The effect of COVID-19 on development of hair and nail disorders: a Turkish multicenter, controlled study.

BACKGROUND: A broad spectrum of skin diseases, including hair and nails, can be directly or indirectly triggered by COVID-19. It is aimed to examine the type and frequency of hair and nail disorders after COVID-19 infection. METHODS: This is a multicenter study conducted on consecutive 2171 post-COVID-19 patients. Patients who developed hair and nail disorders and did not develop hair and nail disorders were recruited as subject and control groups. The type and frequency of hair and nail disorders were examined. RESULTS: The rate of the previous admission in hospital due to COVID-19 was statistically significantly more common in patients who developed hair loss after getting infected with COVID-19 (P < 0.001). Telogen effluvium (85%) was the most common hair loss type followed by worsening of androgenetic alopecia (7%) after COVID-19 infection. The mean stress scores during and after getting infected with COVID-19 were 6.88 ± 2.77 and 3.64 ± 3.04, respectively, in the hair loss group and were 5.77 ± 3.18 and 2.81 ± 2.84, respectively, in the control group (P < 0.001, P < 0.001). The frequency of recurrent COVID-19 was statistically significantly higher in men with severe androgenetic alopecia (Grades 4-7 HNS) (P = 0.012; Odds ratio: 2.931 [1.222-7.027]). The most common nail disorders were leukonychia, onycholysis, Beau's lines, onychomadesis, and onychoschisis, respectively. The symptoms of COVID-19 were statistically significantly more common in patients having nail disorders after getting infected with COVID-19 when compared to the control group (P < 0.05). CONCLUSION: The development of both nail and hair disorders after COVID-19 seems to be related to a history of severe COVID-19.

Skin manifestations following anti-COVID-19 vaccination: A multicentricstudy from Turkey.

PURPOSE: After the emergence of the pandemic caused by the COVID-19 virus, vaccination with various vaccines has started to be implemented across the world. To identify dermatological reactions developing after the COVID-19 vaccines administered in Turkey and determine their clinical features and risk factors that may play a role in their development. MATERIALS AND METHODS: The study included patients aged ≥18 years, who presented to 13 different dermatology clinics in Turkey between July 2021 and September 2021 after developing dermatological reactions following the administration of the COVID-19 vaccine. After providing written consent, the patients were asked to complete a standard survey including questions related to age, gender, occupation, comorbidities, the regular medication used, the onset of cutaneous reactions after vaccination, and localization of reactions. Dermatological reactions were categorized according to whether they developed after the first or second dose of the vaccine or whether they occurred after the inactivated or messenger RNA (mRNA) vaccine. The relationship between dermatological reactions and some variables such as gender and comorbidities was also evaluated. RESULTS: A total of 269 patients [116 women (43.1%), 153 men (56.9%)] were included in the study. It was observed that the dermatological diseases and reactions that most frequently developed after vaccination were urticaria (25.7%), herpes zoster (24.9%), maculopapular eruption (12.3%), and pityriasis rosea (4.5%). The rate of dermatological reactions was 60.6% after the administration of the mRNA vaccine and 39.4% after that of the inactivated vaccine. There was a statistically significantly higher number of reactions among the patients that received the mRNA vaccine (p = 0.001). CONCLUSION: The most common reactions in our sample were urticaria, herpes zoster, and maculopapular eruption. Physicians should know the dermatological side effects of COVID-19 vaccines and their clinical features.

The change in the frequency and severity of facial dermatoses and complaints in healthcare workers during the COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in the use of personal protective equipment (PPE). However, the increased use of PPEs may lead to facial skin complaints. AIMS: This survey study aims to evaluate the effect of the COVID-19 pandemic on facial dermatoses and complaints. METHODS: A total of 1017 volunteers (age 18-60 years), consisting of healthcare workers, participated in the study. In the present study, healthcare professionals were screened for facial dermatoses and complaints between 1 and 15 April 2021 with an online survey. RESULTS: The vast majority of the survey were women (82.4%) and between 26 and 35 years old (49.2%). The most new-onset facial complaints were acne (25.3%) and lip dryness (29.2%). Along with the pandemic, 50.9% of patients with seborrheic dermatitis had an increase in lesions. Another remarkable result was a 60.5% increase in acne complaints. Moreover, the rate of exacerbations of rosacea, melasma, and lip dryness was increased after the COVID-19 pandemic (39.1%, 22.0%, and 42.7%, respectively). Exacerbations of seborrheic dermatitis, acne, and lip dryness have occurred more frequently in females when compared to males (p < 0.001). CONCLUSIONS: The current pandemic has had serious impacts on facial dermatoses which had to be managed carefully. Compared to the pre-pandemic period, there was a significant increase in the frequency and severity of complaints in facial dermatoses related to PPE. If the complaints that may develop due to PPE are known in advance, their development can be prevented by taking precautions against them.

Cutaneous and Allergic reactions due to COVID-19 vaccinations: A review.

