The impact of blue light and digital screens on the skin.

INTRODUCTION: The skin is frequently subjected to a variety of environmental trauma and stress. It is unavoidably subjected to blue light due to the increased use of electronic equipment, including indoor lighting and digital gadgets like smartphones and laptops, which have a range of detrimental effects. The method of action and numerous harmful consequences of blue light on the skin are the main subjects of this review. MATERIALS AND METHODS: A literature search has been performed using PubMed, GoogleScholar and EmBase databases and an updated review on the topic has been presented. RESULTS: Numerous studies have shown that being exposed to blue light accelerates the aging process and produces cutaneous hyperpigmentation. It also modifies the circadian rhythm. The two main molecules that mediate cellular responses to blue light are nitric oxide (NO) and reactive oxygen species. However, the precise process is still not fully known. CONCLUSION: These negative consequences may eventually cause more general skin damage, which may hasten the aging process. At times, skin protection may be crucial for protection against blue light.

Cutaneous manifestations of Coronavirus Disease 2019.

BACKGROUND: COVID-19 has been linked to a variety of dermatological conditions. OBJECTIVE: To determine the presence of various cutaneous manifestations in patients with COVID-19, also to define their features in relation to the systemic symptoms. METHODS: This research enrolled a total of 1206 lab-confirmed COVID-19 individuals at a tertiary-care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID-related skin conditions. COVID-19 severity was categorized as asymptomatic/mild, moderate, or severe. RESULTS: Of the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculopapular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer-lasting vascular pattern was related with an older age and a fatal COVID-19 outcomes (P: 0.000) compared with mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared with moderate/severe infection. LIMITATIONS: Single-Center and observational study. CONCLUSION: Vascular lesions were correlated with disastrous COVID-19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, while the urticarial rash was linked to milder course compared with moderate/severe severity infection.

Viral Diseases in Dermatology.

Viral skin infections are some of the most common skin diseases in medical dermatology [...].

COVID-19 and artificial intelligence: Experts and dermatologists perspective.

INTRODUCTION: Artificial intelligence (AI) has an important role to play in future healthcare offerings. Machine learning and artificial neural networks are subsets of AI that refer to the incorporation of human intelligence into computers to think and behave like humans. OBJECTIVE: The objective of this review article is to discuss perspectives on the AI in relation to Coronavirus disease (COVID-19). METHODS: Google Scholar and PubMed databases were searched to retrieve articles related to COVID-19 and AI. The current evidence is analysed and perspectives on the usefulness of AI in COVID-19 is discussed. RESULTS: The coronavirus pandemic has rendered the entire world immobile, crashing economies, industries, and health care. Telemedicine or tele-dermatology for dermatologists has become one of the most common solutions to tackle this crisis while adhering to social distancing for consultations. While it has not yet achieved its full potential, AI is being used to combat coronavirus disease on multiple fronts. AI has made its impact in predicting disease onset by issuing early warnings and alerts, monitoring, forecasting the spread of disease and supporting therapy. In addition, AI has helped us to build a model of a virtual protein structure and has played a role in teaching as well as social control. CONCLUSION: Full potential of AI is yet to be realized. Expert data collection, analysis, and implementation are needed to improve this advancement.

Androgens and COVID-19.

BACKGROUND: The humans have been disproportionately affected by the coronavirus disease (COVID-19) pandemic. The novel coronavirus or the severe acute respiratory syndrome coronavirus 2 (SARS-COV2) causing coronavirus disease (COVID-19) has spread across the globe. Androgens have been suggested to have a role in COVID-19 pathogenesis. OBJECTIVE: The objective of this review article is to study the link between androgens and COVID-19. METHODOLOGY: PubMed and Google Scholar search was performed to retrieve literature related to the topic. Review articles, clinical trials, retrospective studies, observational studies, and case-control studies were considered for the review. RESULTS: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected men are more inclined to be hospitalized for intensive care unit (ICU) as compared with women. This difference in the ICU admissions provides some clue for possible influence of androgens in the severity of COVID-19. The contribution of androgen and androgen receptor in COVID-19 disease and its severity, as well as the numerous medications targeting androgen and its receptor for lowering COVID-19 disease severity, are discussed in this review. Available literature suggests the role of androgen in the pathogenesis and severity of COVID-19. Sensitivity for androgen may be an important factor in regulating the severity of COVID-19 disease. CONCLUSION: There is a scope for the development of COVID-19 treatments based on androgen suppression. Clinical trials may furnish pivotal data and add more evidence-based options for the management of COVID-19.

