Whats' happening on the follicular unit of adolescents after the COVID-19 pandemic: Severe acne is a growing problem of nowadays

Objectives: Acne is a leading skin problem in adolescents. After the end of COVID-19 pandemic, with the gradual transition to the routine life, we started to encounter more severe forms of acne in the last 6-month than we had seen before in the 10 year period of our Paediatric Dermatology outpatient clinic. Method(s): We evaluated the demographic and clinical characteristics, COVID infection and vaccination status, and treatment of patients who were treated at our Paediatric Dermatology outpatient clinic in the last 6 months due to severe acne. Result(s): One of our patients had acne fulminans, and four patients had acne conglobata. The common features of these patients presenting with severe acne were that they were young boys aged 15- 16 years, medium height, normal weight, and skin type 3-4. All patients had a family history of acne in their parents. They had no known comorbidities, additional treatment, history of nutritional supplement use, or accompanying arthralgia or arthritis. Four patients were initially treated with isotretinoin for severe acne, developed acne conglobata, and one developed acne fulminans during the follow-up period. Dapsone therapy was initiated in all patients according to the severity of the lesions, and adalimumab was administered to acne fulminans. Discussion(s): The frequent occurrence of severe forms of acne after the pandemic raises the question of whether COVID-19 infection or vaccination may play a role in its aetiology. Cases of mask-related acne exacerbation during COVID-19 have been well-described in the literature. However, there are no data on the effects of COVID-19 vaccination or infection on the development of severe acne. In this report, we present cases of adolescent patients with severe acne to investigate the possible reasons for the increasing number of severe acne cases presenting to our outpatient clinic during the postpandemic period.

Relationship between acne and the use of mask in doctors during the COVID-19 pandemic.

OBJECTIVE: To identify the characteristics of the use of masks and features of acne lesions and acne-like eruptions, among doctors involved in various clinical settings. MATERIALS AND METHODS: An observational, prospective, cross-sectional study was conducted from June to September 2020. The main tool of the study was a form designed with the Google forms platform, which has 17 items. RESULT(S): The responses of 150 participants from Mexico and Latin America were analyzed: 84 participants (56%) were female. The most frequent academic degree among the participants was Doctor of Medicine. The mask with the highest frequency of use was the N95 mask in 98 participants (65.3%);84% of the participants presented typical acne lesions, nodules were the most frequent lesions, only 24 patients did not present characteristic lesions. The topographic region where these lesions most frequently occurred was the chin region. CONCLUSION(S): The importance of the presence of acne and acne-like lesions in medical doctors who use personal protective equipment during their working hours is demonstrated, in order to issue future recommendations related to skin care during the SARS-CoV-2 pandemic.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Maskne: Its relationship to skin microbiome and response to treatment

Mask-wearing during the ongoing COVID-19 pandemic has been associated with an increased occurrence of a form of acne mechanica, popularly termed 'maskne. However, our understanding of this entity is limited. Hence we aimed to study the role of changes in the skin microbiome in mask induced acne and its response to standard acne treatment regimens. This was a prospective observational study. Adult patients having new-onset of lesions suggestive of acne within 6 weeks of regularly wearing mask or exacerbation of pre-existing acne were recruited. Disease severity was assessed using the 'Global Acne Severity Grading System (GAGS). Sample collection was done from pustules or comedones. Treatment was given according to American Academy of Dermatology Guidelines and follow up was done till 12 weeks. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) v.25. Total 50 patients were recruited in the study. 56% patients were female and 44% were male. 60% patients had a history of similar lesions in the past. 56% patients used surgical mask, 34 % used N-95 mask and 18 % used cloth mask. The average duration of use for mask per day was 6.78 +/- 2.65. Cheeks were the most commonly involved site and 62% of patients had mild GAGS. The severity of acne was significantly higher in patients using N-95 mask ( p<0.05) but not associated with duration of mask use, history of mask re-use and use of moisturizers. 70% cases did not require systemic treatment. KOH was negative in all cases. Gram stain showed gram positive cocci and rods in 22% and 14 % cases respectively. Aerobic culture showed Staphylococcus aureus growth in 30% cases and Anaerobic culture showed Cutibacterum acnes growth in 20% cases. In our study we found that maskne presented with a milder variant of acne which in majority of cases responded well to topical treatment standardized for acne vulgaris and had a microbiome profile similar to acne vulgaris.Copyright © 2023

