COVID-19 and dermatology

The aim of this manuscript is to investigate skin diseases associated with COVID-19 under three main headings: skin problems related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections, and skin findings due to COVID-19 treatment agents. In PubMed and Google Scholar databases, publications on skin lesions related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections and skin findings due to COVID-19 treatment agents subjects were searched in detail. Pressure injury, contact dermatitis, pruritus, pressure urticaria, exacerbation of preexisting skin diseases, and new skin lesion occurrence/new skin disease occurrence may be due to personal protective equipment. The incidence of skin lesions due to COVID-19 was reported to be between 0.2% and 29%. Many skin lesions including maculopapular, urticarial, vesicular, chilblain-like, thrombotic/ischemic, etc., are observed in COVID-19 patients. Some authors have stated that there is an absence of SARS-CoV-2 virus infection-specific skin rashes. Many skin lesions may appear as a result of COVID-19. Even in the absence of a COVID-19 diagnosis, skin findings should be evaluated carefully in the pandemic period.

Granular parakeratosis involving the dorsum of the hands; skin reactions due to irritant agents: A case report.

Key Clinical Message: We described the first case of granular parakeratosis with an unusual presentation of brown discoloration plaques and multiple erythematous on the dorsal part of the patient's hands. Skin maceration and repeated washing could have led to the development of the lesions. Abstract: Granular parakeratosis is a unique acquired keratinization disorder. Here, we described the abnormal presentation of granular parakeratosis. A healthy female aged 27 years old presented brown discoloration plaques and multiple erythematous on the dorsal part of her hands for 8 months. Using detergents, repeated washing, and skin maceration were considered the causes of her lesion.

Adverse Skin Reactions to Personal Protective Equipment Among Healthcare Workers in Oman During the Coronavirus Disease 2019 Pandemic.

Background During the coronavirus disease 2019 (COVID-19) pandemic, healthcare workers (HCWs) were required to use personal protective equipment (PPE) for unusually prolonged periods of time in order to protect themselves. This study was conducted to assess the prevalence of adverse skin reactions to PPE among HCWs from occupational and domestic exposure in Oman. Methods This was a cross-sectional study that used a self-administered questionnaire, modified based on the Nordic Occupational Skin Questionnaire, and was conducted in different categories of healthcare facilities in Oman from September to December 2020. This study involved 431 different categories of HCWs. Stata statistical software, version 12 (StataCorp, College Station, TX), was used to analyze the data, with a P value <0.05 indicating statistical significance. Results Findings indicated that 58.24% of HCWs reported new skin symptoms since the pandemic started, compared to 33.41% of HCWs who had skin symptoms before the pandemic (P<0.001). From the multivariate analysis, being female (odds ratio, or OR, 3.512; 95% confidence interval, or CI: 2.193-5.625), allergic rhinitis diagnosis (OR 2.420; 95% CI: 1.097-5.347), history of skin symptoms (OR 3.166; 95% CI: 1.856-5.400), and total glove use time (OR 1.160; 95% CI: 1.078-1.247) were associated with an increased risk of acquiring new skin symptoms. Conclusion This study demonstrates that there is some association between the prolonged use of PPE during an event such as a pandemic and a previous history of allergic rhinitis and skin symptoms. This study also emphasizes the importance of appropriate protective skin care before and after the use of PPE.