Pathobiology of Cutaneous Manifestations Associated with COVID-19 and Their Management.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has been a rising concern since its declaration as a pandemic by the World Health Organization on 11 March 2020. Recently, its association with multiple underlying organs has been identified that includes cardiac, renal, gastrointestinal, nervous systems, and cutaneous manifestations. Cutaneous COVID-19 findings have been supposedly classified into the following categories: vesicular (varicella-like), papulo-vesiculsar, chilblains-like ("COVID toes") maculopapular, and urticarial morphologies. In this review, we aim to focus on the proposed pathophysiology behind the various dermatological manifestations associated with COVID-19 and their associated management. We also included prevalence and clinical features of the different COVID-19-related skin lesions in our review. A comprehensive narrative review of the literature was performed in PubMed databases. Data from case reports, observational studies, case series, and reviews till June 2022 were all screened and included in the review.

Coronavirus Disease 2019 (COVID-19).

The coronavirus disease 2019 (COVID-19) pandemic has affected almost all aspects of daily life [...].

"Lockdown Dermatoses" during COVID-19-A Series of 127 Patients from the Indian Subcontinent.

Lockdown was enforced in many countries across the globe to flatten the coronavirus disease (COVID-19) curve. In these difficult times, people with skin diseases faced unique challenge, as major clinical facilities came to a standstill. Teledermatology helped to an extent to bridge this provider-seeker gap to an extent. We compiled data of patients seeking dermatology services during this period in Bangladesh, India, and Nepal. Most of the patients were middle-aged (70%) and had good access to teledermatology. Dermatoses were primarily due to frequent handwashing, use of alcohol-based sanitizers, excessive use of water (12.6%), improper skin care (43.3%), sun exposure (20.5%), lockdown-induced stress (22.04%), infections (15.75%), flare of preexisting diseases (8.66%), and hair disorders (11%). Many dermatoses had a causal overlap. Teledermatology proved to be useful for patients with skin diseases who were unable to access direct face-to-face consultations.

Herpes zoster: A Review of Clinical Manifestations and Management.

The Varicella-zoster virus (VZV) or human herpes virus 3 is a neurotropic human alpha herpes virus responsible for chickenpox/varicella and shingles/Herpes zoster (HZ). This review will focus on HZ. Since HZ is secondary to varicella, its incidence increases with age. In children and youngsters, HZ is rare and associated to metabolic and neoplastic disorders. In adults, advanced age, distress, other infections (such as AIDS or COVID-19), and immunosuppression are the most common risk factors. HZ reactivation has recently been observed after COVID-19 vaccination. The disease shows different clinical stages of variable clinical manifestations. Some of the manifestations bear a higher risk of complications. Among the possible complications, postherpetic neuralgia, a chronic pain disease, is one of the most frequent. HZ vasculitis is associated with morbidity and mortality. Renal and gastrointestinal complications have been reported. The cornerstone of treatment is early intervention with acyclovir or brivudine. Second-line treatments are available. Pain management is essential. For (secondary) prophylaxis, currently two HZV vaccines are available for healthy older adults, a live attenuated VZV vaccine and a recombinant adjuvanted VZV glycoprotein E subunit vaccine. The latter allows vaccination also in severely immunosuppressed patients. This review focuses on manifestations of HZ and its management. Although several articles have been published on HZ, the literature continues to evolve, especially in regard to patients with comorbidities and immunocompromised patients. VZV reactivation has also emerged as an important point of discussion during the COVID-19 pandemic, especially after vaccination. The objective of this review is to discuss current updates related to clinical presentations, complications, and management of HZ.

Association of androgenetic alopecia and severity of coronavirus disease 2019.