Gender disparities in isotretinoin prescribing patterns for pediatric patients before and during the COVID-19 pandemic

Background: Isotretinoin is an effective therapy for severe, recalcitrant, and nodular acne. Due to its teratogenic effects, isotretinoin requires strict adherence to the iPLEDGE risk management program and mandatory lab work. During the COVID-19 pandemic, the U.S. Food and Drug Administration lifted laboratory requirements, accepted remote pregnancy tests, and permitted telemedicine visits. This study examines the impact of reduced in-person evaluation and testing on physician likelihood of prescribing isotretinoin. Method(s): A retrospective review on demographics, acne history, and treatment was conducted on 142 patients <=18 years old who met inclusion criteria. Dates were divided into 1/1/2019-3/16/2020 (pre-MGH COVID shutdown and required in-person lab testing) and 5/25/2020-8/8/2021 (post-MGH COVID shutdown and paused lab testing requirements). Multivariate linear regression with backward elimination and Wilcoxon rank-sum tests were conducted. Result(s): The median number of dermatology visits to isotretinoin initiation was 3 visits pre-COVID and remained 3 visits during COVID (p=0.85). Backward elimination demonstrated gender (p<.0001) and the interaction between gender and acne severity (p=0.042) as significantly associated with increased number of visits before isotretinoin initiation, with female patients requiring more visits than males before starting isotretinoin at every acne severity level. Race, pre- or during COVID, and insurance type were removed as nonsignificant. Discussion(s): Removal of lab mandates during the COVID-19 pandemic did not result in fewer visits to initiation of isotretinoin. Female patients continue to face delays in receiving isotretinoin even with the acceptance of remote pregnancy tests and increased utilization of virtual visits, highlighting the persistent gender disparities in prescribing practices for pediatric patients with acne.Copyright © 2023

Silymarin: A Phytoconstituent with Significant Therapeutic Potential-A Narrative Review

Silymarin, is a phytoactive constituent isolated from the fruits and seeds of Silybum maria-num L Gaetn.), also called milk thistle belonging to the family of Asteracease. The phytoactive has been used to treat several physiological disorders. The objective of this manuscript was to review the therapeutic prospective of silymarin due to its ability to treat several physiological disorders. The da-tabases such as Pubmed, Elsevier, and Google Scholar were reviewed for the investigations or reviews published related to the title. The discussion is focused on the immunomodulatory, chemopreventive, and anti-inflammatory mechanisms of silymarin in various metabolic and dermatological disorders. In addition, the review discusses the different therapeutic potentials of silymarin such as the management of the liver disorder, skin carcinogenesis, cardiovascular disorders, diabetes mellitus, neurodegenera-tive disorders, and several dermatological disorders such as melasma, anti-aging, acne, rosacea, atopic dermatitis, and psoriasis. Silymarin is safe even with a dose higher than the therapeutic dose. Si-lymarin had good potential for the safe and effective treatment of numerous metabolic and dermatological disorders. © 2023 Bentham Science Publishers.

