The differentiating effect of COVID-19-associated stress on the morbidity of blood donors with symptoms of hidradenitis suppurativa, hyperhidrosis, or psoriasis.

PURPOSE: The burden of different skin diseases may vary leading individuals to have different sensitivity to stress. Therefore, we compared the health-related quality of life (HRQoL) and stress before and during the universal stress from the severe acute respiratory syndrome coronavirus-2-pandemic in individuals with and without hyperhidrosis, hidradenitis suppurativa, or psoriasis. METHODS: The study cohort was the Danish Blood Donor Study. Overall, 12,798 participants completed a baseline questionnaire before the pandemic, in 2018-2019, and a follow-up questionnaire during the pandemic, in 2020. Regression determined the association between the skin diseases and outcomes. Outcomes were the physical and mental component summary (MCS, PCS, respectively), which assess the mental and physical HRQoL, and the perceived stress scale, which assesses stress in the past four weeks. RESULTS: Overall, 1168 (9.1%) participants had hyperhidrosis, 363 (2.8%) had hidradenitis suppurativa, and 402 (3.1%) had psoriasis. At follow-up, the participants with hyperhidrosis had worse MCS (coefficient -0.59 [95% confidence interval (CI) -1.05, -0.13]) and higher odds of moderate-to-severe stress (odds ratio 1.37 [95% CI 1.13, 1.65]) and the participants with hidradenitis suppurativa worse PCS (coefficient -0.74 [95% CI -1.21, -0.27]) than the control groups. The associations were independent of baseline HRQoL, stress, the Connor-Davidson Resilience scale, and other covariables. Psoriasis was not associated with the outcomes. CONCLUSION: Individuals with hyperhidrosis or hidradenitis suppurativa experienced worse mental or physical well-being and individuals with hyperhidrosis also had higher stress during the pandemic compared to healthy individuals. This suggests that individuals with these skin diseases are particularly susceptible to external stress.

The Impact of Telemedicine on Patients with Hidradenitis Suppurativa in the COVID-19 Era.

(1) Background: Hidradenitis suppurativa is a chronic, inflammatory skin disease. It is characterized by the transformation of normal skin into skin with abscesses, nodules, tunnels, and scars. The most commonly affected areas are the armpits, groins, buttocks, and subscapular area. Patients with HS require constant care under the supervision of the outpatient clinic. Due to the COVID-19 pandemic, consultations have been introduced in the form of telemedicine. The aim of this study was to evaluate the availability of HS treatment during the COVID-19 pandemic and to assess patient satisfaction, problems with access to medical care, and the impact of the pandemic on the course of the disease. (2) Methods: An internet survey with an anonymous questionnaire was used to assess the effectiveness of telemedicine consultations. The survey consisted of 25 closed questions, and responses were kept fully anonymous. (3) Results: Most respondents reported minor problems with accessing specialized HS medical care during the COVID-19 pandemic (n = 25, 35.71%). However, 35.71% (n = 25) of them reported major problems with appointments for specialized ambulatory treatment during the last few months of the pandemic, mainly due to delayed appointments. Almost half of the respondents had been diagnosed with COVID-19 (n = 34, 48.57%), and 58.57% (n = 41) of respondents did not see a correlation between COVID-19 infection and HS progression. (4) Conclusions: Our study showed that the pandemic significantly limited access to medical advice, and patients with hidradenitis suppurativa prefer standard consultations.

Teledermatology for Common Inflammatory Skin Conditions: The Medicine of the Future?

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.

COVID-19 Infection in Hidradenitis Suppurativa Patients: A Retrospective Study.

