The global impact of the COVID-19 pandemic on the management and course of chronic urticaria.

INTRODUCTION: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. AIM: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. MATERIALS AND METHODS: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. RESULTS: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. CONCLUSIONS: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.

Comparison of rituximab and intravenous immunoglobulin in the treatment of autoimmune bullous diseases: Real-life data from a single centre.

BACKGROUND/AIM: Rituximab (RTX) and intravenous human immunoglobulin (IVIG) have been shown to be effective in the treatment of autoimmune bullous diseases (ABD), mainly pemphigus vulgaris (PV). The present study aimed to assess the clinical response of patients with ABD, mainly PV to RTX, IVIG and combined regimen of both. Whether adding IVIG to RTX therapy affects the achievement of complete remission off therapy (CR off), reduces time to CR off, time to steroid cessation, and decreases relapse rate was also investigated. METHODS: Data of 33 patients with ABD [PV (93.9%)], including clinical response to treatment, steroid cessation time, time to CR off and relapse, were recruited from medical charts. RESULTS: CR off and relapse rate, mean time to CR off and relapse was 86.7% (n = 13) vs 60.0% (n = 6) and 53.3% (n = 8) vs 40% (n = 4), 12.77 ± 9.30 vs 11.25 ± 13.40 and 24.1 ± 16.7 vs 13.0 ± 3.6 months in RTX and combination group, respectively. Older age (P = .005), younger age at the time of diagnosis (P = .004), lesser disease duration to the initiation of RTX (P = .004), lesser BMI (P = .026) and female gender (P = .037) were associated factors with CR off. CONCLUSION: Adding IVIG to RTX did not increase CR off rates; it also did not decrease time to CR off, time to steroid cessation, relapse rates and did not increase time to relapse. Patient and disease characteristics, including age, younger age at the time of diagnosis, lesser disease duration before RTX treatment, lesser BMI and female gender, are factors associated with CR off.

Association of serum cortisol and dehydroepiandrosterone sulfate (DHEAS) levels with psychological stress in patients with vitiligo

Background/aim: Vitiligo is a depigmentation disorder that leads to serious psychological burden in patients, who are frequently reported to have depression and anxiety. The aim of this study was to investigate the association between stress-related hormone levels and psychological stress in vitiligo. Materials and methods: In this study46 vitiligo patients and 46 controls were enrolled; their cortisol, dehydroepiandrosterone sulfate (DHEAS),and cortisol/DHEAS levels were measured. Psychological burden was assessed by the Beck Depression Inventory and Perceived Stress Scale. Results: Patients and controls did not differ in terms of cortisol, DHEAS, or cortisol/DHEAS. Patients had higher perceived stress than controls but did not differ in terms of depression scores. Correlation analyses revealed that cortisol/DHEAS correlated positively with perceived stress (P = 0.009, r = 0.272). The correlation between cortisol/DHEAS and perceived stress was stronger in the patient group (P = 0.013, r = 0.363) and close to zero among controls. In regression analyses, lower depression and higher perceived stress were shown to predict cortisol/DHEAS values. Conclusion: Vitiligo patients significantly differed from the healthy population in terms of hormones and psychological distress. There was also an association between perceived stress and cortisol/DHEAS ratio in vitiligo. Abnormality of hormonal response to distress lowers DHEAS, which is known for its antioxidant properties, a possible mechanism for vitiligo development. Another important finding is the significance of using the composite variable cortisol/DHEAS, which seems to be more sensitive to distress than each of its components. We suggest its use in future studies on psychological distress­hormone relationships.

Comparison of Early and Late Onset Psoriasis (EOP and LOP) Regarding Systemic Inflammatory Comorbidities: LOP is a More Rapid Subtype of Psoriasis.

Introduction: Early onset psoriasis (EOP) and late onset psoriasis (LOP) differ regarding genetic background, clinical presentation and course of disease. Objectives: In this study, comparison of EOP and LOP regarding systemic inflammatory comorbidities which are frequently seen in psoriasis and determination of possible differences is aimed. Methods: A total of 160 plaque psoriasis patients (121 with EOP and 39 with LOP) were enrolled for the study. Data was collected with face-to-face questionnaire and patients medical chart evaluation. Collected data included medical and family history, clinical features and parameters indicating severity of psoriasis, results of laboratory work-up, physical and dermatological examination findings, presence of joint and nail involvement and associated inflammatory systemic comorbidities such as cardiovascular diseases (CVD), diabetes mellitus (DM), hypertension (HT), metabolic syndrome (MS), obesity. Results: Nail involvement and PsA occurred more rapidly in LOP compared to EOP (P < 0.01, P < 0.01). Compared frequencies in LOP and EOP were 7.7% versus 0.8% for CVD, 38.5% versus 14% for HT, 33.3% versus 9.9% for DM and 44.7% versus 24.8% for MS, respectively. CVD, HT, DM and MS were significantly more frequent in LOP compared to EOP (P = 0.045, P = 0.001, P < 0.01, P = 0.022). Results of multivariate analysis performed taking into account the age, gender, severity parameters of disease, alcohol consumption, smoking habits and other concurrent systemic comorbidities revealed LOP to be an independent risk factor for CVD and DM (P < 0.01, R2: 0.036, P < 0.01, R2: 0.077). Conclusions: LOP seems to interact with systemic comorbidities hence generates more severe inflammatory burden and shows a more rapid course.

Treatment of psoriasis with biologics in the early COVID-19 pandemic: A study examining patient attitudes toward the treatment and disease course.

BACKGROUND: Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been ongoing all around the world with a wide range of clinical course including asymptomatic cases to severe and fatal respiratory tract disease. Patients on immunosuppressive treatments were predicted to be more susceptible to COVID-19. AIMS: It was aimed to assess treatment continuity, the course of psoriasis and the course and clinical features of COVID-19 in patients treated with biological agents for psoriasis at the early initial period of COVID-19 pandemic. PATIENTS/METHODS: Patients treated with biological agents for psoriasis at our institute were contacted by phone between 1 and 10 July 2020 and fulfilled a questionnaire about their continuity to psoriasis treatments, clinical course of psoriasis, and any suspicion/diagnosis of COVID-19. RESULTS: A total of 106 patients, 41 females and 65 males, were enrolled. Mean age of the patients was 46.1 ± 12.1 years (range: 19-77). Median duration of psoriasis was 18 years (min-max: 1 month-51 years). Twenty-four patients (22.6%) were using tumor necrosis alpha inhibitors (ETA:1, IFX:19, ADA:4), whereas 82 patients (77.4%) were using interleukin (IL) 12/23 or IL-17 inhibitors (UST:48, SECU:30, IXE:4). Seventy-six patients (71.7%) continued the treatment, whereas 30 patients (28.3%) interrupted the treatment voluntarily. Twenty out of 30 patients (66.6%) who interrupted the treatment had an exacerbation of psoriasis. None of the patients were diagnosed with COVID-19 in the study period. CONCLUSION: Patients with psoriasis who received biological therapy continued their treatment at a high rate during the early period of the COVID-19 pandemic. No COVID-19 diagnosis was made among patients whether they continued or discontinued treatment. Recurrence and exacerbation of psoriasis in a significant proportion of patients who interrupted treatment and absence of COVID-19 diagnosis in each group support the importance and safety of continuity of biological treatments for psoriasis in COVID-19 era.