Occupational dermatitis virtual clinic for healthcare workers: clinics to increase training opportunities to dermatology registrars who are working from home

During the COVID-19 pandemic, there has been a demand from frontline healthcare workers (HCWs) wanting dermatological advice for occupational dermatitis due to increased infection-prevention measures. Various dedicated occupational skin disease clinics in the UK have been set up to help these HCWs, from virtual clinics to drop in clinics (O'Neill H, Narang I, Buckley D et al. Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland. Br J Dermatol 2021;184: 575-7). These clinics provide an opportunity for dermatology registrars to enhance their training in contact dermatitis and teledermatology. In a nationwide survey conducted in January 2020, it was felt that dermatology trainees lacked confidence in handling teledermatology referrals (Lowe A, Pararajasingam A, Goodwin RG. A paradigm shift in trainee confidence in teledermatology and virtual working during the COVID-19 pandemic: results of a follow-up UK-wide survey. Clin Exp Dermatol 2021;46: 544-7). At our institution, a virtual telephone clinic has been set up with occupational health input. A standardized pro forma is given and each person sends photos with an occupational health referral to an encrypted email service. By having this additional information beforehand, a history can be taken in the telephone clinic and appropriate management advice given. There is a dermatology consultant who is on hand to help with any queries that the trainee may have. Medications are sent out to the patient and a letter is copied to the patient, as well as the general practitioner, which details the consultation. The patients are usually discharged from the service;however, if the patients need to be seen a face-to-face appointment is given. In these clinics, various occupational dermatoses have been seen and managed. The most common diagnosis was irritant contact dermatitis of the hands due to increased handwashing and alcohol gel use, and most of these patients have a previous diagnosis of atopy (O'Neill et al.). Other occupational dermatoses seen include allergic contact dermatitis, acne and flare-up of atopic eczema. Owing to the COVID-19 pandemic, some dermatology registrars may be working from home. By doing these clinics, training opportunities in dermatology can continue with registrars still seeing patients virtually and managing the conditions. Teledermatology is being introduced in the new dermatology curriculum from August 2021. This service is also appreciated by the HCWs with these patients being seen promptly and getting their conditions managed, maintaining wellbeing in staff.

Occupational dermatoses during the second COVID-19 pandemic wave: an audit of 401 healthcare workers

Healthcare workers (HCWs) assessed by dermatologists during the first wave of the COVID-19 pandemic had high rates of irritant hand dermatitis, facial dermatitis and acne triggered by wearing personal protective equipment (PPE) (Ferguson FJ, Street G, Cunningham L et al. Occupational dermatology in the time of the COVID-19 pandemic: a report of experience from London and Manchester, UK. Br J Dermatol 2021;184: 180-2). We report data from a tertiary National Health Service trust during the second COVID-19 wave in winter 2020-21. At its peak, the Trust had 835 COVID-positive inpatients and 263 intensive care unit (ICU) beds - one of the largest ICUs in Europe. Building on the published experience of dermatology units, we ran 30 dermatology pop-up clinics over 3 weeks in allocated rest areas across the Trust: 08.00-09.00 h and 13.00-14.00 h on weekdays, from 18 January 2021. HCWs requiring formal dermatology referral were provided with letters to their line managers. In 3 weeks, 401 HCWs were assessed: 327 females and 74 males (mean age 35 2 years). The most frequently seen occupation was nurses (n = 130;32 4%) followed by doctors (n = 74;18 4%). On average, staff spent 9 5 h in PPE per shift. Consistent with the existing literature, the most common diagnosis was irritant hand dermatitis (n = 186;46 4%). There was an increased incidence of acne (n = 171;42 6%) vs. the first wave, where the reported incidence was 17% in a multicentre study (O'Neill H, Narang I, Buckley DA et al. Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the UK and Ireland. Br J Dermatol 2021;184: 575-7). Less common in the second wave was facial eczema (n = 50, 12 5%) and pressure injury (n = 30;7 5%). Thirty-one (16 7%) of the HCWs with hand dermatitis required the prescription of potent topical corticosteroids, suggesting at least moderate symptoms. The majority received emollient samples. It was rare for HCWs to require formal referral (n = 11;2 7%). In our cohort, at least four (1 0%) HCWs required time off work owing to their skin problems. Our data support previous reports of increased occupational dermatoses in HCWs during the COVID-19 pandemic. We highlight the sheer scale of the issue, with 401 HCWs presenting for dermatological assessment in only 3 weeks in one trust. Compared with our experience during the first wave, acne exacerbated or precipitated by masks is increasingly common, which may be due to emollient use to prevent facial eczema or injury when wearing masks.