Introduction: Hidradenitis suppurativa (HS) is associated with comorbidities that are risk factors for severe COVID-19 infection. We evaluated demographics and COVID-19 outcomes in HS patients. Methods: HS patients with COVID-19 (HS+/COVID+) and a randomized age-, race-, and sex-matched control population of patients without HS with COVID-19 (HS-/COVID+) were selected through a retrospective chart review. Data were collected on demographics, medications, comorbidities, vaccination status, and COVID-19 treatment/outcomes. Fisher's exact test was used to analyze the relationship between risk factors and COVID-19 outcomes. A p value of <0.05 was considered statistically significant. Results: There were 58 HS+/COVID+ patients, primarily African American (83%, n = 48) and female (88%, n = 51). Compared to HS+/COVID+ patients, HS-/COVID+ patients were significantly more likely to have cardiovascular disease (51% vs. 24%; p = 0.0029) and be pregnant (23% vs. 4%; p = 0.0093). HS+/COVID+ and HS-/COVID+ patients did not vary significantly in vaccination rate at time of COVID-19 diagnosis (6% vs. 5%; p = 0.78). HS-/COVID+ patients were significantly more likely to have COVID-19 complications (35% vs. 7%; p = 0.001) and receive COVID-19 treatment (37% vs. 7%; p = 0.0001) when compared to HS+/COVID+ patients. Conclusion: Our findings support the growing evidence that having HS itself may not be a risk factor for severe COVID-19 outcomes.

Research Roundup

In this regular feature, aesthetic nurse Claudia McGloin presents a brief synopsis of a range of recently published articles on medical aesthetics. Research roundup aims to provide an overview, rather than a detailed summary and critique, of the papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided at the end of each study summary

Dermatologists' Perceptions of the Use of Teledermatology in Managing Hidradenitis Suppurativa: Survey Study

Background: The field of teledermatology has expanded tremendously and has been used for conditions including hidradenitis suppurativa (HS). However, due to the sensitive location of lesions, HS may be considered less suitable for teledermatology. Objective: We sought to assess dermatologists' experiences and perceptions toward using teledermatology for HS relative to atopic dermatitis (AD) as a comparison. Methods: A survey was disseminated electronically to practicing dermatologists in the Asia-Pacific region between February and June 2022. Differences in attitudes and perceptions between HS and AD were compared using random-effects ordered logistic regression, controlling for demographics. Results: A total of 100 responses were obtained comprising of 76 (81.7%) dermatologists and 17 (18.3%) dermatology trainees;62.6% (62/98) of physicians were uncomfortable with using teledermatology for HS. Multivariable regression confirmed increased perceived challenges with managing HS using teledermatology compared to AD. These challenges include the need for photography of hard-to-reach or sensitive areas (odds ratio [OR] 4.71, 95% CI 2.44-9.07;P<.001), difficulties in accurate assessment of severity (OR 2.66, 95%CI 1.48-4.79;P=.001), and inability to palpate lesions (OR 2.27, 95% CI 1.23-4.18;P=.009). Conclusions: This study confirms the relative reluctance of dermatologists to use teledermatology for HS and complements existing data showing mixed levels of willingness from patients. The use of teledermatology for HS may need to be optimized to overcome these challenges, including increasing security features, selection of patients with milder or limited diseases, and selecting patients with an established and strong doctor-patient relationship. ©Valencia Long, Ellie Ci-En Choi, Zhaojin Chen, Moonyza Akmal Ahmad Kamil, Murlidhar Rajagopalan, Erin McMeniman, Nisha Suyien Chandran.

Adalimumab, Ustekinumab, and Secukinumab in the Management of Hidradenitis Suppurativa: A Review of the Real-Life Experience.

To date, adalimumab (ADA) is the only biotechnology drug approved for the management of hidradenitis suppurativa (HS), an inflammatory skin condition. However, it quickly became apparent that the efficacy of adalimumab in daily practice was highly variable. In our review, we highlighted the current evidence from literature on the use of biologics in HS in a real-life setting, particularly adalimumab, secukinumab and ustekinumab. Data on the effectiveness and safety of biologic drugs in HS management have been analyzed. Even if the results are promising, more studies are needed. In our opinion, the armamentarium of drugs for HS management is increasing, and treatment will be based on a tailored-tail approach, minimizing the risk of adverse events. In this context, we want to point out the reported effectiveness and safety data concerning adalimumab, ustekinumab and secukinumab as well as ixekizumab.

