Sina Shahabi; Ifa Etesami; Amirhossein Shahabi; Yasamin Kalantari; Robabeh Abedini; Maryam Daneshpazhooh
Abstract
Background: With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, many people were affected worldwide.This study evaluated patients’ characteristics and skin diseases at a Dermatology Emergency Unit (DEU) of a university skin hospital in Tehran, Iran, during the COVID-19 pandemic. ...
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Background: With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, many people were affected worldwide.This study evaluated patients’ characteristics and skin diseases at a Dermatology Emergency Unit (DEU) of a university skin hospital in Tehran, Iran, during the COVID-19 pandemic. We also compared the results with those of a previous study performed at the same DEU in 2017.Methods: The data of all patients presented to the DEU during the first four months of the pandemic in Iran (February to June 2020) were studied, and variables such as age, sex, complaints, and finaldiagnosis were collected.Results: A total of 3,745 patients (50.3% male) were studied. Infections (32.4%), dermatitis (20.5%), and urticaria (16.8%) were the most prevalent diagnoses in both genders. Infections were significantly more frequent in males (P < 0.001), while urticaria was more common in females (P < 0.001). The highest number of visits occurred between 12:00–18:00 (34.0%) and most patients were between 18–44 years old (48.8%).Conclusion: With the growing number of COVID-19 cases, the DEU of our skin hospital was involved as part of the medical community in screening COVID-19 patients. Compared to the previous study, the general framework of common causes of DEU visits was very similar to that of the non-pandemic era, although a significant increase in the proportion of dermatitis cases was observed. Likewise, the proportion of non-skin complaints was significantly higher, reflecting the public concern about the COVID-19 pandemic.
Fahimeh Abdollahimajd; Reem Diab; Hamideh Moravvej; Ayda Bahmanjahromi; Sahar Dadkhahfar; Azadeh Goodarzi; Afsaneh Sadeghzadeh Bazargan; Sayyed Mojtaba Nekooghadam; Mohammad Nikvar; Mohammad Shahidi Dadras
Abstract
Background: Cutaneous manifestations of coronavirus disease 2019 (COVID-19) are not uncommon and can be the presenting sign of the disease. We aimed to investigate the cutaneous manifestations in COVID-19 patients.Methods: This cross-sectional study was performed on COVID-19 patients referred to Shohada-e ...
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Background: Cutaneous manifestations of coronavirus disease 2019 (COVID-19) are not uncommon and can be the presenting sign of the disease. We aimed to investigate the cutaneous manifestations in COVID-19 patients.Methods: This cross-sectional study was performed on COVID-19 patients referred to Shohada-e Tajrish and Modarres hospitals, Tehran, Iran, from January 1, 2021 to March 31, 2021. Patients with cutaneous lesions were included in the study; if needed, patients were visited in person, and a biopsy was taken.Results: Of the 100 COVID-19 patients in this study, with a mean age of 45.53 ± 17.75 years, 37 (37%) were males. The most common cutaneous manifestation was urticaria (21%), followed by maculopapular eruptions (17%), petechiae/purpura (15%), pityriasis rosea-like lesions (15%), erythema multiforme (7%), pernio (6%), Vesicles/pseudovesicles/bullae (5%), and others (24%). Most lesions were erythematosus (87.63%). Legs (40%) were most frequently involved. The most common accompanying symptom was pruritus (52%), followed by burning sensations (18%) and pain (7%). Six patients had mucosal lesions; these lesions were the only mucocutaneous manifestations in three of them. Skin biopsies were taken from 11 patients, revealing epidermal changesin 10 (90.9%), dermal changes in 7 (63.6%), mucin deposition in 1 (9.1%), perivascular lymphocyte infiltration in 10 (90.9%), and neutrophil infiltration in 1 (9.1%).Conclusion: The frequency of skin manifestations was relatively high in this study, with urticaria as the most common cutaneous presentation of COVID-19. Special attention must be paid to the cutaneous lesions of COVID-19.
