RESUMO
Coronavirus disease 2019 (COVID-19) is responsible for at least 2 546 527 cases and 175 812 deaths as of April 21, 2020. Psoriasis and atopic dermatitis (AD) are common, chronic, inflammatory skin conditions, with immune dysregulation as a shared mechanism; therefore, mainstays of treatment include systemic immunomodulating therapies. It is unknown whether these therapies are associated with increased COVID-19 susceptibility or worse outcomes in infected patients. In this review, we discuss overall infection risks of nonbiologic and biologic systemic medications for psoriasis and AD and provide therapeutic recommendations. In summary, in patients with active infection, systemic conventional medications, the Janus kinase inhibitor tofacitinib, and biologics for psoriasis should be temporarily held until there is more data; in uninfected patients switching to safer alternatives should be considered. Interleukin (IL)-17, IL-12/23, and IL-23 inhibitors are associated with low infection risk, with IL-17 and IL-23 favored over IL-12/23 inhibitors. Pivotal trials and postmarketing data also suggest that IL-17 and IL-23 blockers are safer than tumor necrosis factor alpha blockers. Apremilast, acitretin, and dupilumab have favorable safety data and may be safely initiated and continued in uninfected patients. Without definitive COVID-19 data, these recommendations may be useful in guiding treatment of psoriasis and AD patients during the COVID-19 pandemic.
Assuntos
COVID-19/epidemiologia , Dermatite Atópica/tratamento farmacológico , Psoríase/tratamento farmacológico , SARS-CoV-2 , Humanos , Fatores Imunológicos/efeitos adversos , Interleucina-17/antagonistas & inibidores , Interleucina-23/antagonistas & inibidores , Inibidores de Janus Quinases/efeitos adversos , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in a paradigm shift in disease management. Since immunosuppression may cause increased susceptibility to COVID-19, there is uncertainty as to whether systemically treated nail psoriasis patients are at increased infection risk. While specific data on nail psoriasis treatments and COVID-19 is lacking, we present clinical trial data on rates of upper respiratory infections, nasopharyngitis, viral infection, pneumonia and overall infections. Some systemic medications and biologics are associated with increased in infections risk compared to placebo in clinical trials. However, this data should be regarded cautiously since clinical trials on nail psoriasis, particularly controlled studies, are lacking. Our recommendations may be helpful in guiding physicians managing nail psoriasis patients during the COVID-19 pandemic.
Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Doenças da Unha/terapia , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Psoríase/terapia , COVID-19 , Humanos , Doenças da Unha/epidemiologia , Psoríase/epidemiologia , SARS-CoV-2RESUMO
INTRODUCTION: There is a paucity of randomized trials on nail surgery. Since there are no established guidelines, dermatologists may have false beliefs about best practices in performing nail surgery and post-procedural care. METHODS: We identified five common myths concerning nail surgery. A PubMed search was performed to refute or support these beliefs. RESULTS: We found compelling evidence that refutes these nail surgery myths. We found that epinephrine can be safely used for nail surgery, hydrogen peroxide and tap water is recommended for wound cleansing, prophylactic topical antibiotics should be avoided, calcium alginate, or amniotic membrane dressings are valuable dressing alternatives, and digital dressings have a low risk profile with precise technique. DISCUSSION: Randomized controlled trials for nail surgery are lacking. Data from similar fields may guide dermatologists in performing nail surgery. J Drugs Dermatol. 2020;19(3): 230-234 doi:10.36849/JDD.2020.4861.