Delayed type hypersensitivity reaction to oral intake of trometamol

Case report Trometamol (tromethamine, tris(hydroxymethyl)aminomethane (TRIS)) is an excipient frequently used as buffer in fluids and semisolid agents, including many drugs such as antibiotics, iodinated contrast agents and the COVID-19 vaccine mRNA-1273. Here, we report the first case of a delayed-type hypersensitivity after oral intake of trometamol. A 64-year- old female patient presented to our emergency department with generalized erythematous rash, pruritus and swelling of the face five hours after the intake of one tablet of fosfomycin trometamol for a urinary tract infection. Further medical history revealed a previous erythematous rash five to six hours after administration of the iodinated contrast agent iopromide. We performed skin prick and intradermal tests with trometamol, fosfomycin trometamol and various iodinated contrast agents, including iopromide, iomeprol, iobitridol, iopamidol and iodixanol. These tests showed no reactions initially. However, 48 hours after intradermal testing, macular erythematous lesions developed at the sites tested with trometamol 0.1%, trometamol 0.01% and all sites tested with iodinated contrast agents. Furthermore, when we performed a lymphocyte transformation test with trometamol, fosfomycin trometamol and iopromide, we recorded a positive reaction with cytokine release after stimulating T cells with trometamol and iopromide. In contrast, basophil activation testing showed a negative result for these agents. Based on these results and our patient's history, we diagnosed a clinically relevant type IV sensitization to trometamol. There are only a few case reports about immediate-type allergic reactions to gadolinium contrast agents caused by the excipient trometamol. There are some published cases which report contact dermatitis after topical administration of trometamol-containing agents. To our knowledge, ours is the first case to report a delayed hypersensitivity reaction to oral administration of trometamol. Excipients are indispensable for drugs, vaccines and other products since they stabilize and preserve the active agents. Nevertheless, excipients should always be considered during an allergy workup, especially if the patient reports prior drug reactions that cannot be explained by a chemical cross-reaction. In our case, we diagnosed delayed-type hypersensitivity to the excipient trometamol. This is a consequential diagnosis for the patient, because trometamol is contained in many drugs and in the COVID-19 vaccine mRNA-1273.

A Review on Therapeutic Potential of Indian Herbal Plants to Counter Viral Infection and Disease Pathogenesis

Herbal plant extracts or purified phytocomponents have been extensively used to treat several diseases since ancient times. The Indian Ayurvedic system and Chinese traditional medicines have documented the medicinal properties of important herbs. In Ayurveda, the polyherbal formulation is known to exhibit better therapeutic efficacy compared to a single herb. This review focuses on six key ayurvedic herbal plants namely, Tinospora cordifolia, Withania somnifera, Glycyrrhiza glabra/Licorice, Zingiber officinale, Emblica officinalis and Ocimum sanctum. These plants possess specific phytocomponents that aid them in fighting infections and keeping body healthy and stress-free. Plants were selected due to their reported antimicrobial and anti-inflammatory effects in several diseases and effectiveness in controlling viral pathogenesis. An ad-vanced literature search was carried out using Pubmed and google scholar. Result(s): These medicinal plants are known to exhibit several protective features against various diseases or infections. Here we have particularly emphasized on antioxidant, anti-inflammatory, anti-microbial and immunomodulatory properties which are common in these six plants. Recent literature analysis has revealed Ashwagandha to be protective for Covid-19 too. The formulation from such herbs can exhibit synergism and hence better effectiveness against infection and related dis-eases. The importance of these medicinal herbs becomes highly prominent as it maintains the har-monious balance by way of boosting the immunity in a human body. Further, greater mechanistic analyses are required to prove their efficacy in fighting infectious diseases like Covid-19. It opens the arena for in-depth research of identifying and isolating the active components from these herbs and evaluating their potency to inhibit viral infections as polyherbal formulations.Copyright © 2023 Bentham Science Publishers.

Acute angioedena attacks after COVID-19 disease or COVID-19 vaccination in a population afflicted with hereditary angioedema

