Covid-19
Seven hundred and forty patients, mean age 49 and drawn from the Mount Sinai Health System, were tested with an extensive battery of validated neuropsychological tests at an average 7.6 months following their acute COVID-19 infection. Eleven percent to 24% were found to have defects in various domains of COGNITIVE FUNCTION, with more individuals who were hospitalized demonstrating such defects compared to those who were solely managed in the outpatient setting.
TO READ MORE: Becker JH, et al. Assessment of Cognitive Function in Patients After COVID-19 Infection. JAMA Netw Open. 2021;4(10):e2130645. doi:10.1001/jamanetworkopen.2021.30645.
The U.S. Department of Agriculture has confirmed SARS-CoV-2 infection in 33% of white-tailed deer sampled for viral antibodies in Illinois, Michigan, New York, Ohio and Pennsylvania. In another study done by Penn State researchers, the actual virus was isolated from deer in Iowa. DEER MAY SERVE AS A RESERVOIR FOR COVID-19 and the possibility exists for transmission to other animals and even humans.
TO READ MORE: Crist C. With COVID-19 prevalent in deer, experts urge precautions. MD Edge Family Medicine. November 18, 2021.
PEDIATRIC DERMATOLOGY
A retrospective Australian study of 118 cases of PREPUBERTAL LICHEN SCLEROSUS disclosed that the likelihood of developing a vulvar structural abnormality persisting beyond menarche was increased 3.54-fold among those who were not adherent to topical corticosteroid use regimens.
TO READ MORE: Kherlopian A and Fischer G. Does compliance to topical corticosteroid therapy reduce the risk of development of permanent vulvar structural abnormalities in pediatric vulvar lichen sclerosus? A retrospective cohort study. Pediatr Dermatol. 2021; November 4. doi: 10.1111/pde.14840.
During the initial nationwide lockdown in Argentina, data derived from a pediatric survey (N=1118) disclosed a marked decrease in the prevalence of HEAD LICE. This is presumably due to the interruption in normal insect dispersal due to school closures and social distancing practices.
TO READ MORE: Galassi F, et al. Head lice were also affected by COVID-19: A decrease on Pediculosis infestation during lockdown in Buenos Aires. Parasitol Res. 2021;120(2):443-450. doi: 10.1007/s00436-020-07038-y.
RHEUMATOLOGIC DISEASES
Sjögren’s syndrome can be diagnosed with 91% to 100% sensitivity and specificity by the combination of positive serum SSA/Ro antibody and positive salivary TRIM29. This is the best biomarker combination yet found to differentiate PRIMARY SJÖGREN’S SYNDROME from patients who have dry eye/dry mouth but not true Sjögren’s syndrome.
TO READ MORE: Sembler-Moller ML, et al. Combined serum anti-SSA/Ro and salivary TRIM29 reveals promising high diagnostic accuracy in patients with primary Sjögren’s syndrome. PLoS One 2021:16(10):e0258428. doi:10.1371/journal.pone.0258428.
(Editor’s note: The salivary test is not readily available except in a few research laboratories. It is being developed as a point-of-care test.)
Patients with SYSTEMIC LUPUS ERYTHEMATOSUS may not mount a proper/sufficient response to COVID-19 vaccines. This is especially true if the individual is receiving either systemic steroids and one immunosuppressive medication or two immunosuppressives. Antimalarial medications were not found to adversely alter antibody response to current COVD-19 vaccines.
Izmirly P. Evaluation of SARS-CoV-2 vaccine response in a multi-racial/ethnic cohort of patients with systemic lupus erythematosus. Presented at the Virtual 2021 Annual Meeting of the American College of Rheumatology. (Abstract 1420).
TO READ MORE: A full paper on this abstract has been published in Arthritis and Rheumatology: Izmirly PM, et al. Evaluation of immune response and disease status in systemic lupus erythematosus patients following SARS-CoV-2 vaccination. Arthritis Rheumatol. 2022 Feb;74(2):284-294. doi: 10.1002/art.41937.