Beatrice Raone; Filippo Viviani; Marco Fusconi; Luigi Muratori
Abstract
We report a case of clinically amyopathic dermatomyositis (CADM) with anti-MDA5 positivity associated with rapidly progressive interstitial lung disease. The analogies between CADM-associated interstitial lung disease and coronavirus disease 2019 (COVID-19) pneumonia may hinder the diagnosis and delay ...
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We report a case of clinically amyopathic dermatomyositis (CADM) with anti-MDA5 positivity associated with rapidly progressive interstitial lung disease. The analogies between CADM-associated interstitial lung disease and coronavirus disease 2019 (COVID-19) pneumonia may hinder the diagnosis and delay the start of immunosuppressive therapy. High-resolution computed tomography revealed an evident worsening of the bilateral consolidation, interlobular septal thickening, and ground-glass opacities, highlighting the diagnosis of rapidly progressive interstitial lung disease. The radiological presentation, combined with the laboratory findings, underscored the diagnosis of CADM. In the following days, the respiratory failure progressed, and the patient required extracorporeal membrane oxygenation and lung transplantation. The typical cutaneous rash of dermatomyositis and non-pulmonary clinical differences can help the physician reach a correct diagnosis. Assessing patients with interstitial lung diseases during the COVID-19 pandemic is difficult. Through experience with systemic autoimmune diseases such as clinically amyopathic dermatomyositis, we can develop new pathophysiology models and therapeutic strategies for COVID-19.
Farbod Amiri; Laya Ohadi; Shaghayegh Shahrigharahkoshan; Sahar Dadkhahfar; RM Robati
Abstract
Since December 2019, coronavirus disease 2019 (COVID-19) has been considered a major health issue. Even in the initial days of the pandemic, dermatologists faced several challenges in preventing, diagnosing, and treating COVID-19. Like other physicians, dermatologists encountered several ethical issues. ...
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Since December 2019, coronavirus disease 2019 (COVID-19) has been considered a major health issue. Even in the initial days of the pandemic, dermatologists faced several challenges in preventing, diagnosing, and treating COVID-19. Like other physicians, dermatologists encountered several ethical issues. Dermatologists have served a significant role as front liners, focusing on the cutaneous manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The COVID-19 pandemic affected medical practice significantly. Due to the health emergencies caused by SARS-CoV-2, medical students’ education, patients’ prioritization, care, and cosmetic procedures were affected. Additionally, new strategies were devised to reduce the risk of transmission. This review article examines the effects of the COVID-19 pandemic on dermatology practice. We reviewed 33 articles following a search of the PubMed and Google Scholar databases for articles studying how COVID-19 affected dermatology practice.
Zeinab Aryanian; Azar Shirzadian; Faezeh Bakhshinasab; Soheil Ebrahim Pour; Arefeh Babazadeh; Zeinab Mohseni Afshar; Azadeh Goodarzi; Zahra Nikyar; Parvaneh Hatami
Abstract
Background: During the recent coronavirus disease 2019 (COVID-19) pandemic, we witnessed an increased incidence of contact dermatitis in the hands and other body areas of healthcare workers secondary to using antiseptics and personal protective equipment. This study aimed to investigate the prevalence ...
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Background: During the recent coronavirus disease 2019 (COVID-19) pandemic, we witnessed an increased incidence of contact dermatitis in the hands and other body areas of healthcare workers secondary to using antiseptics and personal protective equipment. This study aimed to investigate the prevalence of skin lesions in healthcare workers in hospitals affiliated with Babol University of Medical Sciences during the COVID-19 pandemic.Methods: In a cross-sectional study, the healthcare workers of Ayatollah Rouhani, Shahid Yahya Nejad, and Shahid Beheshti hospitals in Babol, Iran, were asked to fill out information collection forms about cutaneous lesions during the COVID-19 pandemic.Results: Three hundred healthcare workers were included in the study. Skin lesions were seen in 240 patients (80%), and the hands were the most common site of involvement (36.7%). Skin lesions in healthcare workers had no statistically significant relationship with the variables of age (P = 0.84), sex (P = 0.52), and COVID-19-dedicated wards (P = 0.16). However, skin lesions were more common in those with more working hours (P = 0.01) and increased handwashing frequency (P < 0.001).Conclusion: The present study showed a high prevalence of skin lesions among hospital healthcare workers during the COVID-19 pandemic. Therefore, preventive measures are recommended.