Single staged treatment of a complex full thickness debridement for hidradenitis suppurativa using NovoSorb Biodegradable Temporizing MatrixTM

Treatment of full skin thickness loss due to surgical debridement for difficult wound beds like necrotizing fasciitis and hidradenitis suppurativa (HS) is commonly treated using wide local excision and split-thickness-skin grafting or muscle flaps. Unfortunately, this strategy often leaves large soft tissue defects and can be complicated by infection and poor graft take, resulting in additional surgeries. Novel approaches using acellular dermal substitutes along with skin grafting are treatment options with favorable cosmetic outcomes and improve functionality by reducing contractures. However, patient non-compliance and various complications such as complex wound care, infection, product fragility and financial implications have contributed to a lack of widespread adaptation. NovoSorb Biodegradable Temporizing Matrix (BTMTM) has been demonstrated to function as a dermal scaffold that has robust handling characteristics and requires minimal wound care. This case report describes the treatment course of a high-risk patient with poor nutrition and a history of a 20 pack-year tobacco smoking, methamphetamine use, phencyclidine use, and marijuana use with recurrent and widespread axillary, inguinal, and gluteal HS. This patient was treated using NovoSorb BTMTM as the primary dermal substitute without subsequent grafting to cover a 400 cm2 left gluteal excision due to patient non-compliance. The covered area subsequently spontaneously epithelized after six months of local home health care during the COVID-19 pandemic. Our results show promise for future use of NovoSorb BTMTM to serve as a single stage surgery option to complete wound healing in high-risk patients. Copyright © 2022 The Authors

The Role of Teledermatology During the COVID-19 Pandemic: A Narrative Review.

Teledermatology represented one of the most important and useful tools during the COVID-19 pandemic era. Indeed, due to the severe restriction, and to reduce the spread of the infection, different measures were applied among different countries and hospitals to ensure a continuity of care for patients. In this scenario, teledermatology played a central role, especially in the management of patients suffering from chronic inflammatory skin diseases. The aim of this narrative review is to describe the role of teledermatology during the COVID-19 pandemic to analyze main strengths and limitations of this tool, as well as to provide future perspectives in clinical applications.

Biologic use in hidradenitis suppurativa: patient perspectives and barriers.

INTRODUCTION: Hidradenitis suppurativa (HS) is an inflammatory dermatosis for which the treatment paradigm is rapidly expanding. We aimed to identify HS patient perspectives and barriers on biologics. METHODS: An anonymous survey was distributed between 10/2021 and 1/2022 through HS support groups. Data regarding demographics and perspectives on biologics were collected and analyzed. RESULTS: Of the 196 respondents, 92% were female (180/196) and 75% were white (147/196). 89.3% had Hurley stage 2/3 HS (102/195). The primary healthcare provider (HCP) for HS in 65% (128/196) of patients was a dermatologist, with 12% (23/196) seen at an HS specialty clinic. Most respondents never tried a biologic medicine (62%, 118/192). The top barriers to biologics were fear of side effects (61%, 109/179), high cost/lack of insurance coverage (46%, 83/179), frequency of weekly injections (32%, 58/179). Respondents reporting their main HCP as a non-dermatologist (4.11 vs 3.0, p < .0001) and not seen at a HS specialty clinic (3.5 vs 2.7, 0.039) were significantly more likely to agree 'I do not know enough about how biologics work to help my HS'. CONCLUSION: Our results highlight the importance of specialty care in the education and implementation of biologics. Patients may benefit from comprehensive discussion prior to starting biologics.

A systematic review on mucocutaneous presentations after COVID-19 vaccination and expert recommendations about vaccination of important immune-mediated dermatologic disorders.