A Randomized, Controlled Trial of Trifarotene Plus Doxycycline for Severe Acne Vulgaris

OBJECTIVE: We evaluated the efficacy and safety of trifarotene plus oral doxycycline in acne. METHOD(S): This was a randomized (2:1 ratio) 12-week, double-blind study of once-daily trifarotene cream 50microg/g plus enteric-coated doxycycline 120mg (T+D) versus trifarotene vehicle and doxycycline placebo (V+P). Patients were aged 12 years or older with severe facial acne (>=20 inflammatory lesions, 30 to 120 non-inflammatory lesions, and <=4 nodules). Efficacy outcomes included change from baseline in lesion counts and success (score of 0/1 with >=2 grade improvement) on investigator global assessment (IGA). Safety was assessed by adverse events and local tolerability. RESULT(S): The study enrolled 133 subjects in the T+D group and 69 subjects in the V+P group. The population was balanced, with an approximately even ratio of adolescent (12-17 years) and adult (>=18 years) subjects. The absolute change in lesion counts from baseline were: -69.1 T+D versus -48.1 V+P for total lesions, -29.4 T+D versus -19.5 V+P for inflammatory lesions, and -39.5 T+D versus -28.2 for non-inflammatory lesions (P<0.0001 for all). Success was achieved by 31.7 percent of subjects in the T+D group versus 15.8 percent in the V+P group (P=0.0107). The safety and tolerability profiles were comparable between the T+D and V+P arms. CONCLUSION(S): T+D was demonstrated to be safe and efficacious as a treatment option for patients with severe acne.Copyright © 2022 Matrix Medical Communications. All rights reserved.

Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Background: Telemedicine for adolescent and young adult (AYA) long-acting reversible contraception (LARC) care is understudied, as telemedicine was quickly implemented in response to the COVID-19 pandemic. We compare outcomes of AYA LARC follow-up care via telemedicine vs. in-person visits over 1 year. Method(s): This cohort (IRBP00030775) includes patients who 1) had an intrauterine device (IUD) or implant inserted between 4/1/20-3/31/21 and 2) attended an initial LARC follow-up visit (defined as the first visit within 12 weeks of insertion) at 1 of 4 US Adolescent Medicine clinics. Eligible patients were 13-26 years old with a LARC method inserted without sedation and in situ for at least 12 weeks. We compared outcomes over 1 year between AYAs attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported symptoms, menstrual management, acne management, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of menstrual management. Result(s): Our study included 194 AYAs, ages 13.9-25.7 years, who attended an initial follow-up visit. Most AYAs (86.6%) attended only 1 visit in the first 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site, age, race/ethnicity, prior pregnancy, concurrent medical/mental health diagnoses, and reason for LARC (Table 1). In-person attendees were more likely to have the IUD than telemedicine attendees (Table 1). Patient-reported symptoms over 1 year were similar between groups (Table 2). Menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing than telemedicine attendees (p =.001). However, no positive STI tests were captured in either group. Conclusion(s): Approximately 40% of AYAs attended their LARC follow-up visit via telemedicine. LARC type may have influenced modality of visit. While in-person attendees were more likely to have STI testing, there were no positive STI tests detected in either group during the study period. More research is needed to determine if the decrease in STI testing is clinically significant. Other outcomes were similar between visit modalities, suggesting telemedicine may be useful for AYA LARC care. Supporting Figures or Tables: https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-1-ANY.docx https://www.scorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1370854-2-ANY.docxCopyright © 2023

Parent and guardian social media use in a district general hospital paediatric dermatology outpatient clinic