Zahra Akbari; Mohammad Shafie'ei; Nastaran Sarvipour; Mohadese Ahmadzade; Hamidreza Rouientan; Saeedeh Farajzadeh; Najmeh Ahramiyanpour
Abstract
Background: Among many coronavirus disease 2019 (COVID-19)integumentary system involvements, alopecia is one of the leastinvestigated. This disorder has been reported in many individualswho have suffered from varying severities of COVID-19. Weaimed to systematically review studies evaluating the onset ...
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Background: Among many coronavirus disease 2019 (COVID-19)integumentary system involvements, alopecia is one of the leastinvestigated. This disorder has been reported in many individualswho have suffered from varying severities of COVID-19. Weaimed to systematically review studies evaluating the onset ofdifferent types of alopecia following COVID-19.Methods: The PubMed, Scopus, Web of Science, and Embasedatabases were searched with a specified string of relevantkeywords. After quality assessments, the data of eligible studieswere qualitatively and quantitatively synthesized.Results: Sixteen studies were included in our review, six ofwhich underwent meta-analysis for the differences in the risk ofalopecia between males and females. Though the disorder wasnot differentiated in all the cases, we found that COVID-19 wasassociated with several different types of alopecia, includingtelogen effluvium, alopecia areata, alopecia parvimaculata, andlichen planopilaris. Moreover, although statistically insignificant,the odds of developing alopecia favored the female population.Conclusion: Although many hypotheses have been suggested asto why an individual might be more predisposed to developingalopecia following COVID-19, the data obtained from the studiesyielded results that could not lead to definite conclusions. Therefore,we recommend that further studies be conducted to evaluatethe association between the two phenomena more confidently.
Farnoosh Seirafianpour; Farzaneh Mashayekhi; Milad Dodangeh; Forough Seifi Gharabaghloo; Masoud Pourghahramani Koltapeh; Ali Jamshidi Naeini; Rohollah Valizadeh; Davood Lakestani; Samaneh Mozafarpoor; Azadeh Goodarzi
Abstract
Background: About 20% of patients with coronavirus disease2019 (COVID-19) present with mucocutaneous eruptions. Earlyskin or dermatological manifestations can help pediatriciansprevent the spread of the disease by suspecting COVID-19 inasymptomatic or minimally symptomatic patients.Methods: PubMed, Scopus, ...
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Background: About 20% of patients with coronavirus disease2019 (COVID-19) present with mucocutaneous eruptions. Earlyskin or dermatological manifestations can help pediatriciansprevent the spread of the disease by suspecting COVID-19 inasymptomatic or minimally symptomatic patients.Methods: PubMed, Scopus, Embase, Google Scholar, and theNottingham University website were searched on Sep. 1st, 2020,to retrieve studies regarding COVID-19-related mucocutaneousmanifestations in patients under the age of 18.Results: Data were extracted from 76 articles including 38,387 cases.Chilblain/pernio-like lesions were the most common dermatologicalmanifestation, followed by multisystem inflammatory syndrome inchildren (MIS-C)/Kawasaki-like syndrome. Most dermatologicalsigns were self-limited, presenting before, simultaneously with,or after other COVID-19 manifestations. In 40% of the affectedchildren, these signs were the sole presentation of COVID-19.Conclusion: During the COVID-19 pandemic, each newmucocutaneous event in children, especially acral lesions withvascular color, should be considered a possible indicator ofCOVID-19.
