ABSTRACT
Objective: Coronavirus disease 2019 (COVID-19) vaccine distribution continues to expand; however, increased cutaneous reactions have been reported. Several recent studies suggest a link between COVID-19 vaccination and the development of various cutaneous complications. Lichen planus is a chronic, immune-mediated, inflammatory dermatological illness with an unclear etiology. In this case report, we assessed the relationship between COVID-19 vaccination (Pfizer) and lichen planus diagnosis and evaluated the link between additional doses of the vaccine and disease progression. Methods: Complete clinical, laboratory, and histopathological assessment of a patient was performed with ethical and privacy considerations. Written informed consent for all clinical data, images, and publication was obtained from the patient. Results: New-onset lichen planus appeared 48 hours after the first dose of the Pfizer vaccine. The symptoms worsened following the second dose. The patient responded gradually to topical corticosteroids, and lichen planus was controlled within 21 days. Conclusion: Our case significantly contributes to the literature by highlighting that additional doses of the Pfizer vaccine can contribute to disease progression. Therefore, reporting the patient's condition associated with COVID-19 vaccination should be considered. Future studies should be performed to investigate the combined onset of lichen planus and multisystem COVID-19 vaccine-related complications.
ABSTRACT
BACKGROUND: Even after achieving tremendous advances in diagnosis and treatment of rheumatoid arthritis (RA), many of the patients undergo delays in diagnosis and initiation of treatment, which leads to worsening of the condition and poor prognosis. OBJECTIVE: The objective of this study was to perform a literature review to quantify the lag times in diagnosis and treatment of RA and study the reported factors associated with it. METHODS: The authors searched literature published until September 2016 in electronic full-text and abstract databases and hand-searched the suitable articles. RESULTS: The weighted average of median lag time from symptom onset to therapy was 11.79 months (12 studies, 5,512 patients, range 3.6-24.0 months). Lag1 was 3.14 months (onset of symptoms to first physician consultant; 12 studies, 6,055 patients, range 0-5.7 months); lag2 was 2.13 months (physician visit to RA specialist referral; 13 studies, 34,767 patients, range 0.5-6.6 months); lag3 was 2.91 months (consultation with rheumatologist to diagnosis; 3 studies, 563 patients, range 0-5 months), lag4 was 2.14 months (diagnosis to initiation of disease-modifying antirheumatic drug therapy; 5 studies, 30,685 patients, range 0-2.2 months). Numerous patient-and physician-related factors like gender, ethnicity, primary care physician knowledge of the condition, availability of diagnostics, and so on were responsible for the delays. CONCLUSION: This review estimated the delay times and identified the main factors for delay in RA patients in diagnosis and initiation of treatment. A most plausible solution to this is coordinated effort by the rheumatology and primary care physicians.
