Combination treatment of COVID-19 associated herpes zoster scar with 1540 nm and 755 nm picosecond lasers: a case report.

A 33-year-old female, Fitzpatrick IV phototype, developed varicella zoster eruption over the ophthalmic dermatome of the right trigeminal nerve, confirmed through Polymerase Chain Reaction, 4 weeks after recovering from COVID-19 disease. After the resolution of the acute manifestations, she developed significant atrophic scars on the forehead, about 2 mm deep, with marked post-inflammatory hyperpigmentation. She came to our clinic looking for treatment, as the scars caused significant psychological distress. We decided for a combination treatment with Erbium:glass 1540 nm non-ablative laser and 755 nm Alexandrite picosecond laser. After 16 weeks of starting treatment, significant improvement was observed, with complete resolution of the hyperpigmentation and overall improvement in the atrophic scar. No complications occurred during the treatment period. This strategy may be an effective and safe option to treat these lesions, which may be increasingly found in young individuals after COVID-19 disease or SARS-CoV-2 vaccination, even in darker skin phototypes.

Severe Acute Respiratory Syndrome Coronavirus 2 Vaccines and Cutaneous Adverse Reactions: A Review.

We are entering a new stage of the severe acute respiratory syndrome coronavirus 2 pandemic with the initiation of large-scale vaccination programs globally. In these circumstances, even rare adverse effects of vaccines may be encountered more often, if millions of people are to be vaccinated in a short period. Vaccination has the potential for causing cutaneous adverse effects. Thus, it is paramount that dermatologists worldwide are acquainted with the possible skin reaction patterns to the coming vaccines. Herein, we conduct a review to discuss the most frequent cutaneous adverse effects of vaccines and their management, with a particular focus on the expected adverse reactions for the coming severe acute respiratory syndrome coronavirus 2 vaccines, such as local reactions, as well as immediate- and delayed-type hypersensitivity reactions, including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrosis, serum sickness-like reactions, and vasculitides. We also discuss the yet unanswered questions on vaccines for which we may soon be asked to provide an expert opinion.

Persistent SARS-CoV-2 infection and the risk for cancer.

The current SARS-CoV-2 has put significant strain on healthcare services worldwide due to acute COVID-19. However, the potential long-term effects of this infection haven't been extensively discussed. We hypothesize that SARS-CoV-2 may be able to cause persistent infection in some individuals, and should this be the case, that in a few years we may see a rise in cancer incidence due to carcinogenic effects of this coronavirus. Non-retroviral RNA viruses such as Coronaviridae have been shown to cause persistent infection in hosts. Empirical evidence of viral genomic material shedding weeks after apparent clinical and laboratorial resolution of COVID-19 may be an indirect proof for persistent viral infection. Furthermore, tropism towards certain immune-privileged territories may facilitate immune evasion by this virus. Structural homology with SARS-CoV-1 indicates that SARS-CoV-2 may be able to directly impair pRb and p53, which are key gatekeepers with tumor suppressor functions. Additionally, COVID-19 features preeminent inflammatory response with marked oxidative stress, which acts as both as initiator and promotor of carcinogenesis. Should there be a carcinogenic risk associated with SARS-CoV-2, the implications for public health are plenty, as infected patients should be closely watched during long periods of follow-up. Additional investigation to establish or exclude the possibility for persistent infection is paramount to identify and prevent possible complications in the future.