Mohammad Shahidi-Dadras; Farnaz Araghi; Fahimeh Abdollahimajd; Mehdi Gheisari; Ali Forghanian; Sahar Dadkhahfar
Abstract
During the current coronavirus disease 2019 (COVID-19) pandemic, patients with malignancies like primary cutaneouslymphomas (PCLs) are considered at high risk for severe disease progression given their underlying condition. Mycosis fungoides (MF) is a type of PCL that often needs lifelong treatments, ...
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During the current coronavirus disease 2019 (COVID-19) pandemic, patients with malignancies like primary cutaneouslymphomas (PCLs) are considered at high risk for severe disease progression given their underlying condition. Mycosis fungoides (MF) is a type of PCL that often needs lifelong treatments, including immunosuppressive drugs that predispose patients to catastrophic COVID-19 outcomes. Accordingly, several issues are to be addressed in the management of patients with MF. First of all, patients with this chronic condition may lose access to healthcare services such as phototherapy and inpatient treatments like electron beam therapy. Secondly, the patients’ anxiety of becoming infected while referring for the follow-up visits might impair their adherence to treatments. Finally, the current situation may affect the management strategies of dermatologists adopted for MF patients.We decided to perform this teledermatology study to assess the clinical condition of patients with MF in our referral center. We also evaluated patients’ perceived anxiety during the COVID-19 pandemic based on the Corona Disease Anxiety Scale (CDAS). Our results demonstrated that lockdown could influence adherence to treatment modalities (especially phototherapy) in these patients.
Mohammad Reza Pourani; Fahimeh Abdollahimajd
Abstract
Hand hygiene is one of the most crucial measures against coronavirus disease 2019 (COVID-19) transmission; however, frequent handwashing may lead to contact dermatitis causing many problems. Occupational hand dermatitis is a relatively common but challenging issue that imposes a negative effect on the ...
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Hand hygiene is one of the most crucial measures against coronavirus disease 2019 (COVID-19) transmission; however, frequent handwashing may lead to contact dermatitis causing many problems. Occupational hand dermatitis is a relatively common but challenging issue that imposes a negative effect on the quality of life, work performance, and adherence to hygiene principles. We performed a cross-sectional study to assess the psychosocial impacts of hand dermatitis on healthcare workers (HCWs) using an online Persian version of the Nordic Occupational Skin Questionnaire (NOSQ-2002). Sixty-three from a total of 390 HCWs (21%) reported that hand eczema had adverse effects on their occupation, such as a necessity to use gloves (17.3%) and decreased adherence to hand hygiene (14%). HCWs reported a higher exacerbation of hand dermatitis in winter (40.3%) and fall (24.7%). Hand dermatitis exerted a significant impact on sporting activities, sleep, social life, mood, and sex in 17.7%, 43.3%, 44.3%, 66%, and 11.7% of HCWs, respectively. It seems that hand dermatitis-related impairment of the mentioned activities has increased in HCWs during the COVID-19 pandemic.
Afsaneh Sadeghzadeh-Bazargan; Elham Behrangi; Azadeh Goodarzi
Abstract
Nowadays, the coronavirus disease 2019 (COVID-19) pandemic has become a global health problem and, given the high mortality and transmission rate of this infection and the lack of approved or specific treatments for it so far, the exploitation of the potentials of existing drugs is of paramount importance, ...
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Nowadays, the coronavirus disease 2019 (COVID-19) pandemic has become a global health problem and, given the high mortality and transmission rate of this infection and the lack of approved or specific treatments for it so far, the exploitation of the potentials of existing drugs is of paramount importance, hence, we aimed to investigate all possible COVID-19-related mechanisms of systemic retinoids. We systematically searched all related evidence in various data bases about the effect of retinoic acids on respiratory failure as the most important COVID-19-related complication and the other important potentials of this drug to affect COVID pathomechanism. Considering the various behaviors and presentations of this virus in different people, paying attention to the underlying diseases, physical conditions, genetics, and medications that cause these differences may be helpful in reducing the mortality and morbidity of the disease. In the field of dermatology, retinoids are a group of drugs that have controversial evidence regarding their effects when administered to patients with COVID-19. On one hand, these drugs offer immunomodulatory, immuneenhancing, antiviral, and antiangiogenesis activity, and can stimulate the differentiation and repair of epithelial cells. On the other hand, they can increase inflammation and cause the fragility of oral and nasal mucosae. When prescribe systemic retinoids, all of these aspects should be considered in all fields of the medicine and dermatology is not an exception.
