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Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023
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The proceedings contain 90 papers. The topics discussed include: characterization of nonalcoholic fatty liver disease in children with psoriasis: a pilot study;management of pediatric psoriasis: a representative US survey;severity and patient-related outcomes in atopic dermatitis do not correlate with deprivation index as an indicator of socioeconomic setting in a US metropolitan area;pediatric atopic dermatitis: assessment of burden based on lesional morphology;metered dose applicators: a potential solution for improving topical medication adherence in atopic dermatitis patients;serial staged punch excision technique for linear epidermal nevus and nevus sebaceous;the molecular basis of superficial vascular lesions of the skin: genotype-phenotype correlation of capillary malformations;utilization and effect of telehealth for the treatment of hemangioma before and after COVID;image analysis of port wine birthmarks using optical coherence tomography;image analysis of port wine birthmarks using optical coherence tomography;and responsiveness to change of the morphea activity measure.
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Studies for vaccine development have been completed in an unprecedented time to prevent further outbreak of the dangerous and potentially fatal coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Some of these vaccines have been approved by various authorities and made available worldwide. While vaccine applications continue globally, the number of dermatological side effects reported after vaccination is increasing daily. Many cutaneous reactions have been reported in the literature, such as injection site reactions, pernio lesions, pityriasis rosacea, herpes zoster, and exacerbations of chronic inflammatory dermatoses such as atopic dermatitis and psoriasis. Most COVID-19 vaccines require two doses and a booster dose, and considering the new variants of the coronavirus, vaccination is estimated to continue for a while. In this context, dermatologists are more likely to encounter vaccine-related dermatological side effects in their daily practice. Dermatologists play an essential role in many issues such as diagnosis and treatment of cutaneous reactions after COVID-19 vaccination, informing patients and providing necessary counseling. This perspective will also provide helpful information for the future in terms of vaccination strategies to be developed for repeated doses. In this study, most of the cutaneous reactions reported after COVID-19 vaccination in the current literature are reviewed.
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Purpose: Atopic dermatitis (AD) is a chronic, relapsing and remitting inflammatory skin disease characterized by intense itch. The disease burden includes physical limitations, psychosocial discomfort, and a reduced quality of life (HRQoL). This study presents the results of a parent-reported survey on the psychosocial impact of AD on Italian pre-adolescent children (6-11 years old), with a specific focus on bullying, self-isolation, absenteeism, and presenteeism. Methods: An online questionnaire was sent to 3067 random recipients and 160 matched the inclusion criteria for age, self-reported AD diagnosis, localizations (according to ISAAC), and disease severity (POEM ≥8). 100 children, with comparable ages, not matching the inclusion criteria for AD, were recruited as a control group. Results: Children with AD and their caregivers had a significantly lower quality of sleep (QoS) compared to the control group. The presence of AD was directly responsible for many restless nights, both in children and caregivers (58.9 and 55.4 respectively). Children with AD and their parents also experienced significantly more daytime drowsiness (43.6 and 54.6 days, respectively). Children with AD were more frequently victims of bullying at school (20.0% vs 9.0%; p≤0.05) or in other social environments (16.9% vs 3.0%; p≤0.05). AD caused 17.7 days of absenteeism and 20.1 days of presenteeism per student over the previous 12 months, accounting for 37.8 days of study impairment overall. Severe/very severe AD had a significantly greater impact on presenteeism than moderate AD (25.1 vs 17.5 days; p≤0.05). Presenteeism, which was more pronounced among bullied students, was positively correlated with absenteeism only in the AD cohort. Conclusion: AD has a detrimental impact on the HRQoL of pediatric patients, causing stigmatization and social isolation. Functional distress was also reported by caregivers. Our study might inform the public and policymakers about the disease burden of AD at a young age.