PSORIASIS
Successful biological therapy for psoriasis may sometimes need to be interrupted (surgery, family emergencies, travel with lost or forgotten drug, and so on). This comprehensive analysis, including 35 major manuscripts, revealed no significant impact on skin clearance rates following TREATMENT INTERRUPTION FOLLOWED BY RE-INSTITUTION OF THE SAME THERAPY. This has been shown definitively for etanercept, adalimumab, ixekizumab, brodalumab, guselkumab, risankizumab, and tildrakizumab. Preliminary data also suggest that drug withdrawal followed by re-institution is not often associated with increased immunogenicity.
TO READ MORE: Wang CY, et al. Biological therapy interruption and re-treatment in chronic plaque psoriasis. J Drugs Dermatol. 2021;20:1063-1071. doi: 10.36849/JDD.5716.
A retrospective Turkish study of 115 patients receiving biologic drug therapy for psoriasis for at least one year and who switched specific therapy at least once, disclosed that the single most important factor promoting a TREATMENT ALTERATION was secondary drug failure (rather than adverse events or initial failure). Other factors associated with changing biologic agent included younger age and the presence of psoriatic arthritis.
TO READ MORE: Akdogan N, et al. Age and psoriatic arthritis are important predictors of biologic agent switch in psoriasis. Expert Rev Clin Pharmacol. 2021; September 23. doi: 10.1080/17512433.2021.1979394.
CONTACT DERMATITIS
A retrospective analysis was conducted of over 43,000 patients who had been patch tested with the standardized 65 to 70 North American Contact Dermatitis Group allergen set, as well as supplemental allergens. Nearly 22% (21.9%) had relevant reactions to one or more supplemental ALLERGENS. Dermatitis was most common on the face and hands among those with positive reactions to supplemental allergens. The most frequent source of patch test positive supplemental allergens was personal care products.
TO READ MORE: Warshaw EM, et al. Importance of supplemental patch testing beyond a screening series for patients with dermatitis. JAMA Dermatol. 2021; November 3. doi: 10.1001/jamadermatol.2021.4314.
The UTILITY OF CONTINUOUS BLOOD SUGAR MONITORING DEVICES may be limited in some patients due to severe contact dermatitis to a component of the device itself or its recommended adhesive.
TO READ MORE: Kamann S, et al. Modern diabetes devices for continuous blood sugar measuring: Limitations due to contact allergies. J Dtsch Dermatol Ges. 2021; November 9. doi: 10.1111/ddg.14621.
HAIR AND NAILS
A nationwide population-based cohort study, utilizing data derived from the Taiwanese National Health Insurance Research Database, compared alopecia areata patients to matched controls. Alopecia areata was associated with more than three times greater risk of RETINAL DISEASE, including detachment and vascular occlusion.
TO READ MORE: Ting HC, et al. Association between alopecia areata and retinal diseases: A nationwide population-based cohort study. J Am Acad Dermatol. 2021; October 31. doi: 10.1016/j.jaad.2021.10.045.
Another nationwide population-based cohort study, utilizing data derived from the Taiwanese National Health Insurance Research Database, compared 2,534 adult alopecia areata patients (mean age 53.9) to 25,340 matched controls. Investigators found a threefold higher risk of developing any type of DEMENTIA and a fourfold higher risk of developing Alzheimer’s disease in those with alopecia areata versus the controls.
TO READ MORE: Li CY, et al. Association of Alopecia Areata and the Risk of Dementia: A Nationwide Cohort Study. J Clin Psychiatry. 2021 October 26;82(6):21m13931. doi: 10.4088/JCP.21m13931.
HIDRADENITIS SUPPRATIVA
A small (N=20 per group) prospective Italian study revealed that Hurley stage I and II hidradenitis patients who received five sessions of Alexandrite-laser-assisted HAIR REMOVAL (inguinal/axillary) plus oral zinc did better than the comparable control group who only received oral zinc. Hair removal sessions were performed at six-week intervals.
