Psoriasis Flares in Patients With COVID-19 Infection or Vaccination: A Case Series.

Much of the literature involving COVID-19 and chronic inflammatory dermatological conditions have focused on the safety of immunomodulatory therapy in the setting of this highly infectious virus. While general mortality associated with the infection and vaccine has been studied in depth, the effects of the virus and vaccine on inflammatory skin disease states have not been. It is well known that psoriasis can be triggered by stress, infection, certain medications, and, although not as common, vaccinations. Further, existing literature has briefly commented on psoriasis flares after COVID vaccination, but these have not touched on flares among their patients' current therapy, nor flares after COVID infection. In this case report, we report five cases observed at our institution over the last year of either new-onset psoriasis or flares of previously well-controlled psoriasis shortly after infection with COVID-19 or COVID-19 vaccination, with no other identifiable triggers. These cases can serve to raise awareness of issues related to managing stubborn psoriatic flares and bring to the forefront conversations that are likely to arise with our patients regarding the risks and benefits of COVID vaccination and boosters. While the definitive etiology of the association between COVID and psoriasis remains unclear, it is important that the dermatologic community be aware when evaluating patients with new-onset or worsening psoriasis as we move forward in times of this COVID-19 era.

Skin disease in HIV-positive persons living in Puerto Rico.

OBJECTIVES: To determine the frequency of skin disease in persons infected with the human immunodeficiency virus (HIV), to validate the agreement of self-reported skin condition(s) versus objective data obtained by physical examination, and to describe the characteristics of HIV-positive persons with skin disease in Puerto Rico. DESIGN: Descriptive correlational design. SETTING AND PARTICIPANTS: Ninety-five HIV-positive adults in San Juan, Puerto Rico. Ninety-five adults who were HIV-positive participated. RESULTS: Ninety (94.7%) participants had skin disease and/or signs or symptoms suggestive of disease. Diseases most often reported were onychomycosis (n=16; 17.8%) and nongenital warts (n=11; 12.2%). Signs and symptoms reported were dryness (n=59; 65.6%), itch (n=58; 64.4%), erythema (n=30; 33.3%), induration (n=13; 14.4%), postinflammatory hyperpigmentation (n=9; 10.0%), and excoriation (n=9; 10.0%). Kappa index confirmed the relationship between self-reported skin condition or signs and symptoms and the diagnosis of a skin disease by the physician (k=.42). Positive predictive value was 97.7% (95% confidence interval [CI], 94.7%-100%). Condyloma acuminata was associated with male gender (chi2=4.09, P=.043). Tinea pedis (P=.0215), excoriations (P=.002), and prurigo nodularis (P=.0096) were associated with having a low CD4 cell count. CONCLUSIONS: This study shows that persons infected with HIV can identify significant skin manifestations that are associated with the diagnosis of a skin disease. This validates the use of self-reporting of skin conditions in these patients and points to the importance of educating patients and providers to report patient skin problems. Although the high prevalence of skin disease found in this study population supports a need for improving dermatologic care in HIV-infected patients, the findings of such prevalent cutaneous disease can also provide caretakers with ample evidence to suspect and, therefore, test for HIV infection.

Postsurgical use of imiquimod 5% cream in the prevention of earlobe keloid recurrences: results of an open-label, pilot study.

BACKGROUND: Traditional surgical modalities for the management of earlobe keloids are often associated with high recurrence rates. A recent report suggests that imiquimod 5% cream can be effective in the prevention of keloid recurrences after surgical excision. OBJECTIVES: To establish the safety and efficacy of imiquimod 5% cream in the prevention of recurrences of excised earlobe keloids. METHODS: Patients who attended a dermatologic surgery clinic for the treatment of earlobe keloids were recruited into the study. Earlobe keloids underwent parallel shave excision. Imiquimod 5% cream was applied daily for 8 weeks followed by an observation period of 16 weeks. In patients who presented with bilateral earlobe keloids, paired comparisons of imiquimod versus intralesional steroid injections were performed. RESULTS: Eight earlobes were treated with imiquimod 5% cream after parallel keloid removal. Twenty-four weeks after surgery, six (75%) remained recurrence free. Four patients underwent bilateral paired comparisons. At the end of the observation period, two patients (50%) remained recurrence free in the imiquimod-treated areas while experiencing recurrences in the intralesional steroid-treated areas. Local irritation secondary to imiquimod application required rest periods in three cases. In all cases, patients were able to resume therapy and completed the study without further complications. CONCLUSION: Although small and uncontrolled, the results of this open-label, pilot study suggest that imiquimod 5% cream may prove to be a reasonably effective adjuvant therapeutic alternative for the prevention of recurrences in excised earlobe keloids.