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Previous studies suggest that allergic diseases may be a protective factor in SARS-CoV-2 infection. However, data regarding the impact of dupilumab, a widely used immunomodulatory medication, on COVID-19 in an allergic population are very limited. To investigate the incidence and severity of COVID-19 among moderate-to-severe atopic dermatitis (AD) patients treated with dupilumab, a retrospective cross-sectional survey was conducted among patients with moderate-to-severe AD who presented at the Department of Allergy of Tongji Hospital from 15 January 2023 to 31 January 2023. Healthy individuals matched for gender and age were also enrolled as a control. All subjects were asked about their demographic characteristics, past medical history, COVID-19 vaccination history, and medications, as well as the presence and duration of individual COVID-19-related symptoms. A total of 159 moderate-to-severe AD patients and 198 healthy individuals were enrolled in the study. Among the AD patients, 97 patients were treated with dupilumab, and 62 patients did not receive any biologicals or systemic treatments (topical treatment group). The proportions of people who were not infected with COVID in the dupilumab treatment group, topical treatment group and healthy control group were 10.31%, 9.68% and 19.19%, respectively (p = 0.057). There was no significant difference in COVID-19-related symptom scores among all groups (p = 0.059). The hospitalization rates were 3.58% in the topical treatment group and 1.25% in the healthy control group, and no patient was hospitalized in the dupilumab treatment group (p = 0.163). Compared with healthy control group and topical treatment group, the dupilumab treatment group had the shortest COVID-19-associated disease duration (dupilumab treatment group, 4.15 ± 2.85 d vs. topical treatment group, 5.43 ± 3.15 d vs. healthy control group, 6.09 ± 4.29 d; p = 0.001). Among the AD patients treated with dupilumab for different times, there was no appreciable difference (<0.5 year group, 5 ± 3.62 d vs. 0.5-1 year group, 4.84 ± 2.58 d vs. >1 year group, 2.8 ± 1.32 d; p = 0.183). Dupilumab treatment shortened the duration of COVID-19 in patients with moderate-to-severe AD. AD patients can continue their dupilumab treatment during the COVID-19 pandemic.
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In children, coronavirus disease 2019 (COVID-19) starts as a minor illness compared to adults, but during the ongoing COVID-19 pandemic, distinct SARS-CoV-2 variants and subvariants have changed options for therapies in both adults and children, especially for those with comorbidities such as allergies. On 25 April 2022, Remdesivir (RDV), a viral RNA-dependent RNA polymerase inhibitor, was approved by the Food and Drug Administration (FDA) for the treatment of pediatric patients 28 days and older, weighing ≥3 kg, hospitalized or non-hospitalized, who are at high risk of progression to severe forms of COVID-19. While RDV has been shown to have favorable effects in numerous types of research conducted on adults, such as shortening hospital stays, and has shown it has antiviral effects on various RNA viruses, there is a lack of findings regarding safety, tolerability, and efficacy of RDV in allergic pediatric patients since its initial FDA approval. This study aims to assess RDV's efficacy and tolerability in treating pediatric patients with mild and severe forms of COVID-19-associated allergies such as asthma, allergic rhinitis, and atopic dermatitis and how RDV affects the duration of hospitalization, especially for these comorbidities. The most recent pandemic wave among children rose due to the high transmissibility of the Omicron variant, and this study analyzed changes between July 2020 and September 2022 at the National Institute of Infectious Diseases "Prof. Dr. Matei BalÈ", Bucharest, Romania. Our retrospective study included 250 children <18 years old, 42 (16.8%) had allergies, 132 were males (52.8%), age group 0-5 years old (80%), with a positive viral test for SARS-CoV-2. Severity was categorized as mild (43.6%), moderate (53.2%), and severe (1.6%) COVID-19, and treatment with RDV was administered in 50.4% (126/250) of children included in the study. The presence of comorbidities, asthma (7.2%), allergic rhinitis (4.4%), and atopic dermatitis (4.4%), was associated with an increased risk of developing severe COVID-19 infection in children, p < 0.05. We did not register deaths and severe complications; all cases evolved favorably under the instituted treatment. Laboratory abnormalities in transaminase levels 53.97% (ALT) and 61.9% (AST) were grades 1 or 2 and did not require discontinuation of the antiviral treatment, p < 0.05. RDV in children reduced the duration and evolution of COVID-19 and decreased the length of hospitalization in group-associated allergies; p < 0.05. This article summarizes RDV's efficacy among children with COVID-19 and allergies when the clinical result was improved and reports positive effects on tolerability and reduced duration of hospitalization, especially in children with asthma, atopic dermatitis, and allergic rhinitis. More studies are needed to confirm our findings.
