to reduce their morbidity and to select the correct treatment. Line-field confocal optical coherence tomography (LC-OCT) is a new imaging device that can characterize healthy skin and basal cell carcinoma, but no large studies are available on keratinocyte cell tumours. Objectives To identify and describe LC-OCT criteria associated with SCC and AK and to compare LC-OCT findings in these tumours. Methods A retrospective observational multicenter study was conducted. Lesions were imaged with LC-OCT device before surgery and had histological examinations. LC-OCT criteria for AK/SCC were identified and their presence was evaluated in all study lesions. Univariate and multivariate analyses were performed to compare AKs and SCCs and to investigate differences between in situ and invasive tumours. Results We included 158 patients with 50 AKs and 108 SCCs (62 in situ and 46 invasive). Cytological and architectural alterations were found in most lesions and differences were found among AKs and SCCs. Although the visualization of the DEJ was often hampered by hyperkeratosis and acanthosis, an outlined DEJ without broad strands was observed in almost all AKs and SCCs in situ and only in three invasive SCC (p Conclusions Our results suggest that LC-OCT can help clinicians in the identification of AK and SCC and their differentiation, providing a real-time and non-invasive examination. Further studies are needed to confirm our data.
TL;DR: In this paper, a multinominal regression with stepwise variables selection was performed to distinguish BCC subtypes in line-field confocal OCT (LC-OCT) images.
Abstract: BACKGROUND Basal cell carcinoma (BCC) is the most common skin cancer in the general population. Treatments vary from Mohs surgery to topical therapy, depending on the subtype. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) have gained a foothold in daily clinical practice to optimize diagnosis and subtype-oriented treatment. The new technique of line-field confocal OCT (LC-OCT) allows imaging at high resolution and depth, but its use has not yet been investigated in larger studies. AIM To evaluate the main LC-OCT criteria for the diagnosis and subtyping of BCC compared with histopathology, OCT and RCM. METHODS In total, 52 histopathologically confirmed BCCs were evaluated for imaging criteria. Their frequency, predictive values and ROC curves were calculated. A multinominal regression with stepwise variables selection to distinguish BCC subtypes was performed. RESULTS Nodular BCCs were mainly characterized by atypical keratinocytes, altered dermoepidermal junction (DEJ), tumour nests in the dermis, dark clefting, prominent vascularization and white hyper-reflective stroma. Superficial BCCs showed a thickening of the epidermis due to a series of tumour lobules with clear connection to the DEJ (string of pearls pattern). Infiltrative BCCs were characterized by elongated hyporeflective tumour strands, surrounded by bright collagen (shoal of fish pattern). The overall BCC subtype agreement between LC-OCT and conventional histology was 90.4% (95% CI 79.0-96.8). CONCLUSION LC-OCT allows noninvasive, real-time identification of BCCs and their subtypes in vertical, horizontal and three-dimension mode compared with histology, RCM and OCT. Further larger studies are needed to better explore the clinical applications of this promising device.
TL;DR: In this article, a pityriasis rubra pilaris (PRP)-like eruption occurred following administration of the Pfizer-Biontech mRNA COVID-19 vaccine, with worsening of the condition following the second dose.
Abstract: We describe a case of a pityriasis rubra pilaris (PRP)-like eruption occurring following administration of the Pfizer-Biontech mRNA COVID-19 vaccine, with worsening of the condition following the second dose. To our knowledge, this is the first reported case of a PRP-like eruption as a cutaneous adverse event of the Pfizer-Biontech mRNA COVID-19 vaccine.
TL;DR: Dermatological issues are uniquely represented among certain visually-driven social media platforms, presumably owing to the impact of skin-health on the self-esteem and outward appearance.
Abstract: Dermatological issues are uniquely represented among certain visually-driven social media platforms, presumably owing to the impact of skin-health on the self-esteem and outward appearance.1 From a dermatology health-promotion perspective, familiar platforms (SnapchatTM , InstagramTM )2,3 have been evaluated; TikTokTM is yet to be explored.
TL;DR: Capillary malformation–arteriovenous malformation (CM‐AVM) syndrome is a rare syndrome with characteristic skin lesions that are associated with fast‐flow vascular malformations (FFVMs) in one‐third of patients.
Abstract: BACKGROUND Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a rare syndrome with characteristic skin lesions that are associated with fast-flow vascular malformations (FFVMs) in one-third of patients. Few case series have been described, and none in Spain. AIM To identify the prevalence of dermatological parameters, FFVMs and associated features in a large series of patients with CM-AVM. METHODS We conducted an observational study of patients with CM-AVM syndrome diagnosed in 15 Spanish hospitals over 3 years. The main clinical, radiological, genetic findings and associated diseases were analysed. RESULTS In total, 64 patients were assessed. In 26.5% of cases, the diagnosis was incidental. In 75% of patients, there was one significantly larger macule, which we termed the 'herald patch'. FFVMs were detected in 34% of the patients, with 30% located on the skin, 7.8% in the brain and in 1.5% in the spine. There was a positive family history in 65% of the 64 patients. Genetic analysis was performed for RASA1 mutations in 57 patients, of whom 42 (73%) had a positive result. All 4 patients tested for EPHB4 mutations had a positive result. No tumour lesions were detected in the series, except for five infantile haemangiomas. CONCLUSIONS Our data on clinical lesions, associated FFVM, family history and genetics are similar to those previously published in the literature. An extensive data analysis failed to demonstrate any statistically significant association between the presence of an FFVM and any clinical, familial or genetic parameter that could predict its onset, although a link between the presence of a herald patch on the midline face and the presence of a brain FFVM was observed. We did not detect any genotype-phenotype correlation.