In the age of 'influencers', social media is exerting an ever-increasing impact in dermatology. More than half the world's population use social media and its popularity continues to grow. However, studies have confirmed that content is not always evidence based. Owing to its accessibility, social media is frequently used as an information resource for patients on managing their own skin condition. The influence that it has on parents and guardians in paediatric dermatology is less well described. A 10-point questionnaire was designed to assess social media use in parents and guardians with regard to their child's skin condition. Data were collected on parent or guardian age, sex, online platforms used and changes in management as a direct result of social media-sourced information. Children's demographics, diagnosis and disease duration were also noted. Questionnaires were anonymously distributed in a general paediatric dermatology outpatient clinic waiting room over 3 months. A chi2-test of independence was used to examine the relationship between social media use and parent or guardian age, sex and child's disease duration. In total, 116 parents and guardians participated in the survey. Average child age was 9.9 years (range 0-18), male-to-female ratio 1 : 1. Diagnoses included eczema (n = 35;30%), naevi or other skin lesions (n = 27;23%), acne (n = 18;15%) and psoriasis (n = 4;3%). Ninety-three (80%) of the dermatoses had a duration of > 1 year. Over 40% (n = 48) of parents and guardians used social media on at least one occasion as an educational resource for their child's skin condition across eight online platforms, most commonly Facebook (n = 21;44%), Google (n = 15;31%) and YouTube (n = 8;16%). There was no significant relationship between social media use and parent or guardian age (P = 0.89), sex (P = 0.10) or disease duration (P = 0.77). Of the 48 social media users, 26 (54%) parents and guardians changed their use of over-the-counter products, and a further 14 (29%) altered use of physician-prescribed treatments as a result of social media-derived information. Our findings suggest that a significant number of parents and guardians use social media to understand their child's dermatosis and some change the management based on it. Following the COVID-19 pandemic, a shift to virtual platforms for human interactions has fuelled the use of social media. With its growing popularity, it is likely that dermatologicalrelated content will also increase and therefore this should be addressed in both adult and paediatric clinics.

136. Telemedicine for Adolescent and Young Adult Long-acting Reversible Contraception Initial Follow-up Visit: Outcomes Over 1 Year

Purpose: Telemedicine for adolescent and young adult (AYA) care, including long-acting reversible contraception (LARC) care, was quickly implemented in response to the COVID-19 pandemic. Therefore, outcomes of telemedicine LARC care is understudied. We compare outcomes of AYAs receiving LARC follow-up care via telemedicine and in-person over 1 year. Methods: This cohort study includes patients who had LARC, intrauterine device (IUD) or implant, inserted between 4/1/20-3/31/21 and attended an initial LARC follow-up visit at 4 US Adolescent Medicine clinics. Initial LARC follow-up visit was defined as the first visit within 12 weeks of insertion. Eligible patients were 13-26 years old, had LARC inserted without sedation, and had LARC in place for at least 12 weeks. We compared outcomes over 1 year between patients attending the initial follow-up visit via telemedicine (telemedicine attendees) to those who completed the visit in-person (in-person attendees). Outcomes included patient-reported side effects, medical menstrual management, acne management, IUD malposition or expulsion, sexually transmitted infection (STI) testing and results, and LARC removal. Descriptive statistics described the sample and compared groups. Adjusted Poisson regression examined factors associated with number of visits and adjusted logistic regression models examined the association between initial visit modality and initiation of medical menstrual management. Site-specific institutional review board approvals were obtained. Results: Our study included 194 AYAs, ages 13.9-25.7 years (mean 18.7 years, SD = 2.3) who attended an initial follow-up visit. Most AYAs (n = 168, 86.6%) attended only one visit in the 12 weeks post-insertion. Telemedicine attendees comprised 40.2% of the sample. Telemedicine and in-person attendees were similar with regards to site of LARC insertion (p =.43), age (p =.17), race/ethnicity (p =.25), prior pregnancy (p =.95), complex medical diagnoses (p =.32), menstrual diagnoses (p =.11), and reason for LARC (p =.82). In-person attendees were more likely to have the IUD than telemedicine attendees (p =.003). Bivariate analyses showed similar frequency of patient-reported symptoms over 1 year between groups. Outcomes of menstrual management (OR = 1.02, CI: 0.40-2.60), number of visits attended (RR = 1.08, CI: 0.99-1.19), acne management (p =.28), IUD expulsion (p =.13), IUD malposition (p =.51), and LARC removal (p =.95) were similar between groups. In-person attendees were more likely to have STI testing done (p =.001) than telemedicine attendees. However, no positive STI tests were captured in either group. Conclusions: Roughly two-fifths of patients presenting to an initial LARC follow-up visit did so via telemedicine. Type of LARC may influence modality of follow-up visit. Except for STI testing, outcomes over 1 year were similar regardless of the first visit modality. Reassuringly, no positive STI tests were detected in either group over 1 year of follow-up. More research is needed to determine if the decrease in STI testing for patients seeking care via telemedicine is clinically significant. Telemedicine may play an important role in AYA LARC follow-up care, and more research is needed in this area. Sources of Support: N/a.

