IADVL Academy Position Statement on Emerging Dermatoses in India: Monkeypox.

As we were on the road to recovery from the coronavirus disease-19 (COVID-19) pandemic, the world is waking up to yet another potential adversary. Monkeypox (or human monkeypox) caused by monkeypox virus (an orthopox virus) is fast emerging in more than 80 countries worldwide, where it has never been historically reported. We in India, have already seen the advent of this outbreak since July 2022, with a progressive rise in number of cases being seen. Though the virus is not a novel virus; it is presenting with atypical manifestations as compared to our conventional knowledge of the disease. Through this document, the Indian Association of Dermatologists, Venereologists, and Leprologists Academy aims to sensitize dermatologists toward recognizing the clinical features and responding promptly, to contain the outbreak at the earliest. In view of the non-availability of specific antiviral drugs as well as vaccines; early detection, isolation, and prevention of spread form the mainstay of our approach towards the outbreak, which has been declared to be a "Public Health Emergency of International Concern" by the World Health Organization.

Hand Dermatitis: A Comprehensive Review with Special Emphasis on COVID-19 Pandemic.

Hand dermatitis (HD) is a chronic, relapsing, and remitting inflammatory condition that adversely affects the quality of life of the individual and gravely impacts the mental and socioeconomic well-being by causing professional hindrance and often leading to loss of wages. Despite being one of the most common skin conditions seen by dermatologists, it is often underreported. With the coronavirus pandemic ongoing, there is an emphasis on hand hygiene-being a widely publicized and important preventive measure to control the spread of the Coronavirus disease (COVID-19) virus. Emphasis on hand hygiene has led to a surge in HD, and the presence of HD, in turn, leads to compromised hand hygiene practices and this breach in the skin barrier contributes to another portal of entry of infective agents. We undertook a comprehensive English literature search across multiple databases such as PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane using keywords and MeSH items to obtain and review several relevant articles. Thus, this review focuses on various clinical, diagnostic as well as therapeutic aspects of this much prevalent and debilitating skin condition which deserves more attention especially during the times of the COVID-19 pandemic where the utmost emphasis is being given to handwashing leading to a vicious cycle of a surge in the cases of HD and compromised skin barrier causing increased susceptibility to the COVID-19 infection.

Virology and Etiopathogenesis of COVID-19 with Special Reference to Cutaneous Implications.

Severe Acute Respiratory Virus Corona Virus 2 (SARS-CoV-2) has got its name Corona from Latin meaning "crown." It has crown-like spikes present on the surface, which encloses the RNA, genetic material of this deadly virus. The virus attacks pneumocytes after binding with the angiotensin-converting enzyme 2 (ACE2) of the cell surface, which ultimately leads to chemotaxis followed by leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung leading to various symptoms. Skin provides a window to the internal changes of the body and also to mechanisms that are not readily visible. Commonly observed skin manifestations include vesicular lesions, maculopapular exanthema, urticarial eruptions, livedo or necrosis, and other forms of vasculitis, chilblain-like lesions. The skin lesions are attributed to either the virus directly affecting the skin or interferon dysregulation due to viral RNA or vascular involvement associated with alteration in coagulation or drug-induced skin manifestations. Observation of skin involvement and the vasculature due to SARS-CoV-2 illustrates the need for a precise stratification and differential diagnostic valuation so that the mechanisms of this novel virus are clearer for better management of the condition in the future. Vascular skin lesions are not seen in all the patients of COVID, but certain lesions should definitely alarm us to evaluate for coagulation abnormalities, complement levels, and skin biopsy, especially in critically ill patients. This review attempts to outline the pathogen briefly and the pathomechanism behind the development of various cutaneous manifestations.

Staff and clinic protection during COVID pandemic

The impact of novel coronavirus pandemic (COVID-19) on the healthcare system has been devastating and the medical fraternity is facing challenges to tackle this catastrophic outbreak. With regard to dermatology practice, we review various outbreak response measures to be followed by the dermatology staff at clinic in constrained environment. Preventive measures like social distancing, hand hygiene practices and protective measures such as introduction of personal protective equipment (PPE) for staff, standardization of clinical guidelines and continuing medical services via teleconsultation are recommended. Physical consultation has been limited to emergency-based services. Although teledermatology would never replace physical consultation, it might serve as an adjunctive role in providing adequate services to the non-emergent conditions and minimizes the risk of exposure of both doctors and patients. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Dermatologists should also recognize and educate health care workers about primary cutaneous features of COVID-19 as well possible dermatological side effects arising from prolonged usage of PPE and hand hygiene practices. Limited office-based and in-patient services with a parallel increase in teledermatology consultations will allow effective dermatologic care and services to the public while ensuring minimum transmission of the virus.

