Hyaluronic Acid in Facial Rehabilitation—A Narrative Review

Background: Hyaluronic acid fillers (HAF) are a versatile tool in esthetic medicine. They also have a potential for medical indications including facial rehabilitation. Materials and methods: We performed a literature search on PUBMED and Google Scholar until December 2022. Clinical trials, clinical studies, review articles, systematic reviews, meta-analyses, case series, and case reports were considered for review. Keywords "facial rehabilitation”, "acne scars”, "traumatic scars”, "oral restoration”, "facial lipoatrophy”, "facial asymmetry”, "periocular correction”, "nasal obstruction”, "ear lobe restoration”, "morphea”, AND "hyaluronic acid filler” were used to select articles. Results: We prepared a narrative review on the use of HAF for correction of facial asymmetry and asymmetric lips, improvement of different types of scars, improvement of the jaw line, improvement of ear lobes, periocular and oral restoration, and the treatment of nasal obstruction and morphea en coub de sabre. The amount of HA used in these indications is often less than 1 mL. The bolus technique, fanning, and dual-plane injections can be utilized for treatment. Duration of clinical effects depends upon the anatomical region and is usually maintained between 2 months and 2 years. Adverse events are often mild and temporary. Vascular occlusion is a severe adverse event, but it has not been reported yet for these medical indications. Repeated injections are recommended to obtain a longer-lasting improvement. In cases of morphea, only stable and non-inflammatory plaques should be treated. The advantage of HAF compared to permanent and semipermanent fillers is the availability of hyaluronidase for rapid removal of filler material and to revise overcorrection. Conclusions: HAF play an auxiliary role in facial rehabilitation. Knowledge of filler qualities, anatomy, and underlying diagnoses is important for their safe application. More prospective controlled trials are necessary to improve evidence.

SARS-CoV-2 vaccination-induced cutaneous vasculitis: Report of two new cases and literature review.

Currently the most powerful tool in combating the COVID-19 pandemic is vaccination against SARS-CoV-2. A growing percentage of the world's population is being vaccinated. Various vaccines are worldwide on the market. Several adverse reactions have been reported as a part of post-marketing surveillance of COVID-19 vaccines. Among the possible adverse events, cutaneous vasculitis has occasionally been reported. We present a narrative review on cutaneous vasculitis related to COVID-19-vaccination to summarize clinical findings, histopathology, treatment and outcome. We searched for "COVID vaccine", "COVID vaccination" AND "cutaneous vasculitis" in PUBMED. Articles in English have been selected, from inception to December 2021, and analyzed for patient's characteristics, type of vaccine, time of appearance of cutaneous vasculitis and clinico-histopathologic type. Treatment and outcome have also been considered in this narrative review. Two new unpublished cases of ours were added. Cutaneous vasculitis is a rare adverse event to COVID-19 vaccination. It has been observed with mRNA and adenovirus-vector vaccines. IgA vasculitis, lymphocytic and ANCA-associated vasculitis, leukocytoclastic and urticarial vasculitis have been reported. This adverse event can occur after first or second shot. Most cases run a mild to moderate course. Cornerstone of medical treatment are systemic corticosteroids. Complete remission could be achieved in most patients. Vasculitis may not be considered as a contraindication of vaccination, being uncommonly reported and shows a favorable prognosis. The benefit of the vaccination remains high especially for immunocompromised patients. COVID-vaccine induced vasculitis is important in the differential diagnosis of purpuric and vasculitis disorders.

Herpes zoster: A Review of Clinical Manifestations and Management.

