Dermatology consultations in patients with hematological and solid organ malignancies

Aims: Patients with hematological or solid organ malignancies are susceptible to various skin disorders. This study described the cutaneous problems related to the underlying diseases or their management in hematology and oncology inpatients. Methods: In this retrospective study with a cross-sectional analysis, we examined the medical records of inpatients with hematologic or solid organ malignancy who consulted the dermatology department from January 2018 through March 2021. Sociodemographic characteristics, medical history and comorbidities, cancer type, and dermatological findings and diagnoses were noted. Patients who have consulted the outpatient clinic and those with inadequate medical records were excluded. Results: The study included 200 patients (age, mean±standard deviation, minimum-maximum: 51.4±18.2, 18-89 years;female 51%). Most of the consultations were from the internal medicine clinic (26.4%), followed by the hematology and oncology clinics (12.5%). A quarter of the patients had acute myeloid leukemia, the most frequent disease among hematological malignancies. Breast cancer (7%) and testis cancer (7%) were the most common solid organ malignancies. The most common dermatological diagnoses were cutaneous infections (33.5%) and drug reactions (13.5%). Skin biopsies were performed in 19.5% (n=39) of the patients. The evaluation of the patient by a dermatologist for a cutaneous symptom or finding led to modifications of disease management in 67 patients (33.7%). Conclusions: Dermatology consultations are frequently required in hematological or solid organ malignancies. A successful evaluation of skin manifestations in these patients may improve the quality of care in this vulnerable population.

The role of online consultation requests to personal social media accounts and instant messaging services of dermatologists in occupational burnout: An emerging problem.

BACKGROUND: Burnout affects all physicians, including dermatologists. Long working hours, high workload, and work-related activities outside working hours are common risk factors for burnout that disrupt the work-life balance. This study aimed to evaluate dermatologists' approach to online consultation requests via social media (SM) and instant messaging services (IMS), the psychological effects of these consultations on dermatologists, and their relationship with burnout syndrome. MATERIALS AND METHODS: A cross-sectional, descriptive research was conducted as an online survey using Google Forms. The survey consisted of 55 items and was sent to dermatologists through a closed Facebook group of the Turkish Society of Dermatology. The burnout levels of dermatologists were evaluated using three subscales of the Maslach Burnout Inventory (MBI): emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). RESULTS: Out of the total 270 participants, 268 (99.3%) participants reported using SM and IMS, whereas 263 (98.1%) received personal consultation requests on these applications. Among all IMS, WhatsApp (n=258, 98.1%) was the most common IMS for online consultation requests. Median (IQR) scores for EE, DP, and PA subscales were 18 (11), 6 (5), and 21 (6), respectively. A positive correlation was observed between the frequency of online consultation requests and MBI-EE subscale scores (r = 0.136; 95% CI, 0.013-0.254; p = 0.026). Fatigue (95.1%), anger (66.6%), and unhappiness (45.2%) were among the most common adverse effects of online consultations on dermatologists. CONCLUSION: Online consultation requests to dermatologists' personal IMS and SM accounts can lead to burnout. The current study findings raise the awareness of the risks of burnout among dermatologists. There is an implicit need for further research, mobile apps other than frequently used IMS and SM apps, and regulations to avoid problems related to the consequences of online dermatology consultations through IMS and SM.

A case of psoriasis successfully treated by extracorporeal photopheresis during COVID-19 pandemic.

Psoriasis is a chronic inflammatory skin disease that is characterized by well-demarcated erythematous plaques with a silver scale. Although many new and emerging therapeutic agents are often sufficient to control the disease, there is still a need for alternative treatment options in challenging cases. Extracorporeal photopheresis (ECP) has been applied to many T-cell-mediated diseases to restore immune homeostasis and treat psoriasis effectively. In this paper, we present a psoriasis patient who did not respond to methotrexate, narrowband ultraviolet B, or acitretin. Because of a diagnosis of non-Hodgkin lymphoma, the patient had contraindications for cyclosporine, fumaric acid esters, and biologics but achieved remission with a total of 12 sessions of ECP in two and a half months. Although exacerbation was recorded after polymerase chain reaction (PCR) confirmed coronavirus 2019 (COVID-19) disease infection at the end of the first month, scores from the psoriasis area severity index (PASI) and dermatological life quality index (DLQI) were regressed significantly within two and a half months. ECP seems to provide an effective and rapid response for psoriasis and should be considered for psoriasis patients who fail to respond or have contraindications to existing treatments.

