ABSTRACT
The Cochrane systematic review “Hydrosurgical debridement versus conventional surgical debridement for acute partial-thickness burns” analyzed existing randomized controlled trials (RCTs) enrolling participants with acute partial-thickness burn injuries requiring debridement and grafting;this yielded one eligible study randomizing 61 pediatric patients to either conventional debridement (n=31) or hydrosurgery (n=30) [1]. Study conclusions were very low certainty on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment, showed a high risk of reporting bias, and were limited by the small sample size (not powered to detect differences in primary outcomes). RPD is a Joint Coordinating Editor for Cochrane Skin, a dermatology section editor for UpToDate, a Social Media Editor for the Journal of the American Academy of Dermatology, a Podcast Editor for the Journal of Investigative Dermatology (JID), Editor-in-Chief of JMIR Dermatology, a coordinating editor representative on Cochrane Council, and Cochrane Council cochair and director of the University of Colorado Anschutz Medical Campus United States Cochrane Affiliate.
ABSTRACT
BACKGROUND: The innate immune system is recognized as an essential aspect of COVID-19 pathogenesis. Toll-like receptors (TLRs) are important in inducing antiviral response, triggering downstream production of interferons (IFNs). Certain loss-of-function variants in TLR7 are associated with increased COVID-19 disease severity, and imiquimod (ImiQ) is known to have immunomodulating effects as an agonist of TLR7. Given that topical imiquimod (topImiQ) is indicated for various dermatologic conditions, it is necessary for dermatologists to understand the interplay between innate immunity mechanisms and the potential role of ImiQ in COVID-19, with a particular focus on TLR7. SUMMARY: Our objective was to survey recent peer-reviewed scientific literature in the PubMed database, examine relevant evidence, and elucidate the relationships between IFNs, TLR7, the innate immune system, and topImiQ in the context of COVID-19. Despite limited studies on this topic, current evidence supports the critical role of TLRs in mounting a strong immune response against COVID-19. Of particular interest to dermatologists, topImiQ can result in systemic upregulation of the immune system via activation of TLR7. Key Message: Given the role of TLR7 in the systemic activation of the immune system, ImiQ, as a ligand of the TLR7 receptor, may have potential therapeutic benefit as a topical immunomodulatory treatment for COVID-19.