OBJECTIVE: To establish the association of androgenetic alopecia (AGA) and the severity of coronavirus disease 2019 (COVID-19). DESIGN: Observational study. METHODOLOGY: A total of 300 hospitalized patients of COVID-19 were included. Scoring of AGA was done, and severity of COVID-19 was measured as better and worse hospital outcomes. Correlation between severity of AGA and severity of COVID-19 was noted. RESULTS: Out of 300 patients, 220 (73.33%) were male and 80 (26.67%) were female. In males, mild-to-moderate Hamilton-Norwood scale (HNS<3) and severe alopecia (HNS3-7) were noted among 43(20%) and 177(80.55%) patients, respectively. In females, 43(54%) had no AGA while 37(46%) had AGA. In 37 females with AGA, mild-to-moderate (Ludwig scale <2) and severe alopecia (Ludwig scale 2-3) were seen in 9(24.32%) and 28(75.68%) patients, respectively. We report a significant increase in frequency (95%) and severity of AGA and worse outcomes in males (p-value 0.000, chi-square: 18.90) compared with females (46%) (p-value 0.273, chi-square: 7.544), with notable adverse COVID-19 disease outcomes in the younger age group of men and also in few women of younger age group suffering from AGA without any comorbidities. CONCLUSION: Our study shows a significant increase in frequency and severity of AGA and worse outcomes in men compared with women. There was a significant association between AGA severity and hospital disease outcome in men compared with women. Younger age group patients with severe AGA particularly men also faced adverse outcomes while having no known comorbidities, supporting the hypothesis that anti-androgen drugs might be valuable in patients of COVID-19.

Cutaneous and Allergic reactions due to COVID-19 vaccinations: A review.

INTRODUCTION: The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has had an unprecedented impact on the overall health and the global economy. Vaccination is currently the most dependable strategy to end the pandemic, despite the slower-than-hoped-for rollout, particularly for low-to-middle-income countries, and the uncertain duration of protection afforded by vaccination. The spike protein of the virus (immunodominant antigen of the virus) is the main target of the approved and candidate SARS-CoV-2 vaccines. This protein binds to the ACE2 receptor of the host cell, initiating the entry of the virus into the cell and the chain of subsequent events ending to Acute Respiratory Distress Syndrome. The safety profile of these vaccines needs is closely assessed. METHODS: This comprehensive review includes searching the PubMed, EMBASE, and Web of Science databases using the keywords "coronavirus", "COVID-19", "vaccine", "cutaneous reactions", "allergic reactions", and "SARS-CoV-2". Manual searching of reference lists of included articles augmented the research. The research was updated in June 2021. RESULTS: In this narrative review, we tried to investigate and discuss the cutaneous and allergic reactions related to SARS-CoV-2 vaccines currently available in the literature. As a result, although COVID-19 vaccines can be reported to develop allergic and anaphylactic reactions, especially after m-RNA vaccines, they remain at a low rate, and it is observed that these reactions may develop more frequently, especially in patients with previous allergies and mast cell disorders. Fortunately, these reactions are generally transient, benign, self-limited. CONCLUSION: Although there is still no definitive evidence, as dermatologists, we must be aware of the possibility of cutaneous reactions, newly diagnosed dermatoses, or exacerbation of existing dermatoses that may develop after the COVID-19 vaccinations.

Can SARS-CoV-2 vaccine increase the risk of reactivation of Varicella zoster? A systematic review.

INTRODUCTION: Although the COVID-19 vaccination is deemed safe, exact incidence and nature if adverse effects, particularly dermatological ones, are still unknown. OBJECTIVE: To describe the demographic, clinical, morphological characteristics, outcomes, and timing of development of herpes zoster to the various COVID-19 vaccines. And to identify on whether COVID-19 vaccine has temporal relationship between development of herpes zoster (HZ). METHODS: We have performed a systemic review of articles from PubMed and Embase using MeSH and keywords like "Shingles," "Herpes zoster," "Varicella zoster," "COVID-19," "Vaccine," "SARS-CoV-2." No filters including country of publication, language, type of articles were applied. Individual case report references were filtered for any pertinent cases. RESULTS: A total of 54 cases consisting of 27 male and 27 female patients have been reported. There were cases with known risk factors for herpes zoster, which included age more than 50 years (n = 36), immunological disorders (n = 10), chronic disease (n = 25), metabolic disorder (n = 13), malignancy (n = 4), and psychiatric disorder (n = 2). The mean (SD) period between development of herpes zoster and COVID-19 vaccination was 7.64 (6.92) days. Majority of the cases were from the high-income and/or middle-income countries. 86.27% of the cases of HZ were reported due to mRNA vaccine. Thirty-six patients 36/45 (80%) developed herpes zoster following the priming dose of COVID-19 vaccine among those who received mRNA vaccine. CONCLUSION: We could not establish definite link but there may be possible association between COVID-19 vaccine and shingles. Large-scale studies may help to understand the cause-effect relationship.