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Silymarin, is a phytoactive constituent isolated from the fruits and seeds of Silybum maria-num L Gaetn.), also called milk thistle belonging to the family of Asteracease. The phytoactive has been used to treat several physiological disorders. The objective of this manuscript was to review the therapeutic prospective of silymarin due to its ability to treat several physiological disorders. The da-tabases such as Pubmed, Elsevier, and Google Scholar were reviewed for the investigations or reviews published related to the title. The discussion is focused on the immunomodulatory, chemopreventive, and anti-inflammatory mechanisms of silymarin in various metabolic and dermatological disorders. In addition, the review discusses the different therapeutic potentials of silymarin such as the management of the liver disorder, skin carcinogenesis, cardiovascular disorders, diabetes mellitus, neurodegenera-tive disorders, and several dermatological disorders such as melasma, anti-aging, acne, rosacea, atopic dermatitis, and psoriasis. Silymarin is safe even with a dose higher than the therapeutic dose. Si-lymarin had good potential for the safe and effective treatment of numerous metabolic and dermatological disorders. © 2023 Bentham Science Publishers.
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Background: Although hypersensitivity reactions to corticosteroids are rare in the general population, they are not uncommon in high-risk patients who receive repeated doses of them. It is known that delayed reactions are more common than immediate ones. Atopic dermatitis is a risk factor for the development of allergic contact dermatitis from topical corticosteroids. Patients can also develop hypersensitivity reactions to nasal, inhaled, oral and parenteral corticosteroids. Method(s): We reported one case of a 72-year- old man with history of chronic obstructive pulmonary disease (GOLD 4) and atopic dermatitis, who experienced a morbilliform rash after intravenous hydrocortisone administration during his hospital admission for SARS-COV- 2 infection. Since 1995 he had experienced several late skin reactions with corticosteroids and after performing an allergy study he was diagnosed of delayed hypersensitivity to corticosteroids with good tolerance for intravenous hydrocortisone and inhaled mometasone. Closed patch tests were performed with hydrocortisone with immediate and late lectures of 48-96 hours. We also performed a controlled intravenous challenge with hydrocortisone (200 mg) as well as an oral challenge with deflazacort (30 mg) under surveillance in the intensive care unit. Result(s): Patch tests were negative and intravenous hydrocortisone challenge went positive after 48 hours with the same previous skin reaction. Our patient showed a good tolerance to deflazacort. Conclusion(s): Choosing an alternative corticosteroid is pivotal to the patient's safety and also decreases the worry of developing an allergic reaction. This evaluation becomes especially important in high-risk groups where steroids are a life-saving treatment. Baeck et al. classified corticosteroids according to their chemical structure, improving treatment options and recommendations that can be prescribed. Nevertheless, discordance continues to be observed between the results of patch tests and the patient's tolerance to various commercial preparations. In order to provide alternative treatments, it is advisable to perform exposure tests with corticosteroids from a group other than the one the patient is sensitized to. Deflazacort could be an alternative in emergency cases. (Figure Presented).