Background: Few studies demonstrating the involvement of the complement system in COVID-19 pathogenesis have been published, suggesting its role in pulmonary symptoms and endothelial permeability, which is known to be crucial in the origin of Hereditary Angioedema (HAE).1 Post-morten tissue of COVID-19 patients reported depots of complement, activated by the lectin pathway, in type I and II alveolar epithelial cells.2 After this evidence and the link that infectious processes have as triggers of angioedema episodes, in patients with HAE, we propose to study the implication of both the infection and de doses of the COVID vaccine, in the appearance of episodes of angioedema in our population with a diagnos is of HAE. Method(s): Telemedicine interventions (telephone consultations) were carried out by trained Allergists from Hospital Universitario de Canarias, reaching out patients with a confirmed diagnosis of HEA by Skin Allergy Unit (SAU) within the local health district. Result(s): A total of 17 (11 females) were finally screened, and 2 (11.76%) passed a confirmed COVID-19 disease in January 2022 associating no acute attacks or need for rescue medication. Both subjects were fully vaccinated (3 doses-schedule) prior to the infection and suffered from a COVID-19 mild disease only. Only an individual dose of COVID-19 vaccination (Vaxzevria, Astra-Zeneca) -out of 40 overall given doses in 15 subjects and 3 different brands-was associated to an acute episode of abdominal swelling demanding immediate self-administered rescue therapy (icatibant) thus, preventing the patient from rushing to the Emergency Department. The subsequent 2 doses of the COVID-19 vaccination were safely scheduled in the same patient. Conclusion(s): In accordance with former reports4, only mild COVID-19 symptoms were associated in subjects with a confirmed diagnosis of HAE.

Allergic contact dermatitis to the elastic bands of an N95 mask

Case report Introduction: In the wake of the COVID-19 pandemic, occupational contact dermatitis related to the use of personal protective equipment (PPE) has become increasingly prevalent. While most cases are irritant in nature, allergic contact dermatitis (ACD) remains an important cause of occupational dermatitis. We report a case of ACD to rubber accelerators in the elastic bands of an N95 mask. Informed consent was obtained from the patient for this report. Case Report: A 27-year-old healthcare worker presented with a progressive pruritic eruption over her face and neck, 1 week after she began wearing N95 masks at work. She had only worn disposable surgical masks. She had no medical history apart from hand dermatitis, which was well controlled with topical medications. Examination revealed linear eczematous plaques along her lateral cheeks and posterior neck, corresponding to contact areas between the mask bands and her skin. Patch tests revealed a positive reaction to several rubber accelerators, including Thimerosal, 2-Mercaptobenzothiazole (MBT), and Methylisothiazolinone. We performed another patch test to several N95 mask straps, to which the patient developed an eczematous reaction to the elastic bands of 2 N95 mask types with elastic bands. Clarification with the manufacturer confirmed the use of rubber accelerators similar in properties to MBT in the production of these masks. A diagnosis of allergic contact dermatitis to rubber accelerator was made. The patient's dermatitis resolved with topical corticosteroids and the avoidance of N95 masks with elastic bands. Discussion and Conclusion(s): The use of facial PPE such as masks is a recognised cause of occupational dermatitis among healthcare workers. A variety of dermatoses are associated with the use of facial PPE, with contact dermatitis being the most common. However, while the majority of contact dermatitis are irritant in nature, ACD remains an important and preventable cause of occupational dermatitis. Commonly implicated allergens associated with mask use include preservatives and adhesives used in their production, as well as metals in the nose clip. Although less common, mask elastic bands have also been reported to be a potential source of ACD, with rubber accelerators being identified as potential allergens. However, there is often a lack of declaration of such chemicals used in the production of PPE. Given the need for continued use in the occupational setting, early identification and avoidance of allergens are key. Failure to do so may result in the progression of skin lesions, ultimately affecting the patients' quality of life and work performance. With the ubiquitous use of masks in the current climate, we wish to highlight the need for greater awareness of rubber accelerators as potential allergens, and their presence in the elastic bands of frequently used PPE.

