ABSTRACT
BACKGROUND/OBJECTIVE: Stress may affect patients with atopic dermatitis (AD). The aim of this study was to examine the impact of the COVID-19 pandemic and the earthquake in Zagreb, Croatia (March 2020), on AD patients and their disease severity, symptoms/itch, and perceived stress. METHODS: Our observational cross-sectional study included three groups of AD patients diagnosed by a physician: group 1 (n = 50), who experienced both the pandemic (quarantine) and the earthquake; group 2 (n = 50), who experienced only the pandemic; and group 3 (n = 50), the comparison group, who experienced neither disaster (patients examined 2018-2019). Groups 1 and 2 were examined May-June 2020, immediately after the national lockdown/quarantine. Disease severity (SCORAD), data from the Perceived Stress Scale (PSS), and information on patients' confirmed allergies were recorded for all groups, while groups 1 and 2 additionally completed a questionnaire concerning their disease, hand hygiene, and experience during the pandemic and/or earthquake. RESULTS: The patients exposed to both disasters reported more pronounced AD worsening (p < 0.001; r = 0.388) and more frequent itching (p < 0.001; r = 0.350) than those exposed to the pandemic only. Notably, we found certain differences by gender: during the pandemic, women significantly more frequently washed their hands (81% of women washed "very frequently," while 52% of men washed "quite often") and had significantly higher PSS levels than men (p < 0.05). Concerning allergies, present or absent, during the pandemic, there was no significant difference in SCORAD between groups 1 and 2, neither when analyzed separately for indoor nor for outdoor allergens. The most commonly reported psychological disturbances during the pandemic were concern (46%), anger (18%), anxiety (16%), depression (9%), and increased alcohol, cigarette, and opioid agent use (6%). CONCLUSION: The COVID-19 pandemic together with the earthquake significantly increased disease severity and influenced AD worsening, itching, and psychological disturbances. This indicates that stressful events meaningfully affect the course of AD.
ABSTRACT
The COVID-19 pandemic has changed many areas of life, including habits and trends in dermatological practice and dermatology patients' lifestyles. This article presents cases of patients infected with COVID-19, patients that developed lesions due to pandemic-related public health measures affecting the skin, and those that developed skin lesions after COVID-19 vaccination. One case concerned a female patient with widespread urticaria that had repeatedly gone to emergency rooms and had been administered corticosteroids and antihistamines for an undiagnosed COVID-19 infection that had been triggering her urticaria outbreaks. Another patient complained of urticaria outbreaks and was examined and treated multiple times at emergency rooms until a dermatological follow-up determined he was suffering from dysmorphophobia. Among those with lesions due to frequent hygiene during the pandemic, we examined a female with contact dermatitis triggered by repeated and prolonged contact with hand disinfectant. Another patient presented with a phototoxic reaction on the neck after using hand disinfectant. In addition, we saw widespread lesions on a patient that reported recently being vaccinated against COVID-19. Finally, in an effort to prevent COVID-19 transmission, we believe that a first-time onset of non-specific exanthema indicates COVID-19 testing because it may be an early indicator of viral infection.