Is there an etiological role for polyethylene glycol (PEG)-2000 in COVID arm due to mRNA vaccines?

Background: Delayed local reactions due to mRNA vaccines or COVID arm have been reported. COVID arm commonly presents as an itchy and painful erythematous plaque with swelling and is characterized by a delayed onset of 7 to 10 days after vaccination. New excipients used in mRNA vaccines (polyethylene glycol (PEG)-2000, tromethamol and 1,2-distearoyl-sn-glicero-3-phosphocholine) have increased the awareness about their role in such cutaneous adverse reactions. Objectives: To define the excipient accountability in COVID arm through specific skin provocation testing. Methods: Health workers of a tertiary level hospital suffering COVID arm were patch, skin prick (SP) and intradermal (ID) tested with PEG-400, PEG-2000, tromethamol and 3-phosphocholine at different concentrations (0.001%, 0.01%, 0.1% and 1%). Positive long standing ID reactions were biopsied. Results: Eleven patients were included. Patch tests were always negative. PEG-2000 presented positive SP at 1% (4 patients) and 0.1% (1 patient). PEG-2000 ID was positive at 1% (10 patients), 0.1% (7 patients) and 0.01% (6 patients). Three showed long standing positive reactions to ID of PEG-2000 on day 2, whose biopsies depicted perivascular lymphocytes, occasional eosinophils and dermal edema. In addition, 6 patients reacted to PEG-400, all of which also reacted to PEG-2000. SP and ID for the other excipients were negative. Conclusions: The presence of immediate and delayed reactions to PEG-2000 in patients. with COVID arm poses a challenge on whether PEG-2000 acts as a delayed sensitizer or. these infrequent reactions are irritative.

Medicolegal aspects of teledermatology

Teledermatology has facilitated specialist care during the crisis caused by the coronavirus disease 2019 pandemic, eliminating unnecessary office visits and the possible exposure of patients or dermatologists. However, teledermatology brings forward certain ethical and medicolegal questions. A medical consultation in which the patient is not physically present is still a medical act, to which all the usual ethical and medicolegal considerations and consequences apply. The patient's right to autonomy and privacy, confidentiality, and data protection must be guaranteed. The patient must agree to remote consultation by giving informed consent, for which a safeguard clause should be included. Well-defined practice guidelines and uniform legislation are required to preserve the highest level of safety for transferred data. Adequate training is also needed to prevent circumstances involving what might be termed “telemalpractice.”

Medicolegal Aspects of Teledermatology. / Aspectos médico-legales de la teledermatología.

Teledermatology has facilitated specialist care during the crisis caused by the coronavirus disease 2019 pandemic, eliminating unnecessary office visits and the possible exposure of patients or dermatologists. However, teledermatology brings forward certain ethical and medicolegal questions. A medical consultation in which the patient is not physically present is still a medical act, to which all the usual ethical and medicolegal considerations and consequences apply. The patient's right to autonomy and privacy, confidentiality, and data protection must be guaranteed. The patient must agree to remote consultation by giving informed consent, for which a safeguard clause should be included. Well-defined practice guidelines and uniform legislation are required to preserve the highest level of safety for transferred data. Adequate training is also needed to prevent circumstances involving what might be termed «telemalpractice¼.