Desensitization protocol for anti-SARS- CoV- 2 vaccines in allergic patients: A case series

Background: Vaccination has proven to be the best viable tool for preventing the spread of SarsCov2 infection. The fear of adverse events represents one of the limits of this vaccination campaign. As Allergists, we had a fundamental role evaluating the allergological risks and performing specific tests. The only absolute contraindication to SARS-CoV- 2 vaccination is hypersensitivity to its components. When an individual is allergic to an indispensable medication, it is possible to resort to desensitization. Given the lack of a standardized scheme, the aim of our study is to propose a desensitization protocol for anti-SARS- CoV- 2 vaccines. Method(s): The desensitization protocol we developed consists in the fractioned administration of the entire vaccine dose into 5 separate injections of increasing quantity, through a 2-hour period. Premedication with antihistamines and chromones was administrated. Between January 2021 and January 2022, 23 patients referred to our Unit were deemed with a high risk of hypersensitivity reactions to the vaccines and underwent the desensitization protocol. We here describe 23 consecutive cases of patients who underwent desensitization to anti-SARS- CoV- 2 vaccine. Result(s): 4/23 had positive allergy skin test to Polysorbate and underwent desensitization for their entire vaccination cycle. 19/23 had a previous hypersensitivity reaction to an anti-SARS- CoV- 2 vaccine (18 after the first dose and 1 after the second one). Among 4 patients with sensitization to Polysorbate none developed hypersensitivity reactions after fractionated administration of BNT162b2 vaccine. Among 19 patients that underwent desensitization because of hypersensitivity reactions after I or II dose of vaccine, 15 experienced a reaction following vaccination with BNT162b2, 4 with mRNA-1273 and 4 with ChAdOx1-S recombinant. Furthermore, we categorized their reactions according to WAO score per systemic reactions: 15/19 (79%) grade1, 2/19 (10.5%) grade2, 2/19 (10.5%) grade3. No severe late hypersensitivity reactions were observed. All but one of this 19 patients had no hypersensitivity reactions after vaccination through the desensitization protocol. 1 patient experienced anaphylaxis during desensitization with BNT162b2 vaccine (WAO grade4). No late hypersensitivity reactions were observed. Overall, 22/23 (95.6%) patients that underwent anti-SARS- CoV- 2 vaccination through the desensitization protocol did not experience hypersensitivity reactions. Conclusion(s): Our results suggest that desensitization can be implemented to extend the vaccination to currently ineligible individuals. Larger studies are needed to prove the safety and efficacy of this approach.

Epidemiological characteristics and disease spectrum analysis of outpatients in the dermatology department of a hospital in Wuhan during the COVID-19 epidemic.

Objective: To investigate epidemiological characteristics of outpatients and disease spectrum in the dermatology department during the COVID-19 epidemic Methods: A retrospective comparison of outpatient visits, gender, age and disease types in the dermatology department of Wuhan No.1 Hospital was performed between COVID-19 epidemic period (from 23th January 2020 to 15th April 2020) and the same period in 2019. Enumeration data were analyzed by Pearson's chi-square test. Result(s): During the COVID-19 epidemic, the number of outpatient visits to the dermatology department of the hospital decreased markedly, and the average daily number of outpatient visits (236 visits/day) was only 8.81% of that during the same period in 2019 (2 678 visits/day) ;the ratio of male to female patients was reversed from 1:1.37 in 2019 to 1.16:1 in 2020;the proportions of patients aged 0-6, 7-12, 13-17 and 18-45 years significantly decreased compared with those in 2019 (all P < 0.001), and the proportions of patients aged 46-69 and > 69 years significantly increased (both P < 0.001). During the COVID-19 epidemic, there were 171 types of skin diseases in the dermatology outpatient department, and the number of disease categories decreased compared with that during the same period in 2019 (442 types) ;the number of patient visits for allergic skin diseases, erythematous papulosquamous skin diseases, viral infectious skin diseases and bacterial infectious skin diseases significantly increased compared with that during the same period in 2019 (all P < 0.001), while the number of patient visits for sebaceous and sweat gland disorders, pigmented skin diseases and physical skin diseases significantly decreased (all P < 0.001). Conclusion(s): Compared with the same period in 2019, the number of outpatient visits, patient sex ratio, age distribution and disease types in the dermatology department have undergone marked changes during the COVID-19 epidemic, and this study provides a reference for healthcare workers in dermatology department to respond to various epidemics and natural disasters in the future.Copyright © 2021 by the Chinese Medical Association.

