ABSTRACT
Introduction: Hidradenitis suppurativa (HS) is associated with comorbidities that are risk factors for severe COVID-19 infection. We evaluated demographics and COVID-19 outcomes in HS patients. Methods: HS patients with COVID-19 (HS+/COVID+) and a randomized age-, race-, and sex-matched control population of patients without HS with COVID-19 (HS-/COVID+) were selected through a retrospective chart review. Data were collected on demographics, medications, comorbidities, vaccination status, and COVID-19 treatment/outcomes. Fisher's exact test was used to analyze the relationship between risk factors and COVID-19 outcomes. A p value of <0.05 was considered statistically significant. Results: There were 58 HS+/COVID+ patients, primarily African American (83%, n = 48) and female (88%, n = 51). Compared to HS+/COVID+ patients, HS-/COVID+ patients were significantly more likely to have cardiovascular disease (51% vs. 24%; p = 0.0029) and be pregnant (23% vs. 4%; p = 0.0093). HS+/COVID+ and HS-/COVID+ patients did not vary significantly in vaccination rate at time of COVID-19 diagnosis (6% vs. 5%; p = 0.78). HS-/COVID+ patients were significantly more likely to have COVID-19 complications (35% vs. 7%; p = 0.001) and receive COVID-19 treatment (37% vs. 7%; p = 0.0001) when compared to HS+/COVID+ patients. Conclusion: Our findings support the growing evidence that having HS itself may not be a risk factor for severe COVID-19 outcomes.
ABSTRACT
Introduction Hidradenitis suppurativa (HS) is associated with comorbidities that are risk factors for severe COVID-19 infection. We evaluated demographics and COVID-19 outcomes in HS patients. Methods HS patients with COVID-19 (HS+/COVID+) and a randomized age-, race-, and sex-matched control population of patients without HS with COVID-19 (HS−/COVID+) were selected through a retrospective chart review. Data were collected on demographics, medications, comorbidities, vaccination status, and COVID-19 treatment/outcomes. Fisher's exact test was used to analyze the relationship between risk factors and COVID-19 outcomes. A p value of <0.05 was considered statistically significant. Results There were 58 HS+/COVID+ patients, primarily African American (83%, n = 48) and female (88%, n = 51). Compared to HS+/COVID+ patients, HS−/COVID+ patients were significantly more likely to have cardiovascular disease (51% vs. 24%;p = 0.0029) and be pregnant (23% vs. 4%;p = 0.0093). HS+/COVID+ and HS−/COVID+ patients did not vary significantly in vaccination rate at time of COVID-19 diagnosis (6% vs. 5%;p = 0.78). HS−/COVID+ patients were significantly more likely to have COVID-19 complications (35% vs. 7%;p = 0.001) and receive COVID-19 treatment (37% vs. 7%;p = 0.0001) when compared to HS+/COVID+ patients. Conclusion Our findings support the growing evidence that having HS itself may not be a risk factor for severe COVID-19 outcomes.
ABSTRACT
INTRODUCTION: Hidradenitis suppurativa (HS) is an inflammatory dermatosis for which the treatment paradigm is rapidly expanding. We aimed to identify HS patient perspectives and barriers on biologics. METHODS: An anonymous survey was distributed between 10/2021 and 1/2022 through HS support groups. Data regarding demographics and perspectives on biologics were collected and analyzed. RESULTS: Of the 196 respondents, 92% were female (180/196) and 75% were white (147/196). 89.3% had Hurley stage 2/3 HS (102/195). The primary healthcare provider (HCP) for HS in 65% (128/196) of patients was a dermatologist, with 12% (23/196) seen at an HS specialty clinic. Most respondents never tried a biologic medicine (62%, 118/192). The top barriers to biologics were fear of side effects (61%, 109/179), high cost/lack of insurance coverage (46%, 83/179), frequency of weekly injections (32%, 58/179). Respondents reporting their main HCP as a non-dermatologist (4.11 vs 3.0, p < .0001) and not seen at a HS specialty clinic (3.5 vs 2.7, 0.039) were significantly more likely to agree 'I do not know enough about how biologics work to help my HS'. CONCLUSION: Our results highlight the importance of specialty care in the education and implementation of biologics. Patients may benefit from comprehensive discussion prior to starting biologics.