TO READ MORE: Molinelli E, et al. Alexandrite laser as an adjuvant therapy in the management of mild-moderate hidradenitis suppurativa: a controlled prospective clinical study. J Am Acad Dermatol. 2021 November 11. doi: 10.1016/j.jaad.2021.10.060.
A small study (N=67) of actively treated hidradenitis suppurativa patients disclosed common (37%) use of ALTERNATIVE OR SUPPLEMENTAL TREATMENT MODALITIES, regardless of age, gender, ethnicity and disease severity. Such modalities may interfere with traditional treatments.
TO READ MORE: Lane J, et al. A comparison of alternative medicine users and non-users in patients with hidradenitis suppurativa. J Drugs Dermatol. 2021;20:1072-1074. doi: 10.36849/JDD.6046.
CUTANEOUS ONCOLOGY, SURGERY AND LASERS
Using the SEER database, researchers found that among localized MERKEL CELL TUMORS, those in the scalp or neck were associated with the highest probability of mortality at five years (26%).
TO READ MORE: Cullison CR, et al. Tumor primary site as a prognostic factor for Merkel cell carcinoma disease-specific death. J Am Acad Dermatol. 2021;85:1259-1266.
LYMPHOVASCULAR INVASION (LVI) is a critical factor in predicting adverse outcomes, as witnessed by the multicenter retrospective review of 10,707 invasive cutaneous squamous cell carcinomas. Tumors with LVI versus those without: local recurrence (12.3% v. 1.1%), metastases (4.2% v. 0.4%) and disease-specific death (16.2% v. 0.4%).
TO READ MORE: Kus KJB, et al. Higher metastasis and death rates in cutaneous squamous cell carcinomas with lymphovascular invasion. J Am Acad Dermatol. 2021 November 10; doi: 10.1016/j.jaad.2021.11.002.
DRUGS AND DEVICES
IMMUNE CHECKPOINT INHIBITORS have truly revolutionized the management of numerous advanced malignancies. Unfortunately, this class of drugs is associated with a variety of cutaneous immune-related adverse events, including: morbilliform dermatoses, itching, lichenoid and psoriasiform eruptions, and bullous pemphigoid. This paper succinctly points out currently recommended interventions for these adverse events. Depending upon severity, topical, oral and parenteral steroids comprise the mainstay of therapy.
TO READ MORE: Adusumilli NC, et al. Treating cutaneous immune-related adverse events from immune checkpoint blockade. J Drugs Dermatol. 2021;20:1133-1134. doi: 10.36849/JDD.0421.
GENERAL DERMATOLOGY
Investigators analyzed data from 28 published studies (26 of which were based on hospitalized patients). They found that mortality in bullous pemphigoid and pemphigus vulgaris was primarily due to respiratory disease and heart failure, rather than infection. The reason(s) for these findings are unclear.
TO READ MORE: Hasanaj A, et al. Cause-specific mortality in people with bullous pemphigoid and pemphigus vulgaris: A systematic review and meta-analysis. Br J Dermatol. 2021; September 12. Doi: 10.1111/bjd.20759.
Firm subcutaneous masses or exophytic nodules at sites of insulin injections may represent CUTANEOUS AMYLOIDOSIS. These lesions may interfere with insulin absorption and lead to poor glucose control.
TO READ MORE: Kranc CL, et al. Cutaneous insulin-derived amyloidosis presenting as hyperkeratotic nodules. Cutis. 2021;107:e6-e9. doi: 10.12788/cutisD161.
(Editor’s note: Initial large-scale studies on this modality were done in Europe with nearly all subjects being Caucasian.)
A case of chronic urticaria was demonstrated due to changes in position and named “POSTURAL URTICARIA.” This entity was not well controlled despite combination of omalizumab and optimized antihistamine therapy.
TO READ MORE: Gabrielli S, et al. Case of postural urticaria in a 14-year-old girl. BMJ Case Rep. 2021 Oct 28; 14(10). doi: 10.1136/bcr-2021-246276.