Contact allergy investigations in healthcare workers with face mask-related skin disease.

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.

Risk factors for the development of acne in healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has led to many healthcare workers having prolonged contact with tight-fitting masks, leading to maskne. "Maskne" is defined as acne secondary to mask use. There are limited studies on maskne during the COVID-19 pandemic. The objective of this study is to identify risk factors for the development of maskne amongst healthcare workers. A cross-sectional survey was completed by 227 medical students, resident physicians, and nursing students at Johns Hopkins Medicine, with 68.7% of participants reporting development of maskne. Surgical masks and respirators were the most prevalent mask types worn at work. The most common prevention methods were the use of mild cleansers and moisturizers. Chi-squared analysis was used for data analysis. The results of this study indicate that gender (p = 0.003) and duration of mask use (p = 0.048) are significant risk factors for maskne development. These factors are non-modifiable, but may be used for more targeted education for prevention.

Occupational dermatitis virtual clinic for healthcare workers: clinics to increase training opportunities to dermatology registrars who are working from home

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.

Palmoplantar inflammation with a broad differential diagnosis made clear upon patch testing

A 51-year-old woman presented to our service with a 2-year history of severely painful, thickened skin of her bilateral hands and feet. She advised of considerable skin pain on mobilizing. She intermittently applied acrylate nails. This was on a background of chronic urticaria, asthma and allergic rhinitis. She described a positive family history of psoriasis. On examination, there was marked hyperkeratosis with welldemarcated erythema on the central palms and entire fingers with deep fissuring and scale. Similar finding were noted on the soles of the feet particularly affecting the heels, arch and also the tips of the toes. The morphology of the lesions favoured psoriasis, but the differential diagnosis included chronic hand dermatitis. She was referred for topical psoralen + ultraviolet A (PUVA) and patch testing to standard battery and acrylates. Treatment with topical PUVA was discontinued and patch testing lists were cancelled as a result of the emergence of COVID-19 in Ireland. Topical therapy of clobetasol propionate was initiated. On follow-up review, the appearances of her feet and hands had deteriorated significantly. She was commenced on acitretin 10 mg once daily, which was escalated to 20 mg 2 months later. Clinical improvement was noted, but appearances deteriorated once again following the application of acrylic nails. Further history revealed the patient had assisted with the application of acrylic nails to clients years prior to her initial review. Patch testing took place 18 months after initial review due to outpatient list cancellations secondary to the COVID-19 pandemic. Upon review 48 h after the application of the (METH) Acrylate Series, the patient was found to have a +2 reaction to 2- hydroxyethyl methacrylate and a further +2 reaction to 2- Hydroxypropyl methacrylate. At her 96-h review, both reaction sites were marked at +1. Following complete avoidance of acrylates, the palmoplantar inflammation entirely resolved. This case highlights the importance of a detailed clinical history where contact dermatitis is considered. In our patient's case, the clinical history and examination of the palmoplantar eruption combined with the first-degree family history of psoriasis were highly suggestive of a diagnosis of psoriasis. The episodic severe flares and its refractory nature to treatment raised suspicion for allergic contact dermatitis. Dermatologists should remain alert for potential contact allergens in cases of severe palmoplantar psoriasis. A further area for consideration is the deleterious effect the COVID-19 pandemic had on the successful diagnosis and treatment of dermatological patients through the cancellation of outpatient services.

