Facial topical cream promotes facemask tolerability and compliance during COVID-19 pandemic.

Objectives: Facemask use is essential for managing the COVID-19 pandemic, but may cause facial dermopathy. Topical creams may minimise facemask complications. This clinical study explores the impact of different topical creams on facemask tolerability and complications. Methods: This was a prospective observational study involving 80 adults. Participants voluntarily chose and used topical creams during facemask use. Data were collected using validated scales before and after topical cream application. Results: About 23.8% of the participants used lidocaine gel, 17.5% used petrolatum, 16.2% used hydrocortisone cream, 16.2% used diphenhydramine cream, 13.8% used arnica cream, and 12.5% used zinc oxide cream. Duration of facemask use was 6 h amongst staff and 4 h amongst patients, and was similar both with and without topical cream. Facial temperature rise was lower with all creams (p = 0.033), as was facial redness (p = 0.037) and facial pain (p = 0.025). Facemask compliance was better for all creams (p = 0.015). The facial temperature rise was the lowest with topical lidocaine (p = 0.021). Early facial redness was lowest with topical hydrocortisone or diphenhydramine (p = 0.042). Severe redness was lowest with topical hydrocortisone or zinc oxide (p = 0.044). Facemask pain was lowest with topical lidocaine (p = 0.035), and facemask compliance was best with topical lidocaine (p = 0.001). Petrolatum had the best user satisfaction and odour ratings (p = 0.041). Conclusion: Topical creams minimise facemask complications, thereby promoting compliance; topical lidocaine was the most effective in reducing pain and enabling facemask compliance. Topical hydrocortisone, diphenhydramine, and zinc oxide were effective in reducing facial redness, and topical petrolatum produced the best user satisfaction.

Delayed surgical diagnosis and treatment of severe sickle cell arthropathy: The need to raise clinicians' awareness.

OBJECTIVES: Sickle cell disease (SCD) is associated with femoral head osteonecrosis and is treated with hip arthroplasty 18 weeks after presentation. However, there is inadequate data regarding the timing of surgical management of severe hip arthropathy. This study explores the problem of delayed diagnosis and surgical management of severe SCD hip arthropathy by comparing the clinical outcomes of patients from Nigeria, Canada and Britain. METHODS: This is a prospective clinical audit of the routine care of 30 adult SCD patients who underwent hip arthroplasty for femoral head osteonecrosis. The clinical data are collected from five medical centers in Britain, Canada and Nigeria and compared. RESULTS: Hip arthroplasty was delayed beyond 18 weeks in 3 of 14 Nigerian patients (21%), 7 of 10 British patients (70%) and all 6 Canadian patients (100%). The majority of Nigerian patients (79%) and only 30% of British patients had diagnostic imaging and surgical management without delay. CONCLUSION: Inadequate physician awareness and delayed surgical management of SCD hip arthropathy can be mitigated by improving the education of physicians who manage patients with SCD. It is essential to recruit, train and support physicians with an interest in SCD. As this primarily affects young patients, it is necessary to set an international standard for the timing of surgical management of SCD hip arthropathy.