Pustular psoriasis flare-up in a patient with COVID-19.

INTRODUCTION: The various cutaneous manifestations have lately appeared in the setting of COVID-19. Psoriasis flare-ups have been reported during a COVID-19 infection. CASE PRESENTATION: We present a case of a 32-year-old woman with COVID-19 who presented with generalized pustular psoriasis. She received oral prednisolone, hydroxyzine, and topical clobetasol. The patient received follow-up two weeks later and found that her lesions were favorably desquamating. METHODS: The PubMed, SCOPUS, and ISI Web of Science databases were thoroughly searched for English studies reporting psoriasis flare-ups following SARS-CoV-2 infection. Ten case reports/series were included after screening. CONCLUSIONS: Our case report brings awareness to clinicians for the possible cutaneous manifestation of COVID-19, which should be considered part of the differential diagnoses.

COVID-19 and exacerbation of dermatological diseases: A review of the available literature.

Since the emergence of the new coronavirus disease 19 (COVID-19) pandemic, there has been a concern for the patients with chronic autoimmune diseases including dermatological conditions over the potential exacerbation of these underlying conditions after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV2). We performed a systematic review to evaluate presentations, postinfection change in the manifestation, diagnosis, and management of flare-ups of underlying dermatologic disease in patients with COVID-19. A total of 17 articles were recovered reporting on flare-ups of dermatological disease including pemphigus vulgaris, psoriasis, subacute cutaneous lupus erythematosus, acrodermatitis continua of Hallopeau, systemic sclerosis sine scleroderma, and Sézary syndrome (SS). Out of these, psoriasis and alopecia areata were the most common conditions. However, most cases of psoriasis could have been attributed to either antimalarial agents that were initially used for the treatment of COVID-19 or discontinuation of treatment following SARS-CoV2 infection.

Synthesis of the Data on COVID-19 Skin Manifestations: Underlying Mechanisms and Potential Outcomes.

The incidence of coronavirus disease 2019 (COVID-19)-related skin manifestations has progressively grown, in parallel with the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. The available evidence indicates that cutaneous signs are heterogeneous and can be divided as follows: a) erythematous rashes, b) lesions of vascular origin, c) vesicular rashes, d) urticarial rashes, and e) acute generalized exanthematous pustulosis (AGEP), erythema multiforme (EM) and other polymorphic/atypical reactions. Most cutaneous manifestations appear simultaneously or after respiratory and/or systemic symptoms such as fever, even if rarely urticaria has been reported as the first sign of the disease. It has been proposed that erythematous and vesicular rashes, as well as urticaria, are the result of immunological activation against Sars-CoV-2, similarly to other viral exanthems; alternatively, reactivation or co-infection of herpesviruses and drug hypersensitivity represent possible etiologic diagnosis that has to be considered. Regarding lesions of vascular origin, ischemic ones are the result of systemic hypercoagulability established in severe infections, whereas chilblains seem to be linked to the type I-interferon massively produced to halt virus replication. AGEP is triggered by drugs, whereas EM could represent a delayed immune response to the virus or a hypersensitivity reaction to drugs elicited by the inflammatory process built to fight the infection. A further pathogenic hypothesis is that the virus, or its particles detected in the skin (particularly in endothelium and eccrine glands), could be responsible for certain skin reactions, including chilblains and EM. From the available data, it appears that chilblains are correlated with younger age and less severe disease, while ischemic manifestations occur in the elderly with severe infection. In conclusion, larger studies are needed to confirm the suggested pathogenetic mechanisms of COVID-19-related skin reactions and to determine the potential prognostic significance of each one.