With dermatologic side effects being fairly prevalent following vaccination against COVID-19, and the multitude of studies aiming to report and analyze these adverse events, the need for an extensive investigation on previous studies seemed urgent, in order to provide a thorough body of information about these post-COVID-19 immunization mucocutaneous reactions. To achieve this goal, a comprehensive electronic search was performed through the international databases including Medline (PubMed), Scopus, Cochrane, Web of science, and Google scholar on July 12, 2021, and all articles regarding mucocutaneous manifestations and considerations after COVID-19 vaccine administration were retrieved using the following keywords: COVID-19 vaccine, dermatology considerations and mucocutaneous manifestations. A total of 917 records were retrieved and a final number of 180 articles were included in data extraction. Mild, moderate, severe and potentially life-threatening adverse events have been reported following immunization with COVID vaccines, through case reports, case series, observational studies, randomized clinical trials, and further recommendations and consensus position papers regarding vaccination. In this systematic review, we categorized these results in detail into five elaborate tables, making what we believe to be an extensively informative, unprecedented set of data on this topic. Based on our findings, in the viewpoint of the pros and cons of vaccination, mucocutaneous adverse events were mostly non-significant, self-limiting reactions, and for the more uncommon moderate to severe reactions, guidelines and consensus position papers could be of great importance to provide those at higher risks and those with specific worries of flare-ups or inefficient immunization, with sufficient recommendations to safely schedule their vaccine doses, or avoid vaccination if they have the discussed contra-indications.

Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications.

BACKGROUND: The most frequent inflammatory skin diseases are psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne. Their management is challenging for dermatologists since their relapsing chronic clinical course is associated with a great impact on quality of life. Nevertheless, the recent introduction of novel therapies, such as biological drugs and small molecules has been changing the history of these diseases. METHODS: A systematic review of the scientific literature of case reports, case series, epidemiological studies, reviews, and systematic reviews regarding teledermatology and inflammatory skin disease. Studies 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 69 cases articles were included in the review. CONCLUSIONS: As we have shown in the review, several experiences of teledermatology for patients affected by inflammatory skin diseases have been demonstrated to increase due to clinical access to hospital and specialized health care services, allowing better access to specialized dermatology care for people living in remote areas, and saving costs and money with health care.

Skin Manifestations in Psoriatic and HS Patients in Treatment with Biologicals during the COVID-19 Pandemic.

The Coronavirus Disease 2019 (COVID-19) pandemic, a global public health emergency, has changed dermatology practice and daily routine in just under two years. Much has been written in the literature about COVID-19-associated skin manifestations. Nevertheless, much less has been written regarding skin manifestations in patients affected by severe immune-mediated skin diseases, e.g., psoriasis and hidradenitis suppurativa, undergoing biological treatment during the COVID-19 outbreak. Thus, the aim of this article is to provide the reader with an overview of the cutaneous manifestations during the COVID-19 pandemic in this subset of patients.

COVID-19 vaccine safety and efficacy in patients with immune-mediated inflammatory disease: Review of available evidence.

Dermatologists diagnose and treat many immune-mediated inflammatory diseases (IMID). Understanding the inherent immune dysregulation of these diseases as well as the additional disruption that comes as a result of IMID treatments has been important during the COVID-19 pandemic. With vaccines becoming widely available, dermatologists need to be familiar with the risks and benefits of vaccination in these patients, particularly those taking biologics, in order to have informed discussions with their patients. In this review, we present the current evidence related to COVID-19 vaccine safety and efficacy in patients with IMID and review existing recommendations for vaccination against SARS-CoV-2. Given the current evidence, there is minimal concern that these patients are at any greater risk of harm from COVID-19 vaccination compared to healthy controls. For most, the benefit of avoiding severe COVID-19 through vaccination will outweigh the theoretical risk of these vaccines. A question that is still outstanding is whether patients on biologics will generate a sufficient immune response to the vaccine, which may be dependent on the specific biologic therapy and indication being treated. This underscores the importance of following patients with IMID after vaccination to determine the safety, efficacy, and duration of the vaccine in this population.