ABSTRACT
Purpose of Review: To summarize diagnostic and therapeutic management of COVID-19 in the outpatient setting for dermatologists. Recent Findings: Paxlovid (nirmatrelvir-ritonavir) is the preferred treatment in patients with mild symptoms at high risk of progression to severe SARS-CoV2 infection. Additional options include monoclonal antibodies (bebtelovimab), remdesivir, and molnupiravir. Summary: Dermatologists need to be aware of recent developments in diagnostic and therapeutic management of COVID-19 in the outpatient setting, as their patients may rely on dermatologists to provide advice, particularly in cases where treatments for dermatological disease may impact the risk of COVID-19 and/or vaccine efficacy. Supplementary Information: The online version contains supplementary material available at 10.1007/s13671-022-00368-3.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic is a grave public health crisis, causing massive disruption to daily life. Dermatology clinical trials in psoriasis, atopic dermatitis, and hidradenitis have been suspended, terminated, or otherwise disrupted. Clinical investigators need to embrace a COVID-19 new normal and adjust research procedures to mitigate the risk of transmitting severe acute respiratory syndrome coronavirus 2 and depleting personal protective equipment while maintaining scientific rigor.
Subject(s)
COVID-19 , Dermatology , Humans , Pandemics , Personal Protective Equipment , SARS-CoV-2ABSTRACT
OBJECTIVE: To update guidance regarding the management of psoriatic disease during the COVID-19 pandemic. STUDY DESIGN: The task force (TF) includes 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation staff. Clinical questions relevant to the psoriatic disease community were informed by inquiries received by the National Psoriasis Foundation. A Delphi process was conducted. RESULTS: The TF updated evidence for the original 22 statements and added 5 new recommendations. The average of the votes was within the category of agreement for all statements, 13 with high consensus and 14 with moderate consensus. LIMITATIONS: The evidence behind many guidance statements is variable in quality and/or quantity. CONCLUSIONS: These statements provide guidance for the treatment of patients with psoriatic disease on topics including how the disease and its treatments affect COVID-19 risk, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 (including novel vaccination), and what they should do if they develop COVID-19. The guidance is a living document that is continuously updated by the TF as data emerge.
Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Psoriasis/drug therapy , Biological Products/therapeutic use , COVID-19/complications , COVID-19/epidemiology , Decision Making, Shared , Evidence-Based Medicine , Humans , Immunologic Factors/therapeutic use , Pandemics , Psoriasis/complications , Risk Factors , United States/epidemiology , COVID-19 Drug TreatmentSubject(s)
Biological Products/adverse effects , Coronavirus Infections/immunology , Interleukin-23 Subunit p19/antagonists & inhibitors , Pneumonia, Viral/immunology , Psoriasis/drug therapy , Respiratory Tract Infections/epidemiology , Antibodies, Monoclonal/administration & dosage , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized/administration & dosage , Antibodies, Monoclonal, Humanized/adverse effects , Betacoronavirus/immunology , Biological Products/administration & dosage , COVID-19 , Clinical Decision-Making , Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Interleukin-23 Subunit p19/metabolism , Odds Ratio , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Psoriasis/immunology , Respiratory Tract Infections/chemically induced , Respiratory Tract Infections/immunology , Respiratory Tract Infections/prevention & control , Risk Assessment , SARS-CoV-2 , Signal Transduction/drug effects , Signal Transduction/immunologyABSTRACT
OBJECTIVE: To provide guidance about management of psoriatic disease during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: A task force (TF) of 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care was convened. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation (NPF) staff. Clinical questions relevant to the psoriatic disease community were informed by questions received by the NPF. A Delphi process was conducted. RESULTS: The TF approved 22 guidance statements. The average of the votes was within the category of agreement for all statements. All guidance statements proposed were recommended, 9 with high consensus and 13 with moderate consensus. LIMITATIONS: The evidence behind many guidance statements is limited in quality. CONCLUSION: These statements provide guidance for the management of patients with psoriatic disease on topics ranging from how the disease and its treatments impact COVID-19 risk and outcome, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 and what they should do if they develop COVID-19. The guidance is intended to be a living document that will be updated by the TF as data emerge.
Subject(s)
Coronavirus Infections/epidemiology , Immunosuppressive Agents/adverse effects , Organizations, Nonprofit/standards , Pneumonia, Viral/epidemiology , Psoriasis/drug therapy , Advisory Committees/standards , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Consensus , Coronavirus Infections/immunology , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Critical Care/standards , Delphi Technique , Dermatology/standards , Epidemiology/standards , Humans , Infectious Disease Medicine/standards , Organizations, Nonprofit/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/immunology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , Psoriasis/complications , Psoriasis/immunology , Rheumatology/standards , SARS-CoV-2 , United States/epidemiologySubject(s)
COVID-19/epidemiology , Clinical Decision-Making/methods , Immunosuppressive Agents/adverse effects , Psoriasis/drug therapy , Tumor Necrosis Factor Inhibitors/adverse effects , COVID-19/immunology , COVID-19/virology , Clinical Trials, Phase III as Topic , Humans , Pandemics , Psoriasis/immunology , Risk Assessment/statistics & numerical data , SARS-CoV-2/immunologyABSTRACT
The COVID-19 pandemic has sparked a demand for safe and highly effective decontamination techniques for both personal protective equipment (PPE) and hospital and operating rooms. The gradual lifting of lockdown restrictions warrants the expansion of these measures into the outpatient arena. Ultraviolet C (UVC) radiation has well-known germicidal properties and is among the most frequently reported decontamination techniques used today. However, there is evidence that wavelengths beyond the traditional 254 nm UVC - namely far UVC (222 nm), ultraviolet B, ultraviolet A, visible light, and infrared radiation - have germicidal properties as well. This review will cover current literature regarding the germicidal effects of wavelengths ranging from UVC through the infrared waveband with an emphasis on their activity against viruses, and their potential applicability in the healthcare setting for general decontamination during an infectious outbreak.