Epidemiology of Occupational Contact Dermatitis (OCD) on health workers in Covid-19

Background Generally, the diagnosis of OCD can be considered after a history of exposure to the suspected material and a thorough physical examination. Meanwhile, vital information about it is often overlooked during the initial consultation. Objective Evaluating the epidemiological profile of OCD cases in health workers due to the COVID-19 pandemic and evaluating complaints, manifestations and causative materials of OCD cases in health workers at the isolation ward of Dr. Soetomo Surabaya Hospital during the Covid-19 pandemic. Methods Purposive sampling was used to design research samples from accessible populations that matched the inclusion requirements while those who met exclusion criteria were included as research samples. Results Majority OCD patients are women and the most common age range is between 22-35 years old. The occupation most affected by OCD while working at isolation ward during the pandemic is nurses. The most common complaint is itching followed by redness of the skin which appears most frequently on the hands. The most prominent clinical manifestations are desquamation followed by erythema-like skin lesions. Medical gloves are the sort of personal protection equipment that causes OCD the most, followed by hand hygiene activities. High risk factors for OCD include a family history of atopic illnesses, history of asthma and an early history of atopic dermatitis. Conclusion The use of PPE can cause several effects on the skin such as physical trauma to the skin, acne, contact dermatitis, urticaria, and aggravate previous skin diseases. The most common skin disorders are erythema, papules, scales, fissures, erosions, ulcers, vesicles and wheals. Complaints of contact dermatitis can be reduced and prevented by taking preventive measures in the form of using moisturizers on areas that are often exposed. Copyright © 2023 Pakistan Association of Dermatologists. All rights reserved.

Assessing Acne Severity: Teledermatology Versus Face to Face Consultations During the COVID-19 Pandemic.

Background: Acne vulgaris is a common skin disorder in pilosebaceous units that is self-limited, especially in adolescents. This disease not only causes permanent physical complications but also psychosocial effects that harm the quality of life. Telemedicine has grown its popularity in recent years, especially during the COVID-19 pandemic. Store and Forward (SAF) teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability, and clinical outcomes similar to face-to-face visits. Objective: We sought to compare the severity of acne vulgaris by teledermatology with face-to-face consultations. We also observe the capability of teledermatology in establishing the severity of acne vulgaris. Methods: This study is an observational analytic study with a cross-sectional design involving 105 patients with a diagnosis of acne vulgaris based on inclusion and exclusion criteria. The characteristics of age and sex were recorded. The severity of acne vulgaris was established directly by the resident and teledermatologically by the dermatologist consultant. Teledermatology was carried out based on photo documentation of five facial lesion areas; namely forehead, chin, right cheek, left cheek, and the entire face, along with photos from the history submitted by the resident. An assessment for acne vulgaris severity was carried out based on the classification from the International Consensus Conference on Acne Classification System. This classification divided acne vulgaris as mild, moderate, and severe with an ordinal measuring scale. A compatibility test was also performed to determine the comparison between teledermatology and face-to-face consultations in establishing the severity of acne vulgaris. Comparison of the severity of acne vulgaris was assessed by the kappa value. Results: Acne vulgaris was found more common in women (n=71, 67.6%) and those aged 18 to 22 years (n=55, 52.4%). Most of the subjects have moderate severity based on face-to-face consultations and teledermatology examination (n=52 (49.5%) and n=50 (47.6%), respectively). The value of the capability test between teledermatology and face-to-face consultations in comparing the severity of acne vulgaris is 0.611, which means the capability is considered good. Conclusion: In this study, the teledermatology examination shows good conformity when compared with face-to-face consultations in assessing severity of acne vulgaris.

