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1.
Cutis ; 109(4): 211-217, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1879659

ABSTRACT

The direct-to-consumer (DTC) telemedicine industry, including teledermatology, has seen rapid expansion in recent years, partly because of the COVID-19 pandemic. The shortage of dermatologists and the visual nature of dermatologic conditions attracted DTC companies to dermatology. As more patients continue to seek medical consultations and prescription medications from these for-profit companies, we must approach their growth with healthy skepticism. Shortcomings of DTC teledermatology include concerns about conflicts of interest (COIs), overdiagnosis, and overprescribing. Although DTC teledermatology is certainly here to stay, an appropriate understanding of this industry will allow dermatologists to advise patients and advocate for best practices.


Subject(s)
COVID-19 , Dermatology , Skin Diseases , Telemedicine , Humans , Pandemics , Skin Diseases/diagnosis , Skin Diseases/therapy
3.
J Telemed Telecare ; 28(7): 533-538, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1666542

ABSTRACT

The policy changes prompted by the COVID-19 pandemic caused synchronous models (primarily video visits) to supplant asynchronous models (store-and-forward or shared digital photographs) as the default and predominant modality of teledermatology care. Here, we call attention to the unique strengths and limitations of these models in terms of clinical utility, accessibility, and cost-effectiveness. Strengths of synchronous visits include direct physician-patient interaction and current reimbursement parity; limitations include variable video image quality, technological difficulties, and accessibility barriers. Strengths of asynchronous visits include greater convenience, especially for clinicians, and potential for image quality superior to video; limitations include less direct physician-patient communication, barriers to follow-up, and limited reimbursement. Both synchronous and asynchronous models have been shown to be cost-effective. Teledermatology is positioned to play a prominent role in patient care post-pandemic. Moving forward, dermatologists are challenged to optimize teledermatology use in order to improve outcomes, efficiency, and workflows to meet diverse patient needs. Future directions will depend on sustainable reimbursement of both teledermatology formats by government and private payers.


Subject(s)
COVID-19 , Dermatology , Skin Diseases , Telemedicine , Dermatology/methods , Humans , Pandemics , Photography , Telemedicine/methods
4.
J Am Acad Dermatol ; 86(1): 113-121, 2022 01.
Article in English | MEDLINE | ID: covidwho-1401554

ABSTRACT

BACKGROUND: Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. METHODS: We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns. RESULTS: Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym "V-REPP" (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5). LIMITATIONS: Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. CONCLUSION: Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19 , Exanthema , Skin Diseases/chemically induced , COVID-19/prevention & control , Exanthema/chemically induced , Humans , Registries
5.
6.
Dermatol Clin ; 39(4): 599-608, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1252650

ABSTRACT

The accelerated implementation and use of teledermatology during the coronavirus disease 2019 pandemic has met with successes and challenges. This review explores how telemedicine was used in dermatology before the pandemic, the regulatory adaptions made in response to the pandemic, and the effectiveness of the rapid implementation of teledermatology during the coronavirus disease 2019 pandemic, and, finally, how teledermatology has expanded in response to the pandemic. This review examines lessons learned and how teledermatology's reliance on digital technologies might paradoxically exacerbate health care disparities, and finally, considers the future outlook.


Subject(s)
COVID-19/epidemiology , Referral and Consultation/statistics & numerical data , Skin Diseases/diagnosis , Skin Diseases/therapy , Telemedicine/statistics & numerical data , Dermatology/organization & administration , Humans , Remote Consultation/statistics & numerical data , Severity of Illness Index
7.
J Am Acad Dermatol ; 85(1): 46-55, 2021 07.
Article in English | MEDLINE | ID: covidwho-1171221

ABSTRACT

BACKGROUND: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. OBJECTIVE: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. METHODS: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. RESULTS: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. LIMITATIONS: Registry analysis does not measure incidence. Morphologic misclassification is possible. CONCLUSIONS: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.


Subject(s)
COVID-19 Vaccines/adverse effects , Drug Eruptions/etiology , Adult , Drug Eruptions/epidemiology , Female , Global Health , Humans , Male , Middle Aged , Registries
10.
Curr Dermatol Rep ; : 1-8, 2021 Mar 12.
Article in English | MEDLINE | ID: covidwho-1141526

ABSTRACT

PURPOSE OF REVIEW: Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. RECENT FINDINGS: Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. SUMMARY: Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.

13.
J Am Acad Dermatol ; 83(4): 1118-1129, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-628238

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations. OBJECTIVE: To characterize the diversity of cutaneous manifestations of COVID-19 and facilitate understanding of the underlying pathophysiology. METHODS: Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies. RESULTS: The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, whereas retiform purpura presented exclusively in ill, hospitalized patients. LIMITATIONS: We cannot estimate incidence or prevalence. Confirmation bias is possible. CONCLUSIONS: This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were nonspecific, whereas others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Registries/statistics & numerical data , Skin Diseases/immunology , Adolescent , Adult , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/virology , Female , Humans , Incidence , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , SARS-CoV-2 , Severity of Illness Index , Skin Diseases/diagnosis , Skin Diseases/epidemiology , Skin Diseases/virology , Young Adult
14.
J Am Acad Dermatol ; 83(2): 486-492, 2020 08.
Article in English | MEDLINE | ID: covidwho-436934

ABSTRACT

BACKGROUND: Increasing evidence suggests pernio-like lesions are cutaneous manifestations of coronavirus infectious disease 2019 (COVID-19). OBJECTIVE: To describe clinical and pathologic findings of pernio-like lesions in patients with confirmed or suspected COVID-19. METHODS: An international dermatology registry was circulated to health care providers worldwide through the American Academy of Dermatology, International League of Dermatologic Societies, and other organizations. RESULTS: We documented 505 patients with dermatologic manifestations associated with COVID-19, including 318 (63%) with pernio-like lesions. Patients with pernio-like lesions were generally young and healthy, with relatively mild COVID-19. Of 318 patients with confirmed or suspected COVID-19 by providers, 23 (7%) were laboratory-confirmed COVID-19 positive, and 20 others (6%) were close contacts of patients with confirmed COVID-19. Given current testing criteria, many patients lacked COVID-19 testing access. For 55% of patients, pernio-like lesions were their only symptom. In patients with other COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms. Pernio-like lesions lasted a median of 14 days (interquartile range, 10-21 days). LIMITATIONS: A case series cannot estimate population-level incidence or prevalence. In addition, there may be confirmation bias in reporting. We cannot exclude an epiphenomenon. CONCLUSIONS: Pernio-like skin changes of the feet and hands, without another explanation, may suggest COVID-19 infection and should prompt confirmatory testing.


Subject(s)
Betacoronavirus/isolation & purification , Chilblains/virology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Skin Diseases/virology , Adolescent , Adult , Bias , COVID-19 , COVID-19 Testing , Chilblains/diagnosis , Chilblains/epidemiology , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Foot , Hand , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Registries/statistics & numerical data , SARS-CoV-2 , Severity of Illness Index , Skin Diseases/diagnosis , Skin Diseases/epidemiology , Time Factors , Young Adult
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