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Background: The use of biologics during the pandemic has raised concerns throughout the scientific community. The current guidelines suggest continuing the use of biologics during the pandemic, while the initiation or continuation of treatment in case of symptomatic disease are remaining controversial unanswered questions. As a result the purpose of this study was to determine the frequency of symptomatic COVID19 infection in patients treated with biologic agents in an Allergy Unit of a University Hospital during the pandemic. Method(s): Patients of the Allergy Unit "D Kalogeromitros", who due to asthma, atopic dermatitis, Chronic Spontaneous Urticaria(CSU) or Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)were under treatment with biologic agents were included in the present study. Treatment of at least 2 months until the 31/12/2021 was necessary for a patient to be included in the present study. Result(s): A total of 77 patients [46 (59.7%) women, mean age 48.2 (range 15-82) years were included. The mean duration of treatment with biologics was 34.9 months (SD: +/-37 months). Overall, 83.1% (64/77) of patients were receiving omalizumab for asthma and CSU [13/64 (20.3%) and 51/64 (79.6%) respectively] while 9.1% (7/77) were receiving dupilumab for atopic dermatitis (4/7) and CRSwNP [4/7 (57.1%) and 3/7 (42.8%) respectively]. In addition, 5/77 (6.5%) and 1/77 (1.2%) were under treatment with mepolizumab and one with benralizumab respectively, due to severe uncontrolled asthma. A total of 6 patients with chronic spontaneous urticaria and 2/19 patients with asthma (1/5 with mepolizumab and 1/13 with omalizumab) had symptomatic COVID 19 infection as confirmed with a positive Polymerase Chain Reaction or Rapid Test. None of the patients treated with benralizumab or dupilumab had symptomatic COVID19 infection. Overall, 8/77 (10.3%) of patients had symptomatic SARS-CoV2 infection during the above period, a rate similar to the onein the same period identified in the general Greek population (11.2%). All patients had mild symptoms during the disease course with no patient admission to hospital. Conclusion(s): The frequency of symptomatic COVID19 infection identified in a population of Greek patients treated with biologic agents was no higher than than the one in the general Greek population. Furthermore, all patients had a mild course of the disease with no admissions, indicating that the use of biologics is a safe choice and can be continued during the pandemic.
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Background: SARS-Cov- 2 is a new respiratory virus that causes COVID-19 disease. It is a new infectious agent and knowledge is still very limited, particularly its interaction with allergic disease. The aim of this study was to assess the effect of allergic disease on the risk of hospitalization for COVID-19. Method(s): A total of 7542 SARS-CoV- 2 infections were diagnosed from 1 March to 31 December 2020 at the Centro Hospitalar Universitario de Sao Joao. A total of 1727 (22.9%) patients were hospitalized (31% in intensive care) and 5815 were followed up by an outpatient clinic. Of this group, 3479 (65%) answered a telephone questionnaire, 3 to 6 months after acute infection, about sociodemographic, clinical, behavioral and psychological characteristics. They were also asked about a previous diagnosis of allergic disease. Individuals aged < 18 years and those with asymptomatic infection were excluded. Result(s): A sample of 2702 participants was analyzed, 33.5% reported allergic disease prior to the diagnosis of COVID-19: 215 (8%) asthma, 517 (19.2%) rhinitis, 138 (5.1%) drug allergy, 36 (1.3%) food allergy, 22 (0.8%) atopic dermatitis and 2 (0.1%) hymenoptera venom allergy. The proportion of participants with asthma is not statistically different across age groups, but when grouping other allergic diseases other than asthma, a reduction was observed with age (21.5% of 18-29 years old vs. 4.9 % with >=80 years, p > 0.001). Allergic disease was significantly more prevalent in women (asthma 9.8% vs. 5.2%;other allergies: 17.9% vs. 12.7%, p < 0.001). In a univariate analysis, the risk of hospitalization of patient with COVID-19 was significantly lower in those with allergic disease (OR = 0.7;95% CI: 0.55-0.92), but for asthma the effect was not significant. Gender was an interaction factor in this association, so in a separate multivariate model for women and men and adjusted for the other significant risk factors -age, obesity and comorbidities -the effect on risk reduction remained only in the men (adjusted OR = 0.6;95% CI:0.33-1.07). Conclusion(s): In this study, allergic disease, excluding asthma, was associated with a decrease in the severity of COVID-19, especially in men. However, further studies, namely prospective studies, are needed to better characterize this effect and the underlying mechanisms.
