The effect of COVID-19 disease on patients diagnosed with skin cancer in the dermatology clinic (preprint)

Objective: We aimed to define the impact of the pandemic on patients presenting to dermatology clinic with skin cancer. Methods: In our study, the characteristics of patients who attended our dermatology clinic before six months and after six months of March 11, 2020, and whose biopsies diagnosed as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM) were evaluated and compared regarding before and after COVID-19 pandemic Results: Patients with BCC attending to the dermatology clinic were found to be younger in the pandemic period (p<0.05). Gender, duration of skin tumors, primary lesions, and their locations were found to be not statistically significant (p>0.05). Conclusion:Patients with suspicious skin lesions could be encouraged to visit a hospital with appropriate COVID-19 protection. Alternatively, teledermatology could be used to evaluate whether the lesions should be excised or biopsied.

Lessons to be Drawn from the COVID-19 Pandemic on the Impact of Occupational Skin Exposure to Disinfectant Products (preprint)

(1) Background: Hand hygiene practice by using alcohol-based hand sanitizers was generalized in all sectors of activity, due the COVID-19 pandemic. The aim of this study was to organize and analyze the scientific data regarding occupational exposure to hand sanitizers, with a particular focus on their use and health effects on workplace settings. (2) Methods: A rapid literature review was carried out searching on the main scientific database, namely: Web of Science Core Collection, Medline, Scielo and Current Content Connect. (3) Results: All studies analyzed included samples from healthcare professionals and eczema as well as irritant contact dermatitis were the most reported skin lesions. (4) Conclusions: The adequate implementation of hygiene and disinfection programs in workplaces is essential to guarantee the workers safety and health. Further research is needed on the effectiveness of contingency plans in different sectors of activity, particularly, in industry.

COVID-19 symptoms are attenuated in atopic dermatitis patients treated with dupilumab Short running title: Reduced COVID-19 symptoms in dupilumab-treated AD (preprint)

Background: In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the Type 2/Th2 polarized skin disease, atopic dermatitis/AD. Since it is believed that Type 1/Th1immunity controls viral infections, and that there is a Th1/Th2 counter-regulation, we hypothesized that Th2 targeting with the IL-4Rα-antagonist, dupilumab, in patients with moderate-to-severe AD rebalances Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms. Methods: : 1,237 moderate-to-severe AD patients in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic[0]-fatal[5]). Scores were compared among 3 treatment groups: dupilumab (n=632), other systemic treatments (n=107), and limited/no treatment (n=498). Demographic and comorbid covariates were adjusted by multivariate logistic regression models. Results: : The dupilumab-treated group showed reduced incidence and severity of COVID-19 symptoms versus other treatment groups. Dupilumab-treated patients were less likely to experience moderate-to-severe symptoms versus patients on other systemics (p=0.01) and on limited/no treatment (p=0.04), and less likely to experience any symptoms versus patients on other systemics (p=0.01). This effect was seen in our entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure. Conclusions: : Patients on dupilumab experienced less severe COVID-19 manifestations and lesser symptoms compared to patients on other systemics and on limited/no treatment. These results suggest that Th2 modulation with dupilumab may have a protective effect on anti-viral immune response in AD patients.

Prevalence of physical and psychological impacts of wearing personal protective equipment (PPE) on health care workers during COVID-19; a systematic review and meta-analysis. (preprint)

