Dermatologists Should Encourage and Resume Photoprotection in Patients with Photodermatoses and Melasma Following the COVID-19 Pandemic

Background

The COVID-19 pandemic may alter individuals' perspectives and behaviors regarding sun exposure and photoprotection. Presently, there is a paucity of information about how the pandemic influences photoprotection in photodermatoses and melasma.

Objective

To compare the photoprotection attitudes and behaviors of individuals with photodermatoses and melasma with those of a control group (other dermatologic patients) before and during the COVID-19 pandemic.

Methods

A questionnaire-based, cross-sectional study was conducted among Thai patients with photodermatoses, melasma, and other dermatological conditions between August 2021 and November 2022. Each of the three groups consisted of 35 patients.

Results

Among the 105 patients, 81.9% were female, and the mean age was 45.83 years. Over 80% of individuals who used surgical masks daily for 4 to 8 hours believed that these masks provided skin protection from the sun. The duration of sun exposure and the frequency of photoprotection practices decreased significantly in all groups during the COVID-19 pandemic compared to the pre-pandemic period. Sunscreen was the most prevalent form of photoprotection, but its usage declined considerably during the pandemic. Upon physical examination, the photodermatoses and control groups exhibited unchanged skin conditions, while the patients with melasma demonstrated improved skin conditions during the pandemic.

Conclusion

Owing to increased indoor activities and the perception that face masks could block sunlight, the COVID-19 pandemic led to notable reductions in sun exposure and photoprotective practices. Despite the absence of photodermatoses exacerbation and the observed improvements in patients with melasma, consistent and effective photoprotection must continue to be promoted.

The Anti-Psoriatic Efficacy and Safety Profile of Topical and Intralesional Methotrexate: A Literature Review

Methotrexate (MTX) has long been considered the first-line oral systemic pharmacotherapy for psoriasis. The drug has several well-known systemic side effects, such as bone marrow suppression and hepatotoxicity. To avoid them, the use of topical or intralesional administrations of MTX has become an interesting option. With the advent of novel drug delivery systems, especially nanocarriers, the usage of a high-efficacy and safe topical MTX for psoriasis has nearly been attained. This review examined the development, anti-psoriatic efficacy and adverse effects of topical forms of MTX (plain MTX; MTX with chemical enhancer; MTX using nanotechnology; MTX with protein transduction domains; MTX with liquid crystalline systems; and MTX with physical enhancer/laser) and intralesional MTX in psoriasis patients and psoriasis-induced animals. The efficacy of topical MTX varied with the drug delivery technology employed. Nevertheless, the overall safety profile of the topical forms was favourable. A 25 mg/mL MTX solution injected intralesionally at the nail matrix worked well for nail psoriasis recalcitrant to topical treatment. To improve the standard of care for patients with psoriasis, randomized controlled trials that establish the most effective MTX-delivery system are needed.