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Background: The sudden COVID-19 has changed people's living habits, and skin diseases closely related to lifestyle have also changed quietly. We aimed to analyze the changing of pediatric dermatological disorders spectrum before and during the COVID-19 pandemic in China. Method(s): This retrospective study encompasses consecutive patients attending a number of dermatological outpatient clinics in National Center for Children's Health from 1 January 2019 and 31 December 2021. The information about the season, age, number, disease type and origin of the patients was filled in for all the patients. The diseases were sub-classified on etiological basis. Result(s): The total number of patients was 449032, including 323142 newly diagnosed patients, with a male/female ratio of 1.15:1. The patients were mainly school-age children. 91.3% of the patients suffered from a single skin disease. During the epidemic of COVID-19-epidemic, Atopic Dermatitis (AD )and other types of dermatitis constituted the main diseases, followed by infectious skin diseases, urticaria, erythema and drug responsive skin diseases, and finally parasites and bite responsive skin diseases. The top three skin diseases ranked in descending order of incidence from 2019 to 2021 were the same, followed by AD, urticaria and papular urticaria. During the epidemic period, the proportion of patients with molluscum contagiosum, verruca vulgaris and vitiligo increased. Because of wearing masks, the proportion of infectious skin diseases transmitted by respiratory tract has decreased significantly. In addition, pediatric telemedicine can be used to increase timely access and improve practical efficiency during the epidemic. Conclusion(s): The pediatric dermatological disorders spectrum has changed during the epidemic of COVID-19. AD is the most common skin disease, and the proportion of infectious skin diseases has decreased significantly. During the epidemic, pediatric internet medical services were fully used to promote the sustainable development of children's skin health.Copyright © 2023
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Background: to evaluate the impact of COVID-19 on the course of allergic diseases in children. Method(s): 32 children with allergic diseases who had a coronavirus infection or their parents were surveyed. The questionnaire consisted of questions about the severity of an allergic disease, the severity and complications of a SARS-CoV- 2 infection, the amount of therapy during infection and after infection. The age of patients is from 5 to 16 years (boys 62%, girls 38%). Result(s): Among the respondents were 53.1% (17 patients) with allergic rhinoconjunctivitis (AlRC), 34.3% (11) with atopic bronchial asthma (ABA), 9.5% (3) with atopic dermatitis (AtD) and 3.1% (1) with a history of acute spontaneous urticaria (OK). 71.9% of patients suffered COVID-19 in mild, 25% in moderate and 3.1% in severe forms. Complications: 11 patients were diagnosed pneumonia with lung damage of less than 25%, 1 case of acute urticaria. The analysis of the effect of COVID-19 on the course of allergic diseases was carried out among patients (25 people) who were in remission before infection: with AlRC -15, ABA -8, AtD-2 patients. Patients with AlRC against the background of COVID-19 disease in 40% cases had increase in symptoms, 33.3% noted a preservation of exacerbation after 1 month after the disease, 26.7% after 3 months. Patients with ABA had increase symptoms against the background of COVID-19 occurs in 37.5%, 25% of cases -1 month after the disease, 12.5% of cases after 3 months, Symptoms did not bother and after 6 months. 1 patient with AtD disease had an exacerbation of dermatitis during of COVID-19 and 1 month after infections. Patients who had an exacerbation of an allergic disease against the background of COVID-19, changed drug treatment on a step upper. Reducing the dose of the drugs and and the volume of drug therapy was possible only 3 months after the infection Conclusion(s): Children with allergic diseases have SARS-CoV- 2 occurs in a mild form in most cases. COVID-19 causes exacerbation of AlRC, ABA, AtD in more than 1/3 of patients. Acute urticaria was presented as a complication in one case. Exacerbation of allergopathology against the background of COVID 19 requires a transition to a step above drug therapy for 3 months. Control over the symptoms of allergic diseases is observed 3 to 6 months after the infection.