Background: The COVID-19 pandemic has necessitated the use of personal protective equipment (PPE) among the frontline health care workers (HCWs). Although PPE offers a great deal of help in preventing infection, it poses significant physical and psychological impacts at varying levels. Correspondingly, multiple independent studies have brought out the PPE associated problems. However, there exists a lacuna on comprehensive information of global prevalence related to the same. Aims: To estimate the prevalence and risk factors of PPE among HCWs during COVID-19 across the globe. Design: Systematic review and Meta-analysis. Method: The review was undertaken as per the protocol registered in PROSPERO xxxxxx following PRISMA guidelines. Two independent reviewers have undertaken the search strategy, study selection and methodological quality assessment. Discrepancies were addressed by the third reviewer. Heterogeneity was addressed through I2 statistics and forest plots generated by open meta-software. Results: A total of 16 articles conducted across 6 different countries among 10,182 HCWs were included in the review. The pooled prevalence of skin lesions, headache, sweating, breathing difficulty, vision difficulty, thirst/dry mouth, fatigue and communication difficulty, anxiety, fear were 57(47-66%),51(37-64%),75(56-90%),44(23-68%),61(21-94%),54%(30-77%),67(58-76%),74%(47-94%),28(24-33%),14(10-17%) respectively. Moreover, the various risk factors included; the use of PPE greater than 6 Hrs. and young females. In addition, the medical management of new-onset problems created an additional burden on the frontline HCWs. Conclusion: The front-line HCWs encountered physical and psychological problems at varying levels as a result of wearing PPE which needs to be addressed to prevent the inadequate use of PPE leading to infections. Relevance to clinical practice: The review sheds light on the need to address the physical and psychological morbidity due to PPE use for ensuring the working morale and optimum health status of frontline HCWs to combat ongoing and future pandemics.

Occupational dermatoses in health care personnel using PPE during the COVID pandemic. (preprint)

Background: A sudden surge of occupation-associated dermatoses among the healthcare workers (HCWs) serving COVID-19 patients have been witnessed recently due to increased usage of PPE (PPE) kits and increased frequency of hygiene practices, with a significant impact on their quality of life and compromised efficacy at work. Hence, this study was conducted to measure the prevalence of occupational dermatoses among HCWs serving Covid-19 patients using PPE kits and hygiene practices and their impact on quality of life. Methods: HCWs of all cadres were screened for occupation-associated dermatoses. Cases with occupational dermatosis were evaluated further regarding the use of a PPE kit, and DLQI was calculated. Results: 19% of HCWs had dermatoses associated with PPE and hygiene practices. Hands were most affected, followed by the face, nasal bridge, and facial skin in contact with goggles. 48% had Mathias score >/= 4. Most cases had reported some impact on their quality of life. A significant association could be established between frequency of hand washing >/= 10 times/day with hand dermatitis (p=0.000). Conclusion: The use of PPE has significantly raised cases of occupational dermatosis among HCWs. Repeated hand washing and hand sanitizer use has increased the incidence of hand dermatitis.

Value of the Lymphocyte Transformation Test for the Diagnosis of Drug-Induced Hypersensitivity Reactions in Severe Hospitalized COVID-19 Patients (preprint)

In the first wave of COVID-19, up to 20% of patients had skin lesions with variable characteristics. There is no clear evidence of the involvement of the SARS-CoV-2 virus in all the cases; some of these lesions may be secondary to drug hypersensitivity. To analyze the possible cause of the skin lesions, we performed a complete allergology study on 11 patients. One year after recovery from COVID-19, we performed a lymphocyte transformation test (LTT) and Th1/Th2 cytokine secretion assays of PBMC. We included 5 nonallergic patients treated with the same drugs without lesions. Except for one patient who had an immediate reaction to azithromycin, all patients had a positive LTT to at least one of the drugs tested (azithromycin, clavulanic acid, hydroxychloroquine, lopinavir, and ritonavir). None of the nonallergic patients had a positive LTT. We found mixed Th1/Th2 cytokine secretion (IL-4, IL-5, IL-13, and IFN-γ) in patients with skin lesions corresponding to mixed drug hypersensitivity type IVa and IVb. In all cases, we identified a candidate drug as the culprit for skin lesions during SARS-CoV-2 infection, although only three patients had a positive drug challenge. Therefore, it would be reasonable to recommend avoiding the drug in question in all cases.