The Varicella-zoster virus (VZV) or human herpes virus 3 is a neurotropic human alpha herpes virus responsible for chickenpox/varicella and shingles/Herpes zoster (HZ). This review will focus on HZ. Since HZ is secondary to varicella, its incidence increases with age. In children and youngsters, HZ is rare and associated to metabolic and neoplastic disorders. In adults, advanced age, distress, other infections (such as AIDS or COVID-19), and immunosuppression are the most common risk factors. HZ reactivation has recently been observed after COVID-19 vaccination. The disease shows different clinical stages of variable clinical manifestations. Some of the manifestations bear a higher risk of complications. Among the possible complications, postherpetic neuralgia, a chronic pain disease, is one of the most frequent. HZ vasculitis is associated with morbidity and mortality. Renal and gastrointestinal complications have been reported. The cornerstone of treatment is early intervention with acyclovir or brivudine. Second-line treatments are available. Pain management is essential. For (secondary) prophylaxis, currently two HZV vaccines are available for healthy older adults, a live attenuated VZV vaccine and a recombinant adjuvanted VZV glycoprotein E subunit vaccine. The latter allows vaccination also in severely immunosuppressed patients. This review focuses on manifestations of HZ and its management. Although several articles have been published on HZ, the literature continues to evolve, especially in regard to patients with comorbidities and immunocompromised patients. VZV reactivation has also emerged as an important point of discussion during the COVID-19 pandemic, especially after vaccination. The objective of this review is to discuss current updates related to clinical presentations, complications, and management of HZ.

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.

Pustular psoriasis flare-up in a patient with COVID-19.

INTRODUCTION: The various cutaneous manifestations have lately appeared in the setting of COVID-19. Psoriasis flare-ups have been reported during a COVID-19 infection. CASE PRESENTATION: We present a case of a 32-year-old woman with COVID-19 who presented with generalized pustular psoriasis. She received oral prednisolone, hydroxyzine, and topical clobetasol. The patient received follow-up two weeks later and found that her lesions were favorably desquamating. METHODS: The PubMed, SCOPUS, and ISI Web of Science databases were thoroughly searched for English studies reporting psoriasis flare-ups following SARS-CoV-2 infection. Ten case reports/series were included after screening. CONCLUSIONS: Our case report brings awareness to clinicians for the possible cutaneous manifestation of COVID-19, which should be considered part of the differential diagnoses.

Cutaneous and hypersensitivity reactions associated with COVID-19 vaccination-a narrative review.

Vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV­2) has become a major tool in the battle against the coronavirus disease 2019 (COVID-19) pandemic. Numerous products have been developed and more are to come. Vaccination success varies greatly between different countries. There are a number of different vaccine types, such as mRNA, DNA vaccines, adenovirus vector vaccines, and full-length spike protein nanoparticles with a special matrix. The different types may also cause a different spectrum of adverse events. With mass vaccination, post-marketing surveillance for product safety becomes increasingly important. In this review, we discuss possible hypersensitivity and cutaneous adverse events related to SARS-CoV­2 vaccination-from local reactions like COVID arm to systemic and severe reactions like anaphylaxis. Vaccination may also induce or exacerbate preexisting disorders such as herpes zoster infection. This review should provide information to tailor, whenever possible, vaccination to patients' needs. It is a contribution to patient safety as well. There is general consensus that the benefits of SARS-CoV­2 vaccination currently outweigh the risks of possible adverse events.

Nails and COVID-19 - A comprehensive review of clinical findings and treatment.

The SARS-CoV-2 infection, responsible for COVID-19, has raised the interest for infection-associated muco-cutaneous symptoms. While dermatologic symptoms in general gained an increasing awareness, affection of the nail organ has been mentioned only recently. We provide a narrative review on COVID-19 manifestation on the nail organ and add symptoms induced by personal protective measures and SARS-CoV-2 vaccination. Available treatment options are discussed.

Global scenario of COVID-19

COVID-19, caused by SARS-CoV-2 virus, has developed into a pandemic that is still going on. The disease is transmitted mainly by aerosols. Here we discuss diagnostics and disease control measures. The social distortion by the pandemic has a negative impact on many facettes of society that potentially increase social tensions. Disease control warrants science and transparency. Vaccination provides hope to overcome the pandemic eventually.

Koebner Phenomenon Induced by Face Mask Ear Loops.

We present a case of Koebner phenomenon induced by friction due to tightness of ear loops attached to the face mask used as protective measure against spreading COVID-19 infection.

How dermatology has changed in the COVID-19 pandemic.