INTRODUCTION: The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has had an unprecedented impact on the overall health and the global economy. Vaccination is currently the most dependable strategy to end the pandemic, despite the slower-than-hoped-for rollout, particularly for low-to-middle-income countries, and the uncertain duration of protection afforded by vaccination. The spike protein of the virus (immunodominant antigen of the virus) is the main target of the approved and candidate SARS-CoV-2 vaccines. This protein binds to the ACE2 receptor of the host cell, initiating the entry of the virus into the cell and the chain of subsequent events ending to Acute Respiratory Distress Syndrome. The safety profile of these vaccines needs is closely assessed. METHODS: This comprehensive review includes searching the PubMed, EMBASE, and Web of Science databases using the keywords "coronavirus", "COVID-19", "vaccine", "cutaneous reactions", "allergic reactions", and "SARS-CoV-2". Manual searching of reference lists of included articles augmented the research. The research was updated in June 2021. RESULTS: In this narrative review, we tried to investigate and discuss the cutaneous and allergic reactions related to SARS-CoV-2 vaccines currently available in the literature. As a result, although COVID-19 vaccines can be reported to develop allergic and anaphylactic reactions, especially after m-RNA vaccines, they remain at a low rate, and it is observed that these reactions may develop more frequently, especially in patients with previous allergies and mast cell disorders. Fortunately, these reactions are generally transient, benign, self-limited. CONCLUSION: Although there is still no definitive evidence, as dermatologists, we must be aware of the possibility of cutaneous reactions, newly diagnosed dermatoses, or exacerbation of existing dermatoses that may develop after the COVID-19 vaccinations.

Ultraviolet C Supported Novel Phototherapy Units at the Crossroads of the COVID-19 Pandemic.

The numerous dermatology clinics have decreased or stopped phototherapy sessions due to the increased risk of getting COVID-19 during the current pandemic. In this context, poorly ventilated phototherapy units (PUs) should be redesigned in order to continue UV-based therapies and to protect our patients from getting COVID-19. Recently, it has been reported that ultraviolet C (UVC)-related dose and virus concentration may play a decisive role in the virucidal activity. Considering air changes per hour and viral inactivation time, 30 min of 30-W UVC radiation is able to inactivate poorly ventilated PUs of 3-4 m length, 5.5-7 m width, and 2.7-3 m height. Upper-air UVC radiation for 30 min between sessions would allow us to have more treatment options for numerous dermatological diseases in novel PUs during the COVID-19 pandemic and possible future pandemics.

Oral isotretinoin treatment in patients with acne vulgaris during the COVID-19 pandemic: A retrospective cohort study in a tertiary care hospital.

BACKGROUND: Patients with acne vulgaris continue to present increasingly in dermatology outpatient clinics and seek treatment during the COVID-19 pandemic. As far as we know, the effect of isotretinoin on COVID-19 has not been studied before. AIM: We aimed to evaluate whether patients receiving oral isotretinoin are at increased risk of COVID-19 infection by comparing them with patients on topical treatment for acne vulgaris. METHODS: The data were collected retrospectively from a cohort of 267 acne vulgaris patients, who were under follow-up for acne vulgaris treatment during the pandemic period. RESULTS: Total of 227 patients (141 receiving isotretinoin treatment and 86 receiving topical treatment) were included of whom 29 patients had COVID-19 infection during acne vulgaris treatment. Fifteen (10.6%) patients were receiving oral isotretinoin and 14 (16.3%) were receiving topical acne treatment at the time of COVID-19 infection. The mean cumulative dose was 2340 ± 1988 mg at the time of COVID-19 infection. The mean elapsed time between the onset of isotretinoin treatment and positive PCR result for COVID-19 was 13.3 ± 10.3 weeks. Nine patients (64.3%) receiving isotretinoin treatment and 9 patients (60%) under topical treatment had loss of taste and smell during COVID-19 infection. Isotretinoin treatment was not found to be associated with a significant increased risk of getting COVID-19 (odds ratio, 0.671; 95% confidence interval, 0.247-1.823; P  = 0.434). CONCLUSION: As a conclusion, the results of this study encourage dermatologists and acne vulgaris patients to initiate oral isotretinoin treatment safely during the pandemic period.

Relative changes in the pattern of diseases presenting in dermatology outpatient clinic in the era of the COVID-19 pandemic.

As an increasing number of COVID-19 cases, there were changes in the number of patients who attended the dermatology outpatient clinics. We aimed to investigate the change profiles of dermatologic diseases in the first and second months of the COVID-19 pandemic in Turkey by comparing with the corresponding period of the previous year. The total number and diagnosis of patients, who attended a tertiary care hospital for the dermatology outpatient clinic between 1 April 2020 and 31 May 2020, were included in this study. These data were compared with the corresponding period of the previous year. The percentage of the patients with scabies, contact dermatitis, psoriasis, pityriasis rosea, urticaria, and alopecia areata were statistically significantly increased a month after the occurrence of the COVID-19 pandemic, while the percentage of patients with scabies, alopecia areata, telogen effluvium, acne vulgaris, and xerosis cutis were statistically significantly increased 2 months after the occurrence of the COVID-19 pandemic (P < 0.05). An increase in the number of certain diseases such as urticaria and pityriasis rosea may indicate the risk of asymptomatic COVID-19 carriage in these patients. Polymerase chain reaction (PCR) and/or antibody-based further studies should be performed to explore whether certain dermatologic diseases are related to asymptomatic COVID-19 cases.