Change of dermatological practice after the COVID-19 outbreak resolves.

AIM: Dermatological care has already been deeply impacted by the coronavirus disease-2019 (COVID-19) epidemic. The consequences may continue long after the epidemic resolves. In this study, we aimed to evaluate the change of dermatological practice since the COVID-19 outbreak is almost controlled in mainland China. MATERIAL AND METHODS: Patients requesting a dermatology outpatient visit from January to May in 2019 and 2020 were retrospectively investigated. RESULTS: The number of patients decreased significantly shortly after the COVID-19 outbreak, and it started to increase after the spread of coronavirus was gradually controlled at the end of February in China. The three most common diseases were atopic dermatitis (11.0%), acne (10.2%), and warts (7.2%) in 2019, while acne (8.9%), warts (5.8%), and acute urticaria (5.6%) in 2020. The most statistically significant increased reasons for requesting an outpatient visit from March to May in 2020 was pet-related dermatophytoses, followed by cosmetic consultation and irritated contact dermatitis, an increase of 88.2%, 84.7%, and 58.8%, respectively, over the same period of 2019. CONCLUSION: Understanding the trends and impacts of dermatologic diseases on patients and health systems during this epidemic will allow for better preparation of dermatologists in the future.

Skin Diseases Associated With COVID-19: A Narrative Review.

COVID-19 is an infectious disease caused by SARS-CoV-2, which emerged in China in 2019 and rapidly spread worldwide to become a pandemic in March 2020. Although the most severe manifestations concern the lower respiratory tract, COVID-19 is a multiorgan disease that also affects the skin. Several types of skin lesions have been reported to be associated with SARS-CoV-2 infection, though their causal relationship with the virus has not yet been well documented. In addition to the cutaneous manifestations that develop in patients with COVID-19-thought to be caused by the virus-other findings associated with the pandemic in a broader sense include dermatoses triggered or aggravated by the infection, the adverse cutaneous effects due to the drugs and protective devices used to prevent or fight the infection, and the adverse cutaneous effects of COVID-19 vaccines. We provide an overview of these dermatoses associated with the COVID-19 pandemic.

Age-dependent NK cell dysfunctions in severe COVID-19 patients.

Natural Killer (NK) cells are key innate effectors of antiviral immune response, and their activity changes in ageing and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we investigated the age-related changes of NK cell phenotype and function during SARS-CoV-2 infection, by comparing adult and elderly patients both requiring mechanical ventilation. Adult patients had a reduced number of total NK cells, while elderly showed a peculiar skewing of NK cell subsets towards the CD56lowCD16high and CD56neg phenotypes, expressing activation markers and check-point inhibitory receptors. Although NK cell degranulation ability is significantly compromised in both cohorts, IFN-γ production is impaired only in adult patients in a TGF-ß-dependent manner. This inhibitory effect was associated with a shorter hospitalization time of adult patients suggesting a role for TGF-ß in preventing an excessive NK cell activation and systemic inflammation. Our data highlight an age-dependent role of NK cells in shaping SARS-CoV-2 infection toward a pathophysiological evolution.

Cutaneous Manifestation in COVID-19: A Lesson Over 2 Years Into the Pandemic.

Cutaneous manifestations related to Coronavirus Disease-19 (COVID-19) have been reported over 2 years since the pandemic began. This research aimed to review articles published in English that describe cutaneous manifestations related to COVID-19/SARS-CoV-2. A data search for case reports, original studies, and review articles from the onset of the current COVID-19 pandemic to December 31, 2022, was performed using PUBMED, Cochrane Library, ResearchGate, and Google search engines. Keywords were "coronavirus", "novel coronavirus 2019", "COVID-19", "SARS-CoV-2", and "2019-nCoV" in combination with "cutaneous", "skin" and "dermatology" The extracted data included authors, region, sex, age, number of participants with skin signs, cutaneous signs, its location, symptoms, extracutaneous/associated symptoms, suspected or confirmed status for COVID-19, timeline, and healing duration. Six authors independently reviewed the abstracts and full-texts to identify publications providing these details concerning cutaneous manifestations related to COVID-19. A total of 139 publications with full text (122 case reports, 10 case series, and 7 review articles) that reported cutaneous manifestations were identified, and reviewed from 5 continents. The most common cutaneous manifestations of COVID-19 were maculopapular, followed by chilblain-like lesion, urticarial, livedoid/necrotic, vesicular, and other/non-descript rashes/skin lesions. After 2 years into the COVID-19 pandemic, we can conclude that there is no pathognomonic cutaneous manifestation of COVID-19, since it can be also found in other viral infections.