Occupational Skin Dermatitis among Healthcare Workers Associated with the COVID-19 Pandemic: A Review of the Literature.

The skin is the outermost layer of the human body and is continually exposed to numerous external stimuli, which can cause unwanted skin irritation. Occupational skin diseases are the most prevalent form of work-related illness and are found in a variety of sectors, particularly healthcare. During the recent COVID-19 pandemic, healthcare professionals experienced a variety of unexpected, unusual occupational skin diseases associated with COVID-19-engaged employment. Because the clinical characteristics of these types of skin inflammation are unique, this review focuses on the characteristics of a large category of occupational workers, namely COVID-19-engaged healthcare professionals. Furthermore, we examined the potential pathogeneses of occupational skin disorders associated with COVID-19-engaged labor, as well as different preventative methods.

Comparison between the diagnosis of acne vulgaris by teledermatology and face-to-face consultations

Background: Acne vulgaris is a common skin disorder in the pilosebaceous unit that is self-limited, especially in adolescents. Adam Malik Hospital in Medan reported the incidence of acne vulgaris to be 1.10%. Telemedicine has become popular in recent years, especially during the COVID-19 pandemic. SAF teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability and clinical outcomes similar to face-to-face visits. This study aimed to compare teledermatology’s diagnostic test parameters and accuracy and face-to-face consultations in diagnosing acne vulgaris. Methods: This study was an observational analytic study with a cross-sectional design involving 110 suspected acne vulgaris. The characteristics of sex and age were recorded. The resident established the diagnosis of acne vulgaris directly and teledermatologically by the consultant based on photo documentation of 5 facial lesion areas, namely the forehead, chin, right cheek, left cheek, and the entire face, along with the photo with photos from the history submitted by the resident. Diagnostic tests were carried out, including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and an agreement test. Results: Acne vulgaris was more common in women (76 patients, 69.1%) and patients aged 18-22 years (55 patients, 50%). Of 110 patients, 105 were diagnosed with acne vulgaris by face-to-face consultations and teledermatology. Teledermatology showed 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The agreement test between teledermatology and face-to-face consultations was 1, indicating favorable agreement. Conclusion: There was no significant difference in the diagnosis of acne vulgaris through teledermatology and face-to-face consultations. © 2021, Sanglah General Hospital. All rights reserved.

The dermatology education series: A digital approach to improving patient engagement

Dermatology is unique in that not only are there a shortage of dermatologists in the United States but patient access care to is largely disproportionate. As a response to the chasm of access that exists, many patients have relied on the Internet to obtain information on how to address their concerns, and this often comes at the cost of non-evidence based remedies being promoted. The inception of the 2020 COVID-19 pandemic has led many physicians to restrategize their approach to patient care. Fortunately, utilization of a virtual model has been integral to this process. The purpose of this study was twofold: increase patient confidence in addressing dermatologic concerns by providing targeted education on specific dermatologic topics and define a framework that can be implemented by dermatologists looking to use social media to increase patient education and access to dermatologic care. 3 separate education sessions (webinars) were held where the topics of hair, eczema, and acne were discussed, respectively. Each session was roughly 1 hour in length. Attendees were given pre- and postwebinar surveys to assess existing patient attitude toward their knowledge of dermatologic topics and their comfort in consulting a dermatologist with their concerns. Across the 3-day series, the total number of registrants was 30. 12 registrants for the hair webinar with an overall attendance rate of 33%;12 registrants for the eczema webinar with an overall attendance rate of 33%;6 registrants for the acne webinar with an overall attendance rate of 50%.