Afsaneh Sadeghzadeh-Bazargan; Elham Behrangi; Azadeh Goodarzi
Abstract
The coronavirus disease 2019 (COVID-19) is currently the most important global health problem. Due to its pandemic state and high mortality rate, it is critical to find useful interventions that reduce the mortality rate and boost patient survival. Since there is no specific antiviral treatment for the ...
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The coronavirus disease 2019 (COVID-19) is currently the most important global health problem. Due to its pandemic state and high mortality rate, it is critical to find useful interventions that reduce the mortality rate and boost patient survival. Since there is no specific antiviral treatment for the disease and given the growing amount of data about the role of the inflammatory response and cytokine storm in increased disease severity, we evaluated the mechanisms and possible positive effects of some specific anti-inflammatory drugs on the disease course of COVID-19 and examined some suggested treatments in the form of a scoping review article. It is important to select patients who may benefit from these treatments without inflicting any serious adverse effects. In our view, in approaching COVID-19 patients, we should consider the severity of the body’s inflammatory response. Mild cases may not require additional anti-inflammatory treatment or at least should be treated with safer immunoregulatory drugs such as chloroquines, whereas in severe cases with an overactive immune response evidenced by high serum inflammatory marker levels (TNF, ESR, CRP, WBC count, LDH, ferritin) and severe lung involvement in chest images, stronger immunoregulatory drugs (targeted immunotherapy) such as TNF and kinase inhibitors may be considered as adjunctive treatments in combination with antiviral drugs. However, further precisely designed studies are needed to confirm the therapeutic effect and safety of each of these anti-inflammatory drugs in COVID-19 patients and to determine their optimal dose, route of administration, and possible side effects.
Kuntal Das
Abstract
The daily work plan of the human has changed dramatically due to the spread of the coronavirus disease 2019 (COVID-19) pandemic. The viral infection was first detected in Wuhan, China, and was first transmitted via the bat as a zoonotic disease that was confirmed in December 2019. On 30th January 2020, ...
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The daily work plan of the human has changed dramatically due to the spread of the coronavirus disease 2019 (COVID-19) pandemic. The viral infection was first detected in Wuhan, China, and was first transmitted via the bat as a zoonotic disease that was confirmed in December 2019. On 30th January 2020, this viral outbreak was declared a public health emergency or epidemic. Subsequently, on 11th February 2020, the World Health Organization (WHO) declared it a pandemic. The potentially lethal virus has become a threat to the global population. The WHO provides special precautions and instructions to people all around the world, among which the importance of wearing a face mask, gloves, and a head protector are discussed. Many healthcare workers (especially doctors and nurses) and common people suffer from skin infections with the use of a continuous face mask, gloves, or other protective items. In order to alleviate skin dermatitis, it is important to use well-known natural herbals in the search for new drug sources. It is advisable to use useful herbal extracts in sole or in combination as cosmetic products for the treatment of skin diseases. India is a focal point of medicinal plants. Many Indian herbal plants are essentially used as cosmetics to cure skin infections. Natural herbs are safe, non-toxic, and cost-efficient for treating skin dermatitis during the COVID-19 situation.
Alireza Heiran; Farhad Handjani; Nasrin Saki; Maryam Rezaee
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic and possesses a tropism for multiple organs.
In this systematic review, we put together all relevant papers to assess the link between COVID-19 infection and acral ...
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic and possesses a tropism for multiple organs.
In this systematic review, we put together all relevant papers to assess the link between COVID-19 infection and acral lesions (particularly chilblain-like lesions) and to determine whether these lesions can be put together in a spectrum of manifestations.