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 Usak 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.

Analysis of dermatologic conditions in Turkey and Italy by using Google Trends analysis in the era of the COVID-19 pandemic.

Many areas of life including patterns of dermatological diseases that patients attend to the hospital were tremendously affected by implementing stay-at-home orders during the COVID-19 pandemic. We aimed to identify the dermatologic interest of the public during the COVID-19 pandemic by using Google Trends. The terms "acne", "hair loss", "eczema", "genital warts", "molluscum contagiosum", "botox", "skin cancer", and "sunscreen" were analyzed on April 1, May 1, June1, 2020, and the corresponding period of the previous year in Turkey and Italy by using Google Trends. The searching spectrum was between March 31, 2019 and June 1, 2020. The relative change of search term "acne" was +10, +29, +13/-1, +17,+33, "hair loss" was +14, +40, +16/+3, +16, +15, and "eczema" was +2, +34, -4/ +3, +25, +18, on the other hand, the relative change of the "genital warts" was -15, -48, +10/-44, -30, +18 and "molluscum contagiosum" was -12, -2, -4/-4, -1, -12 while "botox" was, -10, -43, -8/-41, -31, +4, "skin cancer" was -27, -38, -38/-22,+33, -7 and sunscreen was -6, -25, -71/-13, 0, -45 in Turkey/Italy on April 1, May 1, and June 1, 2020, respectively. A statistically significant positive correlation was found between the number of COVID-19 cases in Turkey and search terms of the general dermatology group during the COVID-19 pandemic (P < 0.05). The search terms including "acne", "eczema", "hair loss" appears to be increasing while "molluscum contagiosum", "genital warts" "botox", "skin cancer", and "sunscreen" decreasing in the era of the COVID-19 pandemic. Understanding the trends and impacts of dermatologic diseases on public perceptions during the COVID-19 pandemic will allow for better preparation of dermatologists.

Psoriasis and COVID-19: A narrative review with treatment considerations.

Coronavirus disease (COVID-19) is a highly contagious respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 outbreak has been declared a pandemic by the World Health Organization on March 2020. The pandemic has affected the management of psoriasis not only for those who are under treatment but also for those who are about to begin a new therapy to control their disease. An increasing number of studies in the current literature have focused on the relationship between psoriasis and COVID-19 from different perspectives. This narrative review includes searching the PubMed and Web of Science databases using the keywords "psoriasis," "psoriatic arthritis," "coronavirus," "COVID-19," and "SARS-CoV-2." The search was supplemented by manual searching of reference lists of included articles. A total of 11 relevant original investigations and 6 case studies was identified. The search was updated in May 2019. Due to the absence of randomized controlled trials, it is not likely to have a robust evidence-based approach to psoriasis management in the era of COVID-19. However, the current literature may provide some clues for safety considerations. Conventional immunosuppressive therapies such as methotrexate and cyclosporine, and anti-tumor necrosis factor agents should not be preferred due to increased risk of infection, especially in high-risk areas. The use of cyclosporine may pose additional risk due to the side effect of hypertension, which has been reported to be associated with susceptibility to severe COVID-19. Considering that the current literature has provided no conclusive evidence that biologics increase the risk of COVID-19, withdrawal of these agents should be reserved for patients with COVID-19 symptoms. The treatment approach should be personalized, considering the advantages and disadvantages for each case separately.

Dermatological diseases presented before COVID-19: Are patients with psoriasis and superficial fungal infections more vulnerable to the COVID-19?

Recent studies have focused on the comorbid conditions of the COVID-19. According to the current studies, numerous diseases including lung disease, cardiovascular disease and immunosuppression appear to be at higher risk for severe forms of the COVID-19. To date, there are no data in the literature on the comorbid dermatologic diseases and COVID-19. We tried to analyze the previous dermatological comorbidity of 93 patients with COVID-19 (51 males, 42 females) who presented to the dermatology outpatient clinics for the last 3 years. The most common dermatologic diseases in patients with COVID-19 who have dermatologic diseases for the last 3 years were superficial fungal infections (24, 25.8%), seborrheic dermatitis (11, 11.8%), actinic keratosis (10, 10.8%), psoriasis (6, 6.5%), and eczema (6, 6.5%), respectively. In addition, the number of COVID-19 patients who presented to dermatology in the last 3 months was 17 (11 men, 6 women). The median age of these patients was 58 (minimum 18, maximum 80) years, and the most common dermatologic diseases before diagnosed COVID-19 were superficial fungal infections (5, 25%), psoriasis (4, 20%), and viral skin diseases (3, 15%). The possible similarity between cutaneous and mucosal immunity and immunosuppression suggests that patients with some dermatologic diseases especially superficial fungal infections and psoriasis may be more vulnerable to the COVID-19.