Contact allergy to Efudix cream: a reminder and review

5-Fluorouracil (Efudix) cream is established as a topical treatment for superficial malignant and premalignant skin lesions. Its method of action involves the irreversible binding of the pyrimidine analogue fluorouracil to thymidylate synthetase within a cell. This prevents the incorporation of uracil into nuclear RNA, which destroys abnormal cancer cells (https://dermnetnz.org/topics/5-fluorouracil-cream). The expected sequelae of its use involves the development of a marked inflammatory response. We present a case of a severe, disproportionate reaction to Efudix cream, secondary to contact allergy to the excipients. A 61-year-old man attended the cutaneous allergy clinic with a history of severe, florid, inflammatory and ulcerative skin reactions affecting the lower limbs at sites of application of Efudix cream. This had been used as directed, to treat areas of Bowen disease, at intervals between December 2019 and February 2021. Contact allergy to Efudix cream was suspected and patch testing was performed to the British Standard and Cosmetic series, as well as the excipients of Efudix cream, including stearyl alcohol, propylene glycol (PG), methylparahydroxybenzoate, propylparahydroxybenzoate and white soft paraffin. While the patch tests were applied in the department on day 0, subsequent appointments on days 2, 4 and 7 were performed virtually with photographs as the patient developed COVID-19 symptoms, with positive lateral flow and polymerase chain reaction tests. He was patch test positive on days 4 and 7 to stearyl alcohol and propylene glycol, both being excipients of Efudix cream. A review of our database over a period of 17 years revealed 53 other cases with positive patch test to PG (n = 53/8000;0.66%), none of which were attributable to the use of Efudix cream, and only six cases of a positive patch test to stearyl alcohol (n = 6/8000;0.075%), of which one was attributable to the use of Efudix cream. Allergic contact dermatitis to Efudix cream and its excipients stearyl alcohol and propylene glycol is rare, although it has previously been described in the literature with the earliest reports in 1992, and the most recent being 15 years ago [Meijer B, de Waardvan der Spek F. Allergic contact dermatitis because of topical use of 5-fluorouracil (Efudix cream). Contact Dermatitis 2007;57: 58-60]. This case adds to the existing literature and is a reminder to clinicians that, although inflammation is expected with the use of Efudix cream, severe or disproportionate reactions should raise suspicion of possible contact allergy. Furthermore, this case highlights the challenges of patch testing in the current COVID-19 climate and highlights the importance of teledermatology as a novel option for assessment in cutaneous allergy services facing these conditions.

Post-COVID Cutaneous Manifestations: A Retrospective Study at a Tertiary Care Centre

Introduction: COVID-19 disease is caused by SARS COV-2 virus. Though it primarily affects the lower respiratory tract, reports have indicated that specific cutaneous manifestations are associated with COVID-19. Objective(s): To evaluate the persistent dermatologic long term sequelae of SARS-CoV-2 infection, among recovered COVID-19 infected patients. Method(s): Baseline data were retrospectively collected from patient's medical records from the department of dermatology over 1 year (January 2021-January 2022), at a designated tertiary care centre. The demographic data, severity of COVID disease, and pre-existing cutaneous and systemic co-morbidities were noted. Dermatologic, hair and nail manifestations were recorded. The results were statistically analyzed. Result(s): Record of total 972 patients were analyzed in our study, with 432 males and 340 females. Out of these, 88 cases (9.05%) had skin manifestations, of which 35 (39.77%) were male, and 53 (60.22%) were females. About 50% of cases experienced long term skin diseases after 6 months of the recovery. The majority, 47 (53.4%) of patients with skin manifestations, were in the age group of 30-50 years, followed by 31 (35.22 %) of patients in the 50 years age and above group. Urticaria and Pruritus were the most common manifestations 26 (29.5%), followed by telogen effluvium 24 (27.7%), herpes zoster 16(18.1%), pityriasis rosea, acneform eruptions, acral erythema, irritant contact dermatitis, palmar keratoderma, aphthous ulcer with lip crackling, eruptive pseudo angiomatosis, aquagenic keratoderma, and others. Conclusion(s): Prevalence of cutaneous, hair and nail manifestations among COVID-19 patients was 88 (9.05%) in our study. More extensive research is required to establish our knowledge on the relation between skin and COVID-19.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