Visual vulnerability: Daily burden and psycosocial impact of acne and video calling during COVID-19

Background/Objectives: Acne is a common inflammatory skin disorder in both adolescence and adulthood. Facial and truncal acne adversely impact emotional well-being and daily activities. Acne sufferer perspectives were investigated to understand disease burden and psychosocial impact associated with acne and video calling during COVID-19, as little information exists on acne’s burden and psychosocial impact specifically related to video calls. Methods: A United States quantitative email survey (N = 2000) was administered by Wakefield Research December 4th-15th, 2020. Respondents were ages 14 29 with self-reported moderate facial and/or truncal acne. Results: During COVID-19, 91% (N = 2000) of participants used video calling. Adults ≥ 21 years reported more time than participants < 21 years preparing video call appearance (24 vs. 19 average minutes, respectively). 65% reported planning appearance before a video call. 27% of women reported concealing acne during video calls all the time. 86% indicated ≥1 instance of missed conversation caused by the distraction of assessing acne on screen (13% ‘all the time’, 24% ‘often’). More participants felt comfortable with others seeing facial acne (64%) than truncal (36%) during a video call. Conclusions: Video calling in truncal and facial acne is associated with increased quality of life burden, daily activity adjustments, and anxiety in minors and adults. Survey participants reported milder disease;thus, lost professional and educational opportunities would presumably be greater with more severe acne. Ability to assess patients effectively and provide optimum treatment may be impacted by occlusive behaviors and further add to the burden of their disease.

Facial dermatoses due to increased use of masks in medical students during COVID-19 pandemic: A cross sectional study from JSMU

Objective To determine the frequency of skin manifestations associated with prolonged mask wearing during the course of ongoing COVID-19 pandemic. Methods A cross-sectional study was conducted at Jinnah Sindh Medical University (JSMU), Karachi. A total of 138 medical students, who gave history of wearing masks were enrolled. The demographic data including age, gender, and their year of education was collected. A total of 20 questions were asked related to the type of mask, duration of wearing mask, associated and underlying skin disorders, etc. All information was carefully recorded on Google forms. Results This study included 138 participants, 124 (89.9%) females and 14 (10.1%) males. The type of masks used by the medical students varied, however 84.8% used surgical masks. The average duration of mask wear was 4 hours for 72.4% of the participants. There was no significant relation between skin changes and the type and duration of mask wear. The common skin manifestations reported in this study were itching (24.6 %), redness (27.5%), rash (10.1%), burning sensation (12.3%), acne (24.6%), pimples (37.7%), pigmentation (8.7), cracked skin (1.4%), scaling of skin (2.9%), and 29.7% reported no changes. The most frequently affected locations were cheeks (41.3%), followed by chin (13.8%), nasal bridge (10.1%) and perioral area (8%). Participants with history of atopic dermatitis were affected slightly more by itching, redness, rash, burning sensation, acne than those without a history of atopic dermatitis however these manifestations had no significant relation (p>0.05). Pressure bruises were reported in 23.9% of the participants and there was no significant relation with the skin manifestations. About 33% of the females who use makeup under the mask found it inconvenient due to pimples and itching. (p<0.05). Relationship between different skin types and use of cleansers for maintaining skin hygiene generally (p=0.006) and after taking mask off is significant (p=0.034). Significant relation exists between people experiencing pimples after taking off masks and using oral/systemic drugs (p=0.003), and other products (ice cubes, day cream, steroids, skincare regime) for management (p=0.012). Significant relation exists between acne after taking off mask and use of topical drugs (p=0.034). Conclusion The increase in skin manifestations is associated with the increased use of face masks during the COVID 19 pandemic among medical students. As mask wearing can't be compromised due to the nature of the working environment, certain guidelines need to be established to prevent or reduce the occurrence of such manifestations.