Subject(s)
Biological Products , Hidradenitis Suppurativa , Humans , Female , Male , Hidradenitis Suppurativa/drug therapy , Biological Products/therapeutic use , Severity of Illness IndexSubject(s)
COVID-19/diagnosis , SARS-CoV-2 , Skin Diseases/diagnosis , COVID-19/complications , COVID-19/pathology , Chilblains/diagnosis , Diagnosis, Differential , Exanthema/diagnosis , Herpes Simplex/diagnosis , Herpes Zoster/diagnosis , Humans , Skin Diseases, Viral/diagnosis , Skin Diseases, Viral/etiology , Skin Diseases, Viral/pathology , Urticaria/diagnosisABSTRACT
The COVID-19 pandemic required a transition to telemedicine to limit viral spread. Dermatology seems particularly well-suited for telemedicine, however, this pandemic transformed teledermatology into the predominant means of delivering care. Providers are limited in their ability to promptly and accurately manage disease without access to in-person tools. This monumental switch to teledermatology may disadvantage certain patient populations, including those with limited technological literacy (such as the elderly) or access to the internet. Dermatologists must acknowledge these limitations and recognize the consequences of severely limited in-person visits over a prolonged period of time.
Subject(s)
COVID-19 , Dermatology/methods , Skin Diseases/diagnosis , Telemedicine/methods , Biopsy , Computer Literacy , Humans , Internet Access , SARS-CoV-2 , Skin Diseases/pathology , Skin Diseases/therapyABSTRACT
Dupilumab has recently been approved by the Food and Drug Administration for use for treatment of moderate to severe atopic dermatitis in children aged 6 to 11 years. It presents a novel treatment option with a favorable safety profile for patients who are currently reliant on immunosuppressants, including cyclosporine A, methotrexate, and mycophenolate mofetil. Particularly during the current COVID-19 pandemic, immunosuppression should be avoided to retain intrinsic antiviral immunity. Transitioning to dupilumab should be executed strategically-tapering immunosuppressants and minimizing risk of flare by overlapping with the biologic. Herein, we use results of outcome measurements from LIBERTY AD ADOL and LIBERTY AD PEDS trials of dupilumab in adolescents aged 12 to 18 years and children aged 6 to 11 years, respectively, to propose a schematic for an 8-week transition between medications.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/prevention & control , Dermatitis, Atopic/drug therapy , Drug Substitution , Immunosuppressive Agents/adverse effects , Adolescent , Child , HumansSubject(s)
Dermatology/organization & administration , Evidence-Based Medicine/organization & administration , Hidradenitis Suppurativa/therapy , Academic Medical Centers/organization & administration , Clinical Trials as Topic , Comorbidity , Delayed Diagnosis/prevention & control , Dermatologists/education , Dermatologists/organization & administration , Dermatology/education , Dermatology/methods , Evidence-Based Medicine/education , Evidence-Based Medicine/methods , Hidradenitis Suppurativa/diagnosis , Hidradenitis Suppurativa/epidemiology , Hidradenitis Suppurativa/psychology , Humans , Internship and Residency/organization & administration , Intersectoral Collaboration , Mental Health , Patient Participation , Prevalence , Psychiatry/methods , Psychiatry/organization & administration , Quality of Life , Specialties, Surgical/methods , Specialties, Surgical/organization & administration , Treatment Outcome , United States/epidemiologySubject(s)
Betacoronavirus , Coronavirus Infections , Dermatitis, Atopic , Pandemics , Pemphigus , Pneumonia, Viral , COVID-19 , Humans , SARS-CoV-2ABSTRACT
The COVID-19 pandemic has greatly impacted dermatology clinical trial operations due to mandated governmental and institutional shut-downs and newly implemented restrictions. During this unprecedented time, measures should be taken to maintain research conduct compliance while also ensuring the safety of trial staff and participants. Herein, we underscore the challenges facing dermatology trials during the COVID-19 pandemic, and offer strategies to maintain compliant and safe conduct.