Will teledermatology be the silver lining during and after COVID-19?

The novel coronavirus disease (COVID-19) has limited traditional consultation and minimized health care access. Teledermatology (TD) has come to the rescue in this situation by extending consultation for nonessential conditions to the comfort of patient's homes. This limits the risk of exposure of both doctors and patients to the coronavirus (SARS-CoV-2). And while there is a reported increase in teleconsultations during the ongoing pandemic, there are some demerits that avert the shift to virtualized health care. The authors conducted an online survey to further understand the hesitancy, limitations, merits, and the demographic of dermatologists who were conducive to TD and these data were analyzed and presented in this article. While TD might never replace physical consultation, it definitely serves an adjunctive role in the post-COVID era, provided adequate regulatory measures are in place.

Coronavirus disease (COVID-19): An updated review based on current knowledge and existing literature for dermatologists.

The world entered the year 2020 with reports of the emergence of a new viral illness in Wuhan city, Hubei province, China. In January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified to be the causative novel coronavirus for the cluster of patients suffering from pneumonia in China. The disease was later named as coronavirus disease (COVID-19) and was declared a pandemic by the World Health Organization on March 11, 2020. Several studies, since then, have tried to study and explain the origin of SARS-CoV-2, its structure and pathogenicity, epidemiology, modes of transmission, spectrum of illness and causes of mortality and morbidity. The current management strategies focus on supportive care and prevention of complications. With no definite treatment, as of now, encouraging reports of some anti-viral and anti-malarial drugs in the management of COVID-19 generate some hope. This review intends to cover the current known aspects of COVID-19 and SARS-CoV-19, based on the available literature.

The Safety and Effectiveness of Decapeptide in Patients With Vitiligo: A Real-World Study.

Background Vitiligo, a chronic autoimmune depigmenting skin disease, affects a significant portion of the global population. One of the topical treatment options for vitiligo is basic fibroblast growth factor (bFGF)-related decapeptide (bFGFrP) 0.1% solution. This study aimed to assess the real-world effectiveness and safety of decapeptide in treating vitiligo. Methods This retrospective analysis utilized data collected from routine clinical practice in the management of vitiligo, focusing on patients treated with topical decapeptide lotion (Melgain™, manufactured by Zydus Healthcare Ltd., Ahmedabad, India). The primary outcome measures included the extent of re-pigmentation (EOR) and the grade of re-pigmentation (GOR) assessed at each follow-up visit. Results The analysis included data from 65 patients (24 males and 41 females) with an average age of 30.83 years. Segmental vitiligo was present in 52.31% of cases, with the face being the most commonly affected site. Among the patients, 33 received decapeptide as monotherapy, while 32 received decapeptide alongside adjuvant drug/phototherapy. The mean duration of treatment was five months. The first, second, and final follow-ups were observed to be at a mean of 45 days, two months, and five months, respectively. During the second and final follow-up, a significant response (>75% re-pigmentation) was observed in 12% (eight) and 71% (46) of the patients. A mild response (<50% re-pigmentation) was noted in 45% (29) of the patients during the first follow-up visit, 15% (10) during the second follow-up visit, and 6% (four) during the final follow-up visit. Grade 6 and 7 re-pigmentation occurred in a higher number of patients at the final visit, indicating treatment effectiveness. Overall, nearly all patients (96.92%) reported excellent tolerability of the decapeptide lotion based on the global assessment of tolerability. Conclusion This real-world study demonstrates that decapeptide promotes re-pigmentation and improves patient outcomes in vitiligo. Both decapeptide regimens, as monotherapy or in combination with other therapies, were effective and well tolerated by most patients. Thus, decapeptide represents a safe and effective therapeutic option for vitiligo treatment.

"Lockdown Dermatoses" during COVID-19-A Series of 127 Patients from the Indian Subcontinent.

Lockdown was enforced in many countries across the globe to flatten the coronavirus disease (COVID-19) curve. In these difficult times, people with skin diseases faced unique challenge, as major clinical facilities came to a standstill. Teledermatology helped to an extent to bridge this provider-seeker gap to an extent. We compiled data of patients seeking dermatology services during this period in Bangladesh, India, and Nepal. Most of the patients were middle-aged (70%) and had good access to teledermatology. Dermatoses were primarily due to frequent handwashing, use of alcohol-based sanitizers, excessive use of water (12.6%), improper skin care (43.3%), sun exposure (20.5%), lockdown-induced stress (22.04%), infections (15.75%), flare of preexisting diseases (8.66%), and hair disorders (11%). Many dermatoses had a causal overlap. Teledermatology proved to be useful for patients with skin diseases who were unable to access direct face-to-face consultations.

Noncultured Epidermal Suspension in Vitiligo-A Review of Origins, Modifications, and Innovations for this Surgical Masterstroke!

Vitiligo, a disorder of depigmentation, has a profound psychosocial burden. Surgical techniques using transplantation of tissue grafts or melanocytes have long been used to correct vitiliginous macules, often utilizing noncultured epidermal suspension. This procedure has undergone a remarkable transformation from its original methods in terms of preparation of recipient site, concentration and separation of melanocytes, incubation, and cryofreezing.Vitiligo is an acquired hypomelanotic disorder characterized by depigmented and circumscribed macules or patches, with loss of melanin and functional melanocytes from the epidermis. There is a broad range of therapeutic options for vitiligo, including topical agents, ultraviolet therapy, oral therapy, and surgical modalities. Transplanting autologous melanocytes from a normally pigmented donor area to the depigmented skin forms a common principle in all surgical techniques-be it grafting at tissue level or cellular level.1Surgical modalities are further divided into tissue grafts and cellular grafts. Tissue grafting includes thin dermoepidermal grafts, punch grafts with full thickness, suction blister grafts, and epidermal harvesting systems. Cellular grafting employs noncultured epidermal suspensions and cultured melanocyte suspensions.1 The advantages of cellular grafting include large areas of depigmentation that can be treated with ease. In noncultured epidermal cell suspensions (NCES), keratinocytes are not separated from melanocytes, and they help to furnish factors that sustain and promote growth of melanocytes and homogeneity of repigmentation.2 A minimum density of melanocytes required for satisfactory repigmentation is 210-250 per mm.2,3.

Pseudoepitheliomatous keratotic and micaceous balanitis with malignant transformation.

Pseudoepitheliomatous, keratotic and micaceous balanitis (PKMB) is a non-venereal and extremely rare pre-malignant condition characterized by silvery white plaque with micaceous scaling on glans seen in elderly uncircumcised men. Symptoms include phimosis, pain, and interference with sexual activity. Herein we present a young, 40-year-old male with PKMB of 5 years duration with deviation of urinary stream and histology showing acanthosis, hyperkeratosis with features of cellular atypia and abnormal mitosis suggestive of malignant transformation.

Lymphoedema - distichiasis syndrome with recurrent abortions.

Lymphoedema-distichiasis syndrome, a type of familial lymphoedema praecox, is a rare, primary lymphoedema of pubertal onset associated with distichiasis and other associations including congenital heart disease, ptosis, varicose veins, cleft palate, and spinal extradural cysts. We report a case of familial lymphoedema with associated distichiasis, atrial septal defect, varicose veins, and recurrent abortions in a 29-year-old female.