Prevention of skin lesions caused by the use of protective face masks by an innovative gelatin-based hydrogel patch: Design and in vitro studies.

The recent Covid-19 pandemics led to the increased use of facial masks, which can cause skin lesions due to continuous pressure, tension and friction forces on the skin. A preventive approach is the inclusion of dressings between the face and the mask. However, there are still uncertainties about the protective effect of dressings and whether their use compromises the efficiency of masks. The current study aimed to develop and test the efficacy of a gelatin-based hydrogel patch to be placed between the mask and the facial area. Design of Experiment with a Quality by Design approach tools were used in the patch development and in vitro characterization was performed through rheological evaluation, ATR-FTIR and molecular docking studies. Furthermore, tribology studies were performed to test the patch performance. The results showed that the addition of excipients enhanced gelation temperature, elasticity and adhesiveness parameters. The interactions between excipients were confirmed by ATR-FTIR and molecular docking. The tribology assay revealed similar friction values at room and physiological temperature, and when testing different skin types. In conclusion, the physical properties and the performance evaluation reported in this study indicate that this innovative film-forming system can be used to prevent skin lesions caused by the continuous use of protective masks.

Prevalence of phalangeal bone marrow edema on MRI before and during the COVID-19 pandemic and correlation with chilblain skin lesions.

OBJECTIVE: The purpose of this study is to establish the prevalence bone marrow edema of the phalanges of the feet and hands before and during the COVID-19 pandemic on MRI studies and correlate with clinically chilblain skin lesions and epidemiological data. METHODS: This observational retrospective study. In patients with confirmed bone marrow edema of the phalanges, epidemiological data and clinical findings were collected, including the history of current or remote COVID-19 infection and vaccination status. The two-proportion test was used to compare the frequency of bone marrow edema in the phalanges before and during the pandemic, and the comparison between the categories variables was performed using the one-proportion test. RESULTS: Of the total of 7215 patients, only 20 presented isolated bone marrow edema of the digits in MRI studies; 2 (0.05%) were found two years before the pandemic's beginning, and 18 (0.64%) after the pandemic's onset, demonstrating an increase of 13-fold in this period. 16 were women with a mean age of 40.3 years and 4 were men with a mean age of 53.5 years. The most frequently reported clinical symptoms by the patients were pain (85.0%), and erythema of the skin (45.0%). Of the 18 patients found after the pandemic's onset, only 27.8% had COVID-19 infections confirmed by RT-PCR before the imaging study, and all cases were mild. CONCLUSION: This study demonstrated a significant increase in the prevalence of bone marrow edema of the phalanges after the onset of the COVID-19 pandemic, particularly in middle-aged and younger women.

Monkeypox detection from skin lesion images using an amalgamation of CNN models aided with Beta function-based normalization scheme.