Skin manifestations of COVID-19 vary, ranging from mostly acral chilblain-like, livedoid lesions or ischemia and necrosis to vesicular eruptions, maculopapular lesions, urticaria, oral or periorbital lesions, and drug eruptions.
A great deal of scientific evidence have focused on the peculiar erythematous and purpuric violaceous acral
lesions in young and healthy individuals resembling chilblains (pernio), leading the scientific community to investigate the association between these lesions and SARS-CoV-2. Furthermore, this is suggestive that some COVID-19 skin manifestations like livedo reticularis and acral ischemia and necrosis might share
dermatopathologic features with thrombophilic states.
Mohammad Shahidi Dadras; Sahar Dadkhahfar; Ayda Bahmanjahromi; Hannane Seifian; Fahimeh Abdollahimajd
Abstract
The coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic. In addition to pulmonary symptoms, reports of the involvement of other organs such as the skin are being published. We present the cases of three COVID-19 patients who presented with cutaneous manifestations ...
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The coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic. In addition to pulmonary symptoms, reports of the involvement of other organs such as the skin are being published. We present the cases of three COVID-19 patients who presented with cutaneous manifestations and review the previous reports. Purpura and petechiae, erythematous papules andmacules, and urticarial eruptions are signs seen in the presented cases. Although a growing number of cutaneous manifestations of COVID-19 have been reported, there is no doubt that further reports of both typical and atypical presentations are needed to confirm and understand skin involvement in COVID-19. Since COVID-19 manifests in various forms, dermatologists, as thefirst line of dealing with patients who come with skin rashes, should always be aware of the early diagnosis of this disease.
Santoshdev Rathod; Raju G Chaudhary; Tarun Narang
Abstract
Vaccine makers are racing to develop COVID-19 vaccines and have advanced ten candidates into clinical trials. However, vaccine development is typically a lengthy process. A number of immuneresponse modifiers have also been explored for their efficacy in the management of COVID-19. In this ...
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Vaccine makers are racing to develop COVID-19 vaccines and have advanced ten candidates into clinical trials. However, vaccine development is typically a lengthy process. A number of immuneresponse modifiers have also been explored for their efficacy in the management of COVID-19. In this short communication, we explore the possibility of using Mycobacterium indicus pranii (MIP) for the management of severely ill COVID-19 patients and its plausible role in the mitigation of severe disease in mildly infected patients. The MIP vaccine has a proven role in the prevention of leprosy to house-hold contacts of lepromatous leprosy, category-II tuberculosis patients, and patients with severe septicemia and low CD4 counts. It has also been used as an immune response modifier in patients with bladder carcinoma. Notably, this vaccine may be more efficacious than the BCGvaccine. The possible benefits and risks of using such an agent are described in this article. The use of such an approach could be beneficial in resource-poor countries and countries where diseases like tuberculosis and leprosy are endemic.
Sanjeev Gupta; Ajinkya Gujrathi; Aastha Sharma; sunita Gupta
Abstract
The COVID-19 pandemic has made it difficult for outpatient departments and hospitals to function normally. This has caused many patients to suffer due to a lack of regular follow-ups, with the unchecked progression of their disease further adding to their morbidity. With the advent ...
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The COVID-19 pandemic has made it difficult for outpatient departments and hospitals to function normally. This has caused many patients to suffer due to a lack of regular follow-ups, with the unchecked progression of their disease further adding to their morbidity. With the advent of technology, many centers have adopted the practice of teledermatology, which has allowednormal healthcare services to function to a certain extent. However, physical outpatient (private and institutional) clinics have also recently started accepting patients. Precautions like social distancing and sanitization have already been advised by various healthcare bodies but there are a few more general and specific (dermatologic) precautions for patients, staff and physicians that must be highlighted. As we move ahead navigating through these difficult times we must learn to adapt to the rapidly changing conditions and work toward establishing a safe environment for both patients and healthcare professionals.
Mohammad Injamul Hoq; Shafayet Ahmed Siddiqui; Mohammed Abu Sayeed; Md. Jakaria