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Background: Chronic spontaneous urticaria (CSU) is a common chronic inflammatory disease. There have been small case series of new onset CSU post COVID-19 infection as well as reports of new onset CSU or worsening of existing CSU post COVID-19 vaccination. Dermatological side effects post COVID-19 vaccine are typically delayed, self-limiting urticaria. We have described the characteristics of patients who have developed new onset CSU post COVID-19 vaccination. Method(s): All patients referred to the UCT Lung Institute Allergy clinic from the initiation of the COVID-19 vaccine roll out (February 2021) were reviewed to identify patients that developed new onset CSU within 12 weeks of receiving a COVID-19 vaccine. Medical history, response to therapy, and available laboratory investigations were reviewed by clinic physicians. Result(s): We identified seven patients that developed CSU post COVID-19 vaccine. The median age of the cohort is 39 (IQR 32-45) and the majority are female (n = 5). The most common vaccine was the Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine (n = 6, 85.7%), and one patient received the Jansen Ad26.COV2.S vaccine. No patients had COVID-19 infection prior to vaccination and only one patient contracted COVID-19 post vaccination. The median time to the development of symptoms post vaccination was 14 days (IQR 2;44) and the median time to diagnosis was 90 days (IQR 45;120). Most patients (n = 4) reported angioedema and urticaria, one patient reported isolated angioedema, and two isolated urticaria. The median initial UAS7 score was 37.5 (IQR 24.5;46) and the initial CU-Q2oL score was 72 (IQR 56;76) indicating severe disease activity. All but one patient had a history of atopy with the most common diagnoses being allergic rhinitis (n = 5) and atopic dermatitis (n = 3). All patients had normal eosinophil counts and over half of the patients (n = 4) had an elevated total IgE level (median 26.4 [IQR 9.8;194]). All patients were HIV negative and one patient had positive Helicobacter pylori serology. All had normal serum protein electrophoresis, thyroid function (with negative thyroid autoantibodies), and negative antinuclear antibodies. All patients started on high dose antihistamine therapy with 71.1% having partial or no response to therapy. Conclusion(s): New onset CSU is a rare side effect of COVID-19 vaccination with poor response to high dose antihistamine therapy. It is important that allergists and physicians are aware of the possibility of new onset CSU post COVID-19 vaccine and further research is needed to identify risk factors.
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BACKGROUND: The COVID-19 pandemic period revolutionized daily clinical practice. Several strategies were adopted by clinicians to avoid reducing treatment for diseases without the risk of spreading the infection. Among the adopted strategies, telemedicine played a key role. In this scenario, several tools were used, including e-mails, phone calls, video calls, support groups, and messages. Fortunately, the COVID-19 pandemic period seems to be at an end. However, the use of teledermatology appears to be an excellent strategy for the future as well. Indeed, several patients may benefit from teledermatology. OBJECTIVE: In this manuscript, we aim to investigate the use of telemedicine in the dermatological field to point out how this tool may become the mainstay of future medicine. Only the use of teledermatology with common inflammatory skin conditions have been reported herein. MATERIALS AND METHODS: Investigated manuscripts included metanalyses, reviews, letters to the editor, real-life studies, case series, and reports. Manuscripts were identified, screened, and extracted for relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. RESULTS: A total of 121 records were identified from the analyzed databases. However, only 110 articles were assessed for eligibility. Finally, 92 articles were selected at the end of the literature research for our review. CONCLUSIONS: Teledermatology should be considered as a viable option for the dermatologist for the future. We believe that the pandemic has strengthened this service, and this will allow for ever better development in the future. Guidelines regarding the use of teledermatology are required as well as additional improvements for the future.
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BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused changes in the medical practice. However, it is unclear whether the patients receiving phototherapy for their dermatoses have been affected. OBJECTIVES: This study aimed to identify the impact of the COVID-19 pandemic on phototherapy, focusing on the patient profile, adherence, and attitude before and after the surge. METHODS: The study encompassed the time 5 months prior to and after the surge of the COVID-19 pandemic (from May to July, 2021), resulting in the temporary closure of our phototherapeutic unit. RESULTS: Nine hundred eighty-one patients received phototherapy during this period. Vitiligo, psoriasis (Ps), and atopic dermatitis (AD) represented the groups with the highest patient numbers. For vitiligo, Ps and AD, 39.6%, 41.9%, and 28.4% of the patients resumed phototherapy after the pandemic-related shutdown (PRS). No significant difference was noted in age, gender, and number of weekly sessions between those who resumed or stopped phototherapy after PRS among three groups. Patients who resumed phototherapy after PRS tended to receive more weekly sessions of phototherapy than those who initiated after PRS. Additionally, patients who resumed phototherapy showed no significant difference in the number of weekly sessions before and after PRS. CONCLUSIONS: This study reveals a significant impact of the COVID-19 pandemic on patients undergoing phototherapy. Although the patient number remained similar before and after PRS, a significant portion of patients discontinued phototherapy after PRS. New strategies and continued education are needed to improve patient management in times of pandemic.