The emergence of the coronavirus disease 2019 pandemic has led to a change in the whole world order. The key actors and occupational groups most at risk during this period have been health care professionals. In this pandemic, we, as dermatologists, also have many responsibilities regarding patients, ourselves, and society. Dermatologists have to protect themselves, their families, and their patients while working in pandemic services and outpatient clinics, as well as in their practices. One of their roles is to inform the public about protective measures for cutaneous side effects associated with the intensive use of disinfectants and long-term use of masks. In hospitals, only emergency patients had been admitted for treatment in all units during the pandemic, and elective operations and procedures were delayed. In this context, it is very important to determine what procedures will be carried out during this period in the follow up and treatment of chronic dermatologic diseases, as well as what interventional and cosmetic procedures may performed. Guidelines issued by various medical societies have made valuable contributions. The benefits and associated issues of teledermatology have pros and cons. Finally, one of the issues to ponder in the long term seems to be how we should pursue online education.

Immunosuppressive and immunomodulator therapy for rare or uncommon skin disorders in pandemic days.

Immunosuppressive and immunomodulatory therapies are important in dermatology, but indications are influenced by SARS-CoV-2. We will focus on skin disorders such as autoimmune connective tissue disorders, neutrophilic dermatoses, and vasculitis. Immunomodulators such as colchicine and antimalarials can easily be preferred taking their beneficial effects on COVID-19 into consideration and also given their wide spectrum of action. Among the conventional therapies, methotrexate, azathioprine, and mycophenolate mofetil increase the risk of infection, and thus their use is recommended only when necessary and at low doses. On the other hand, use of cyclosporine is also not recommended as it increases the risk of hypertension, which is susceptible to COVID-19. Anti-TNF agents from among the biological therapies appear to be slightly risky in terms of susceptibility to infection. However, there are ongoing studies which suggest that some biological treatments may reduce cytokine storm impeding the COVID-19 progression as a result, in spite of their susceptibilities to COVID-19. Patients, who will be started on immunosuppressive therapy, should be tested for COVID-19 prior to the therapy, and in the event that COVID-19 is suspected, the therapy should be discontinued.

Flare-up of Rosacea due to Face Mask in Healthcare Workers During COVID-19.

COVID-19 (SARS-COV-2) pandemic is associated with aggravation of facial dermatoses caused by professional prophylactic measures, mostly face masks, especially reported in healthcare workers, such as irritant and contact dermatitis, seborrheic dermatitis, rosacea, acne. We present a case of flare-up of rosacea in a nurse working in an Intensive Care Unit for COVID-19 patients, using FFP1 type mask at work and textile or paper mask outside the hospital.

Angiotensin II receptors: Impact for COVID-19 severity.

COVID-19 is an outbreak of viral pneumonia which became a global health crisis, and the risk of morbidity and mortality of people with obesity are higher. SARS-CoV-2, the pathogen of COVID-19, enters into cells through binding to the Angiotensin Converting Enzyme (ACE) homolog-2 (ACE2). ACE2 is a regulator of two contrary pathways in renin angiotensin system (RAS): ACE-Ang-II-AT1R axis and ACE2-Ang 1-7-Mas axis. Viral entry process eventuates in downregulation of ACE2 and subsequent activation of ACE-Ang-II-AT1R axis. ACE-Ang II-AT1R axis increases lipid storage, reduces white-to-beige fat conversion and plays role in obesity. Conversely, adipose tissue is an important source of angiotensin, and obesity results in increased systemic RAS. ACE-Ang-II-AT1R axis, which has proinflammatory, profibrotic, prothrombotic, and vasoconstrictive effects, is potential mechanism of more severe SARS-CoV-2 infection. The link between obesity and severe COVID-19 may be attributed to ACE2 consumption and subsequent ACE-Ang-II-AT1R axis activation. Therefore, patients with SARS-CoV-2 infection may benefit from therapeutic strategies that activate ACE2-Ang 1-7-Mas axis, such as Ang II receptor blockers (ARBs), ACE inhibitors (ACEIs), Mas receptor agonists and ACE2.