Use of immunosuppressants in vitiligo during COVID-19 pandemic: a quick review

Owing to the recent coronavirus (COVID-19) pandemic, there is a concern regarding the use of systemic immunosuppressive agents. There are no guidelines at present regarding the use of immunosuppressants. The main aim at this time should be to keep the dermatoses under control without exposing the patient to increased risk of infection and the consequent morbidity. In vitiligo, immunosuppressive agents are utilized in stabilization of progressive disease. An informed decision regarding the use of immunosuppressive agents can be made only after understanding the immune response to coronavirus, reviewing the mechanism of action of drug and evidence from previous studies on risk of infection. This review briefly discusses the mechanism of action and the safety data of various immunosuppressants used in vitiligo.

Impact of COVID-19 Pandemic on Dermatology Practice in India.

BACKGROUND: COVID-19 pandemic has disrupted healthcare systems throughout the globe. It has affected dermatology practice to a great extent. Since most of the consultations (except emergencies) in dermatology are deferred as a precautionary measure, dermatologists have taken the route of virtual appointments in order to continue treating patients in the present lockdown state. However, the concept of telemedicine is quite new for doctors as well as for patients in India. MATERIAL AND METHODS: An online questionnaire was circulated among Indian dermatologists which included participant demographics, changes in their practice and teaching during COVID-19, use of virtual or e-health technologies, and attitudes/opinions on their experiences. We also wanted to understand doctor perspectives on their own roles, wellness, and hospital responses to the pandemic. RESULTS: A total of 260 responses from qualified dermatologists of different parts of India were received between 1st and 8th April 2020 and were analyzed. Two-thirds of the respondents were within 10 years of starting practice. Virtual consultations have increased by almost three-fold during the pandemic, which is a major change noticed in the practice when we compare before and during the pandemic. Earlier the focus of teledermatology (TD) was mainly for follow-up care (85%), whereas during the pandemic, both new and follow-up patients were provided virtual consultations. The number of patients coming to them for a consultation has drastically reduced. Only 2% of the responders are still performing minor procedures with proper care. Almost two-thirds do not have systems in place to train their residents and fellows due to the disruptions caused by the pandemic. The rest of them have started to take the virtual route of teaching through webinars, virtual rounds, and providing access to online journals to continue their teaching. Only 18.6% of dermatologists at work were provided with personal protective equipment. TD has opened new doors to virtual consultation and it was evident that 54.4% of doctors are willing to continue it in the future even after the pandemic is over. CONCLUSION: TD platforms hold great promise to improve access to high-quality dermatologic care in the future. Results from this survey of Indian dermatologists suggest that TD is the future of dermatology as it will be accessed by patients in remote areas and it is a cost-effective move for the patients.

Mental distress in dermatologists during COVID-19 pandemic: Assessment and risk factors in a global, cross-sectional study.

There is a sparsity of data regarding the mental health status of dermatologists during COVID-19 pandemic. Evaluate the effects of pandemic on mental health of dermatologists on a large scale and identify risk factors for mental distress. 733 dermatologists were included in this cross-sectional, web-based survey. Mental distress was reported by 77.2% of responders. Considerable percentages of participants experienced stress (73.9%), irritation (33.7%), insomnia (30%), or depression (27.6%), and 78.6% were overwhelmed with the amount of pandemic information they were receiving. Mental distress was significantly associated with practice years, volume of patients seen per week before pandemic, personal protective equipment availability at hospital (P = .001 for each), practice location (continent; P < .001), and participant's assessment that the healthcare system was not equipped for the pandemic (P = .003). Stress was associated with hospital service (P = .003), and depression with being overwhelmed with the amount of pandemic information received (P = .004). In a logistic model, teledermatology use was the most powerful predictor of mental distress (OR, 1.57 [95% CI, 1.07-2.32]). Mental distress was common among dermatologists during this pandemic. Teledermatology use was the most powerful predictor of mental distress. Preventative strategies and psychosocial interventions should be implemented.

Dermatological therapies with relevance to COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel single-stranded RNA virus that has gripped humanity all over. It affects primarily the respiratory system, but is not limited to it, causing widespread involvement of many organ systems. The cases are still rising at an exponential rate and manifold trials are on to test different agents with the hope for potential limitation of spread and control of symptoms. Various classes of drugs have been tried; some with moderate success while many are yet to be proven to be of definite benefit. We have observed that the drugs used in dermatology practice are featured in more than a few of such studies. Here, we wish to highlight the ones that we are familiar with, which has featured at some point, in the management of this very challenging pandemic.