Subject(s)
COVID-19 , Dermatitis, Atopic , Psoriasis , Ultraviolet Therapy , Vitiligo , Humans , Ultraviolet Therapy/methods , Taiwan/epidemiology , Pandemics , COVID-19/etiology , Phototherapy , Psoriasis/therapyABSTRACT
BACKGROUND: During the COVID-19 pandemic, the use of face masks has increased among healthcare workers (HCWs). Questionnaire studies have shown a high frequency of self-reported facial adverse skin reactions. Case reports have been published on face mask-induced allergic contact dermatitis and urticaria. OBJECTIVES: To describe the results of the contact allergy investigations in consecutive HCWs investigated for skin reactions to face masks during the COVID-19 pandemic and the results of the chemical investigations of face masks supplied by the hospital. METHODS: Participants were patch tested with baseline series and chemicals previously reported in face masks not included in the baseline series. Face mask(s) brought by the HCW were tested as is and/or in acetone extract. Chemical analyses were performed on nine different face masks for potential allergens. RESULTS: Fifty-eight HCWs were investigated. No contact allergies were found to the face mask(s) tested. Eczema was the most common type of skin reaction, followed by an acneiform reaction. Colophonium-related substances were found in one respirator and 2,6-di-t-butyl-4-methylphenol (BHT) were found in two respirators. CONCLUSION: Based on this report, contact allergies to face masks is uncommon. Patch test with colophonium-related substances and BHT should be considered when investigating adverse skin reactions to face masks.
Subject(s)
COVID-19 , Dermatitis, Allergic Contact , Dermatitis, Occupational , Facial Dermatoses , Humans , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/epidemiology , Dermatitis, Allergic Contact/etiology , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/epidemiology , Dermatitis, Occupational/etiology , Pandemics , Masks/adverse effects , COVID-19/epidemiology , COVID-19/prevention & control , Patch Tests/methods , Facial Dermatoses/epidemiology , Facial Dermatoses/etiology , Health PersonnelABSTRACT
BACKGROUND: Upadacitinib is a Janus kinase inhibitor that has been approved for the treatment of adults and adolescents with moderate to severe atopic dermatitis (AD). The objective of this study was to characterize the pharmacokinetics (PK), safety, and tolerability of upadacitinib in children with severe atopic dermatitis. METHOD(S): This is an open-label, multiple-dose study. AD patients (n = 35) were enrolled into four cohorts (Cohort 1, 6 to <12 years, low dose;Cohort 2, 6 to <12 years, high dose;Cohort 3, 2 to <6 years, low dose;Cohort 4, 2 to <6 years, high dose). The low and high doses were selected based on body weight to provide comparable plasma exposure in pediatrics to 15 mg and 30 mg QD doses in adults, respectively. All patients continued on the low dose after the PK assessment on Study Day 7. Safety and exploratory efficacy parameters are assessed in the study. RESULT(S): Geometric mean Cmax and AUC over 0-24 hours at steady state were 33.1 ng/mL and 249 ng.h/mL, respectively, in Cohort 1, 95.5 ng/mL and 523 ng.h/mL, respectively, in Cohort 2, 35.2 ng/mL and 264 ng.h/mL, respectively, in Cohort 3, and 101 ng/mL and 625 ng.h/mL, respectively, in Cohort 4. Upadacitinib was generally safe and well tolerated. The most common AEs were COVID infection, headache, and abdominal discomfort. No new safety risks were identified compared to the known safety profile for upadacitinib. In the 29 subjects with available interim efficacy results at week 12, 34.5% achieved validated Investigator's Global Assessment scale for AD score of 0 or 1 and 69.0% achieved Eczema Area and Severity Index by at least 75% at Week 12 with treatment of upadacitinib. CONCLUSION(S): The findings supported the use of current dosing regimens for further investigation of upadacitinib in upcoming phase 3 clinical trials in pediatric AD patients.
