COVID-19 and immunosuppressive therapy in dermatology

PYODERMA GANGRENOSUM MIMICKING GRANULOMATOSIS WITH POLYANGIITIS: CACE REPORT AND RIVIEW OF THE LITERATURE

Pyoderma gangrenosum is an autoinflammatory neutrophilic dermatosis. Diagnosis of the disease remains a difficult task to date, due to the lack of a gold standard of examination and differential diagnostic signs. The primary elements in the development of PG may be papules, pustules or bullae the dissection of which subsequently leads to the formation of ulcers with irregular, violaceous, undermined borders. In rare cases, the diagnosis of the disease can also be complicated by the rapid development of internal organs damage symptoms, which must be regarded as extracutaneous manifestations of PG. Extracutaneous lesions can occur before, during or after the appearance of skin rashes, and the detection of sterile neutrophil infiltrates in the defeat of internal organs confirm the concept of PG as a multisystemic disease. The presented case of a rare course of PG with multiple skin lesions and extracutaneous manifestations, simulating systemic vasculitis, emphasizes the importance of a detailed examination of patients in order to make a correct diagnosis and prescribe timely adequate treatment.

Treatment Adherence in Dermatology During the COVID-19 Pandemic: A Review

The coronavirus disease 2019 (COVID-19) pandemic raised many challenges for dermatology. Safety is a principal concern for many patients, particularly those on medications that affect the immune system. Understanding how the pandemic affects patients' treatment adherence may be informative for counseling or other interventions to assure that treatment plans are not inappropriately interrupted, or for future pandemics. The purpose of this review was to investigate the extent to which the COVID-19 pandemic affected medication adherence in dermatology. A literature search of PubMed was performed using the search terms: adherence, compliance, dermatology, COVID-19, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and pandemic. Eleven primary research studies met the inclusion criteria and were included in the review. During the COVID-19 pandemic, non-adherence in dermatology patients was primarily linked to concern about the risk of COVID-19 infection with long-term use of immunomodulatory and immunosuppressive medications. In some cases, non-adherence was associated with feelings of depression, anxiety, or perceived stress. High adherence was attributed to regular and convenient communication between patients and dermatology providers through the effective use of telemedicine and electronic messaging. Frequent communication with providers to address patient concerns and provide continuity of care improved adherence. An integrated virtual approach to patient care facilitated this, particularly through the use of telemedicine. Implementation of routine virtual questionnaires was, to some extent, effective in replacing limited in-person patient-provider interactions during the pandemic. Finally, the added threat of the pandemic presented an additional mental health component to consider for patients, supporting the need for a multidisciplinary approach to patient care.

COVID vaccine recommendations in dermatologic patients on immunosuppressive agents: Lessons learned from pandemic

BACKGROUND

Since SARS-CoV2 vaccines were approved without enough long-term monitoring due to emergent situations, some issues have been raised about timing and protocol of receiving them by patients treated by different immunosuppressive agents.

AIM AND METHOD

Here, we present different aspects of SARS-CoV-2 vaccination in such patients in the field of dermatology.

RESULT

In brief, SARS-CoV-2 vaccination is recommended in all dermatologic patients, regardless of their disorders and therapeutic regimens. Nevertheless, special considerations should be given to the immunosuppressive therapy and its association with vaccination timing due to the decreased immunogenicity of vaccines in this setting.

CONCLUSION

Novel biologic immunotherapies are advantageous over conventional systemic therapies not only in their safety and selective functions but also in this aspect that many of them do not affect vaccines immunogenicity.

Acrodermatitis continua of Hallopeau: historical perspectives and modern management

Acrodermatitis continua of Hallopeau is a sterile pustular dermatosis primarily of the digits. Often considered a type of pustular psoriasis, it may be difficult to diagnose and even more difficult to treat. Initial involvement of a distal finger or toe may appear as erythema which should not be confused with the chilblains-like findings potentially associated with COVID-19 infection. We review the clinical manifestations of and explore potential therapeutic options for this uncommon, clinically striking dermatosis.

Adherence to systemic therapy in patients with psoriasis during the COVID-19 pandemic: A multicenter study

Background

Adherence to treatment is important in chronic dermatological diseases. There are limited data regarding the adherence to treatment in patients with psoriasis during the COVID‐19 pandemic.

Aims

We aimed to determine the rates of adherence to systemic treatments in patients with psoriasis and to identify the causes of non‐adherence during the COVID‐19 pandemic.

Methods

We conducted a cross‐sectional multicenter study from May 2021 to August 2021. A questionnaire including items regarding sociodemographic characteristics of the patients, disease‐related characteristics, and treatment‐related characteristics were filled out by the physicians. The Psoriasis Area Severity Index (PASI), Hospital Anxiety, and Depression Scale, and the Dermatology Life Quality Index were calculated. The rate of adherence and non‐adherence to treatment and reasons for non‐adherence to treatment were examined.

Results

A total of 342 patients with psoriasis were included (182 male/160 female) in the study. The mean age of the patients was 45.9 ± 14.2 years. The average duration of psoriasis was 192 ± 134.7 months. While the rate of adherence to treatment was 57.6%, the rate of non‐adherence to treatment was 42.4%. There were no significant differences with respect to adherence to treatment in comparison with oral and injection‐therapy groups. The most frequent reasons for non‐adherence to treatment were inability to go to the hospital (19.2%), concern about the COVID‐19 infection (16.3%), discontinuation of the treatment by the doctor (13.7%), inability to reach the doctor (7.3%), and inability to have access to the medication (7.3%).

Conclusion

Adherence to oral and injection therapies was fairly high among our patients with psoriasis during the COVID‐19 pandemic. Psoriasis severity and duration of medication use had a negative impact on adherence to treatment.

Dermatologic comorbidities of the patients with severe COVID-19: A case-control study

The current studies focus on the association between COVID-19 and certain comorbidities. To the best of our knowledge, the association between severe COVID-19 and dermatologic comorbidities has not been reported yet. In this study, we aimed to describe the dermatologic comorbidities of patients with severe COVID-19 and compare it with the control group. Patients who have died at Uşak Training and Research Hospital due to COVID-19 and other diseases in the COVID-19 Intensive Care Units and Internal Medicine Intensive Care Units were recruited into the study. Two groups were compared with each other regarding the most common dermatologic comorbidities. A total of 198 patients including 111 patients with COVID-19 and 87 age and sex-matched patients with other diseases were enrolled in the study. The most common dermatologic comorbidities were pruritus (8.1%), eczema (6.3%), skin infections (3.6%), leukocytoclastic vasculitis (1.8%), and urticaria (0.9%) in the COVID-19 group while they were skin infections (9.2%), eczema (3.4%), pruritus (2.3%), and urticaria (1.1%) in the control group. None of patients in the control group had leukocytoclastic vasculitis. There were no significant differences between COVID-19 and control groups in terms of pruritus, eczema, skin infections, and urticaria (P values were .117, .517, .181, .505, and 1.000, respectively). In conclusion, although it is not statistically significant, it appears that pruritus and leukocytoclastic vasculitis are more common in severe COVID-19 patients. These cytokines-related diseases in the immuno-cutaneous systems may give some clues on the COVID-19 severity. Further studies are required to elucidate the relationship between the immuno-cutaneous system and COVID-19 severity.