A 30-year Patch Testing Experience at Siriraj Dermatology

Objective: To identify trends of contact allergy and patch testing amendments at the Contact Dermatitis Clinic, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University. Materials and Methods: Medical records of 6,862 patients referred to our clinic between January 1992 and December 2021 for patch testing were reviewed. Results: The number of patients patch tested increased and reached a peak of 600 patients/year in 2019 before the COVID-19 pandemic. The most frequently used series was baseline, while the most used specific series was cosmetics. The overall positivity rate was 69%. The highest positivity rate was in the cosmetics series (70.2%). Nickel sulfate was the most common contact allergen found (24.2%). Conclusion: Our patch test service has been growing in the last 30 years. The series of allergens used for patch testing has been amended every few years to be up-to-date with current global trends of contact allergies. Continual surveillance of contact prevalence and periodic updating of those series are necessary to enhance our ability to detect culprit contact allergens, which could help us improve care of our patients © All material is licensed under terms of the Creative Commons Attribution 4.0 International (CC-BY-NC-ND 4.0) license unless otherwise stated

A Randomized, Controlled Trial of Trifarotene Plus Doxycycline for Severe Acne Vulgaris

OBJECTIVE: We evaluated the efficacy and safety of trifarotene plus oral doxycycline in acne. METHOD(S): This was a randomized (2:1 ratio) 12-week, double-blind study of once-daily trifarotene cream 50microg/g plus enteric-coated doxycycline 120mg (T+D) versus trifarotene vehicle and doxycycline placebo (V+P). Patients were aged 12 years or older with severe facial acne (>=20 inflammatory lesions, 30 to 120 non-inflammatory lesions, and <=4 nodules). Efficacy outcomes included change from baseline in lesion counts and success (score of 0/1 with >=2 grade improvement) on investigator global assessment (IGA). Safety was assessed by adverse events and local tolerability. RESULT(S): The study enrolled 133 subjects in the T+D group and 69 subjects in the V+P group. The population was balanced, with an approximately even ratio of adolescent (12-17 years) and adult (>=18 years) subjects. The absolute change in lesion counts from baseline were: -69.1 T+D versus -48.1 V+P for total lesions, -29.4 T+D versus -19.5 V+P for inflammatory lesions, and -39.5 T+D versus -28.2 for non-inflammatory lesions (P<0.0001 for all). Success was achieved by 31.7 percent of subjects in the T+D group versus 15.8 percent in the V+P group (P=0.0107). The safety and tolerability profiles were comparable between the T+D and V+P arms. CONCLUSION(S): T+D was demonstrated to be safe and efficacious as a treatment option for patients with severe acne.Copyright © 2022 Matrix Medical Communications. All rights reserved.

Popper's Dermatitis: A Unique Form of Contact Dermatitis In the MSM Community

Rationale: Men who have sex with men have different contact allergen exposures compared to men who have sex with women due to cultural differences in the LGBTQ+ community. Poppers, a common name for volatile alkyl nitrates, are used more frequently in the MSM community as recreational inhalants. We aimed to identify common anatomic sites and contact allergens associated with popper's dermatitis in the MSM community. Method(s): Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying allergic contact dermatitis associated with poppers in the MSM population. Search terms included 'allergic' or 'contact dermatitis' or 'patch testing' or "poppers" or 'Men who have sex with men'. Date, geographical or language restrictions were not used. No exclusion criteria was used. Result(s): : Common allergens associated with popper's dermatitis in the MSM community included amyl nitrate (N=7), isobutyl nitrate (N=3), isopropyl nitrate (N=2), and fragrance mix (N=5). Common anatomic sites included perioral regions (N=3), chest (N=2), nasal orifices (N=3), cheeks (N=5), penis (N=1), and lateral thigh (N=1). Conclusion(s): Sexual orientation is a relevant factor for dermatologists/allergists to consider, as the standard patch test series does not include common allergens associated with popper's dermatitis which disproportionally affects the MSM community. Our community needs to include gender and sexuality demographics when collecting patch test data.Copyright © 2022