Temporary withdrawal of immunosuppressive treatments in patients with hidradenitis suppurativa during COVID-19 pandemic: A retrospective cross-sectional study

Aims: There is currently no evidence-based guideline to show how to manage immunosuppressive treatment in patients with hidradenitis suppurativa (HS) during the Coronavirus disease-2019 (COVID-19) pandemic. Therefore, we updated our routine clinical protocol to 1) inform patients with ongoing treatment about the potential risks of their medications in the case of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, 2) discuss opt out of treatment temporarily, and 3) perform a closer follow-up on a monthly basis. The aim of this study was to evaluate the clinical outcomes in patients with HS, who suspended and continued immunosuppressive therapy following COVID-19 outbreak. Methods: This retrospective study included patients with HS, who had been receiving biologic/immunosuppressive treatment when the COVID-19 pandemic was announced. Those who withdrew treatment for any reason or continued were analyzed. The primary endpoint was physician-diagnosed disease exacerbation. The secondary outcomes were changes in visual analogue scale (VAS) and COVID-19 diagnosis. Results: A total of 37 patients were included in the analysis. The majority of the patients were on adalimumab treatment (n=33). Fifteen (40.5%) patients withdrew the treatment for COVID-19 related concerns. During 83.2±0.6 days of follow-up following the withdrawal, all patients in this group had at least one exacerbation. Also, the mean VAS score increased from 5.7±0.56 to 8.6±0.57 (p=0.001). On the other hand, three patients (13.6%) who continued the treatment reported worsening in disease course, 12 patients (54.5%) remained stable and seven of them (31.9%) had clinical relief. We did not observe any confirmed SARS-CoV-2 infection in any of our 37 HS patients. Conclusions: The present study suggests that even a temporary withdrawal of biologic/immunosuppressive treatments may have significant adverse consequences on disease course and quality of life in patients with HS. These individuals may safely continue the treatment provided that maximum measures are taken to avoid COVID-19 infection.

Rapid Response to Certolizumab Pegol in Hidradenitis Suppurativa: A Case Report.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of hair follicles which usually affects patients' quality of life negatively. Although there are various therapeutic approaches including topical and systemic antibiotics, retinoids, biological agents, and also surgical modalities, there is no curative treatment option and clinical management of HS is still challenging. CASE PRESENTATION: Herein, we present a 43 year-old man with HS who had used different treatments in 15 years. The patient showed improvement initially with adalimumab, then exhibited secondary unresponsiveness after 18 months. While worsening of HS was recorded due to increased discharge under secukinumab, no additional benefit was observed with methotrexate. He was not willing to undergo surgical procedures due to previous surgical experience. Finally, certolizumab pegol has been started to patient with similar dosing to psoriasis patients. Sartorius, 10-point visual analogue scale (VAS), and dermatological life quality index (DLQI) scores regressed from 171 to 105, 9/10 to 3/10, and 27 to 19 after 3 months with certolizumab pegol treatment. DISCUSSION/CONCLUSION: Certolizumab pegol is a humanized antigen-binding fragment of a monoclonal antibody which binds to TNF-alpha. However, certolizumab pegol is only approved for plaque psoriasis in dermatology; it is likely to be a promising effective agent for HS, especially in challenging cases.

Medical and socioeconomic challenges of private dermatocosmetology clinics during COVID-19 pandemic: A survey from Turkey.

BACKGROUND: Coronavirus 2019 (COVID-19) disease has rapidly spread worldwide with a multitude effects on daily life. Since the transmission risk increases with close contact, some cosmetic procedures are considered high risk and majority of them had to be postponed or canceled in private dermatocosmetology clinics especially during the heavy period of the outbreak. AIMS: We aimed to document the medical and socioeconomic problems emerged in dermatocosmetology clinics in Turkey caused by COVID-19 pandemic and to discuss the management strategies taken by dermatologists. PATIENTS/METHODS: This survey research was conducted with 100 dermatologists who work in private dermatocosmetology clinics. The survey included 38 questions about office re-arrangements including patient admission and office environment, safety precautions taken for cosmetic procedures, management of clinic staff, and financial impact of the pandemic. RESULTS: A remarkable decrease in major cosmetic interest was reported in private clinics; meanwhile, there was an increase in applicants for noncosmetic dermatological complaints. The most avoided cosmetic procedures were application of skin care devices, lasers, chemical peeling, and thread lifting, while botulinum toxin injection was the most performed procedure. Nearly half of the participants had severe financial damage. Of the participants, 55% reported that they worked anxiously during this period and 60% believed that they managed the early period of the pandemic successfully. CONCLUSION: Private dermatocosmetology clinics have to work in a totally different period that they have never experienced before. The pandemic has had serious impacts on both medical and socioeconomic issues which had to be managed carefully.