TL;DR: In this paper, the authors conducted a prospective study to report the prevalence and patterns of cutaneous manifestations in COVID•19 patients from India and found that these cutaneous symptoms have been mostly reported from countries with Caucasian populations with a paucity of data from the skin-of-color populations.
Abstract: Reported cutaneous manifestations of SARS‐Cov‐2 infection include maculopapular rash, urticarial rash, varicelliform or vesicular lesions, petechiae/purpura, livedoid/necrotic lesions, chilblains‐like lesions (Covid toes), erythema multiforme‐like lesions,1 and aphthous ulcers.2 These cutaneous manifestations have been mostly reported from countries with Caucasian populations with a paucity of data from the skin‐of‐color populations.3 We conducted a prospective study to report the prevalence and patterns of cutaneous manifestations in COVID‐19 patients from India.
TL;DR: A 46-year-old man with hypercholesterinaemia and coronary heart disease presented to the emergency department with a 3-day history of fatigue, dry cough and fever and had an oxygen saturation of 91% and a respiratory rate of 16 breaths per minute.
Abstract: A 46-year-old man with hypercholesterinaemia and coronary heart disease presented to the emergency department with a 3-day history of fatigue, dry cough and fever He was febrile with 39 5°C and had an oxygen saturation of 91% while breathing ambient air with a respiratory rate of 16 breaths per minute
TL;DR: This data indicates that the timing between AA and the development of such comorbidities remains poorly understood and further research is needed to fully understand the mechanisms behind this association.
Abstract: BACKGROUND Previous studies have associated alopecia areata (AA) with a number of comorbidities. However, the timing between AA and the development of such comorbidities remains poorly understood. AIM To examine the temporal relationship between AA diagnosis and comorbidity development in Denmark. METHODS A Danish nationwide register-based cohort study was performed on all individuals diagnosed with AA between 2007 and 2016 (n = 1843), and each patient was matched for age and sex with 10 healthy controls (HCs). Time between AA and comorbidity development was assessed, and incidence rate ratios (IRRs) were calculated to assess risk of comorbidity following initial AA diagnosis. RESULTS Use of antidepressant and anxiolytic drugs were mostly started prior to AA diagnosis, and these drugs were used more frequently before than after diagnosis with AA. Additional frequent comorbidities included thyroid disease, hyperlipidaemia, type 2 diabetes and asthma. Most comorbidities occurred prior to AA diagnosis; however, among those that occurred after AA diagnosis, antidepressants (IRR = 1.26, 95% CI 1.01-1.56), anxiolytics (IRR = 1.55, 95% CI 1.17-2.05), atopic dermatitis (AD; IRR = 9.41, 95% CI 4.00-22.16), asthma (IRR = 2.17, 95% CI 1.46-3.21), vitiligo (IRR = 30.35, 95% CI 6.13-150.39), Crohn disease (CD; IRR = 3.04; 95% CI 1.22-7.56) and thyroid disease (IRR = 2.38; 95% CI 1.72-3.29) occurred more frequently among patients with AA compared with controls. CONCLUSION A diagnosis of AA was significantly associated with risk of several comorbidities, most notably vitiligo, AD and CD. Nonetheless, the majority of patients appeared to have developed these comorbidities prior to AA diagnosis, suggesting that a thorough medical history screening by dermatologists at the initial visit may be appropriate.
TL;DR: Radiation recall dermatitis (RRD) is an acute inflammatory reaction that is localized to an area of skin previously exposed to radiation and is known to be triggered by various systemic drugs.
Abstract: Radiation recall dermatitis (RRD) is an acute inflammatory reaction that is localized to an area of skin previously exposed to radiation and is known to be triggered by various systemic drugs It can be observed weeks to years after the cessation of radiotherapy, and the time interval between administration of the reaction‐triggering drug to the onset of lesions varies from minutes to days
TL;DR: From the observation, tofacitinib appears to be a promising steroid‐sparing adjuvant treatment in patients with refractory PG who have failed on other systemic therapies.
Abstract: Pyoderma gangrenosum (PG) is a rare, debilitating, inflammatory skin disease associated with a variety of systemic diseases. Because of its rarity, PG is treated with miscellaneous immunosuppressive agents as there is no US Food and Drug Administration-approved standardized treatment approach. We present four patients with PG treated with tofacitinib in the context of the six existing cases in the literature. Tofacitinib appeared to be beneficial in the small sample of patients (n = 10) who failed an average of four other systemic therapies. The majority of patients had classic PG located on the legs (80%, 8/10), while 20% of cases (2/10) were peristomal. The most common comorbidity was inflammatory bowel disease (78%, 7/9). There were no negative treatment results and 40% (4/10) of patients had complete healing of their ulcers, while the other 60% (6/10) had marked clinical improvement. From our observation, tofacitinib appears to be a promising steroid-sparing adjuvant treatment in patients with refractory PG who have failed on other systemic therapies.