The COVID-19 Pandemic and Recent Earthquake in Zagreb Together Significantly Increased the Disease Severity of Patients with Atopic Dermatitis.

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.

Trends in dermatological practice in work with patients with skin diseases during the COVID-19 pandemic: our experience and observations.

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.

Psychological Stress and Atopic Dermatitis Severity Following the COVID-19 Pandemic and an Earthquake.

BACKGROUND: The course of chronic diseases can be influenced by psychological stress, suggesting a potential influence of current/recent disasters on atopic dermatitis (AD) patients. The aim of the study was to examine effects of the COVID-19 pandemic and Zagreb earthquake on the psychological stress level and disease condition of AD patients. SUBJECTS AND METHODS: This cross-sectional study included 150 AD patients (three groups with 50 patients): 1) those not exposed to either the COVID-19 pandemic or the earthquake; 2) those who only experienced the COVID-19 pandemic; and 3) those who experienced both the pandemic and the earthquake. Patients' data from the Perceived Stress Scale (PSS), on AD severity (SCORAD), and their answers from our newly designed questionnaire on disease-related behaviors and AD condition during the pandemic and quarantine were examined and statistically analyzed. RESULTS: The subjects who experienced both disasters had a greater PSS than those experiencing only the COVID-19 pandemic, especially women, and they also had higher disease severity (SCORAD) than those in the other two groups. Also, 59% of patients reported psychological stress during the pandemic, mostly caused by: the possibility of infection (31%), a changed work life and possible loss of income (23%), general pandemic-related conditions (17%), worry about physical survival (11%) and other (6%). Concerning the earthquake, the PSS significantly positively correlated with the psychological experience of the earthquake and with the intensity of sleep disturbances. CONCLUSION: To the best of our knowledge, this is the first study to specifically confirm that the COVID-19 pandemic influenced AD patients' stress levels and that stress from two disasters affected skin disease. Further research and therapeutic measures are needed.