We have recently been witnessing that our society is starting to heal from the impacts of COVID-19. The economic, social and cultural impacts of a pandemic cannot be ignored and we should be properly equipped to deal with similar situations in future. Recently, Monkeypox has been concerning the international health community with its lethal impacts for a probable pandemic. In such situations, having appropriate protocols and methodologies to deal with the outbreak efficiently is of paramount interest to the world. Early diagnosis and treatment stand as the only viable option to tackle such problems. To this end, in this paper, we propose an ensemble learning-based framework to detect the presence of the Monkeypox virus from skin lesion images. We first consider three pre-trained base learners, namely Inception V3, Xception and DenseNet169 to fine-tune on a target Monkeypox dataset. Further, we extract probabilities from these deep models to feed into the ensemble framework. To combine the outcomes, we propose a Beta function-based normalization scheme of probabilities to learn an efficient aggregation of complementary information obtained from the base learners followed by the sum rule-based ensemble. The framework is extensively evaluated on a publicly available Monkeypox skin lesion dataset using a five-fold cross-validation setup to evaluate its effectiveness. The model achieves an average of 93.39%, 88.91%, 96.78% and 92.35% accuracy, precision, recall and F1 scores, respectively. The supporting source codes are presented in https://github.com/BihanBanerjee/MonkeyPox.

Presentation and Management of Cutaneous Manifestations of COVID-19.

INTRODUCTION: The spread of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has instigated a fervent race of the medical community to identify its manifestations, the patients at risk, and optimal disease management. While the COVID-19 illness is largely associated with respiratory consequences, there is increased reporting of other organ-specific disease sequelae that include the skin. OBJECTIVE: To identify, describe, and classify the main skin manifestations of COVID-19 and associated protocols for management. METHODS: Forty-five patients from three clinical centers in North and South America with positive COVID-19 PCR and/or serology presenting cutaneous manifestations were included in this retrospective chart review. Medical history, biopsies, dermoscopy, laboratory findings, clinical photography, and disease management were documented. RESULTS: Seven main types of cutaneous manifestations were identified: exanthema/molbilliform, urticaria, papular/pustular/vesicular, petechiae/purpura, livedo reticularis, chilblains, and alopecia. Histopathogical analysis from skin biopsies and/or dermoscopy highlighted an inflammatory or vascular pathophysiology depending on the type of manifestation. While the first three types of COVID-19 skin manifestations preceded or coincided with other symptoms such as anosmia, fever, chills, chilblains, and livedo were found in later disease stages. All cases had a positive resolution with appropriate treatment. CONCLUSIONS: Cutaneous symptoms are part of the COVID-19 disease spectrum. Early identification, diagnosis, and management through a multidisciplinary approach can facilitate safe disease resolution for patients. J Drugs Dermatol. 2021;20(1):76-83. doi:10.36849/JDD5676.

Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020. / Lesiones cutáneas asociadas con el uso de respiradores N95 en profesionales de la salud de Brasil durante 2020.

OBJECTIVE: to investigate the prevalence of skin lesions and factors associated with the use of N95 respirators among health professionals in Brazil. METHOD: cross-sectional study conducted with 11,368 health professionals using a respondent-driven sampling method adapted for online environments. Univariate and multivariate analyses were performed to investigate the association between the "skin lesions with the use of N95 respirators" variable and gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and high-quality Personal Protective Equipment. RESULTS: the prevalence of skin lesions was 61.8%. Women were 1.203 times (95% CI: 1.154-1.255) more likely to develop a lesion than men. The chances of skin lesions in psychologists (PR=0.805; 95% CI: 0.678-0.956) and dentists (PR=0.884; 95% CI: 0.788-0.992), were lower when compared to Nursing professionals. Professionals with a positive COVID-19 diagnosis and working in the Intensive Care Unit have an increased chance of presenting skin lesions (PR=1.074; 95% CI: 1.042-1.107); (PR=1.203; 95% CI: 1.168-1.241), respectively. CONCLUSION: the prevalence of skin lesions caused by the use of N95 respirators was 61.8% and was associated with female gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and highquality Personal Protective Equipment. (1) The overall prevalence of skin lesions was 61.8%. (2) The most affected professional category was Nursing. (3) Women were more likely to develop skin lesions than men.