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Setting up an inpatient teledermatology service over 1 year at our National Health Service-based district general hospital made absolute sense on two grounds: The COVID pandemic and the ever-increasing role of teledermatology enabling dermatology departments, often with limited resources, to 'work smart'. Over a 43-week period, 124 referrals were dealt with on our teledermatology platform (around 12 referrals per month). Average response time to referral was 0.65 days: 56% same-day response, 32% next-day response;and 92% a response within 3 days. Following this, 32% of patients were seen face to face on the wards and 40% were dealt with via remote advice and guidance. Around 10% of referrals were deemed not to be appropriate for dermatology review/advice. Around 12% of referrals were given dermatology face-to-face outpatient appointments rather than review on the wards, and 7% were declined an appointment (pending further information being received) as insufficient information was given for triage/advice and guidance. Initially, just 10% of referrals were sent (first time) with clinical images, but this increased to 54% after 4 months, and although there has been some monthly variation, up to 64% has been achieved (noting that clinical images are not always required for the question being asked). Around 50 different diagnoses were made, illustrating the diversity and complexity of dermatological practice, and the scale of the diagnostic problems facing ward-based teams. Previously published data revealed that around one-third of inpatient dermatology referrals were for 'red legs', which was replicated in the current results, with diagnoses of venous or atopic eczema (14%), drug reactions (12%), skin neoplasia (6%), cellulitis/erysipelas (5%), intertrigo (4%), erythroderma (4%), Gianotti-Crosti syndrome (2.5%), bullous pemphigoid (2.5%), pyoderma gangrenosum (2.5%) and vasculitis (2%). Having an inpatient teledermatology service benefits dermatology departments, enabling efficient working, appropriate triage, training opportunities and ease of second opinions from colleagues. Benefits for referrers are acute ward-based teams including rapid responses to referrals, enabling skin concerns to be dealt with quickly and avoiding delays in investigation, treatment and discharge. Some hospitals where dermatology does not have a permanent base may be able to access dermatology advice and guidance via teledermatology. Overall, patients benefit from teledermatology and it is COVID secure.
ABSTRACT
During the COVID-19 pandemic, there has been a demand from frontline healthcare workers (HCWs) wanting dermatological advice for occupational dermatitis due to increased infection-prevention measures. Various dedicated occupational skin disease clinics in the UK have been set up to help these HCWs, from virtual clinics to drop in clinics (O'Neill H, Narang I, Buckley D et al. Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland. Br J Dermatol 2021;184: 575-7). These clinics provide an opportunity for dermatology registrars to enhance their training in contact dermatitis and teledermatology. In a nationwide survey conducted in January 2020, it was felt that dermatology trainees lacked confidence in handling teledermatology referrals (Lowe A, Pararajasingam A, Goodwin RG. A paradigm shift in trainee confidence in teledermatology and virtual working during the COVID-19 pandemic: results of a follow-up UK-wide survey. Clin Exp Dermatol 2021;46: 544-7). At our institution, a virtual telephone clinic has been set up with occupational health input. A standardized pro forma is given and each person sends photos with an occupational health referral to an encrypted email service. By having this additional information beforehand, a history can be taken in the telephone clinic and appropriate management advice given. There is a dermatology consultant who is on hand to help with any queries that the trainee may have. Medications are sent out to the patient and a letter is copied to the patient, as well as the general practitioner, which details the consultation. The patients are usually discharged from the service;however, if the patients need to be seen a face-to-face appointment is given. In these clinics, various occupational dermatoses have been seen and managed. The most common diagnosis was irritant contact dermatitis of the hands due to increased handwashing and alcohol gel use, and most of these patients have a previous diagnosis of atopy (O'Neill et al.). Other occupational dermatoses seen include allergic contact dermatitis, acne and flare-up of atopic eczema. Owing to the COVID-19 pandemic, some dermatology registrars may be working from home. By doing these clinics, training opportunities in dermatology can continue with registrars still seeing patients virtually and managing the conditions. Teledermatology is being introduced in the new dermatology curriculum from August 2021. This service is also appreciated by the HCWs with these patients being seen promptly and getting their conditions managed, maintaining wellbeing in staff.