Cutaneous manifestations & Dermatologic care IN COVID-19
care IN COVID-19
A variety of cutaneous manifestations have been reported in ptns with confirmed diagnosis or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease that may include a morbilliform rash; urticaria; pernio-like, acral lesions; livedo-like, vascular lesions; & vesicular, varicella-like eruptions. A severe multisystem inflammatory syndrome with muco-cutaneous, systemic, lab profile, and multiple imaging of atypical, severe Kawasaki disease has also been observed in children & adolescent COVID-19 infection. Skin injury, mechanical/friction dermatitis, & hand irritant contact dermatitis owing to personal protective equipment (PPE) & hand hygiene precautions have been observed in most of the health care stafs involved in the care of ptns with COVID-19 infection. The use of a barrier film or dressings at pressure points of PPE, in addition to the frequent use of emollients after hand washing may help reducing skin damage & irritation.
The COVID-19 pandemic has its contribution in the need to consider the aspects of dermatologic care. For example, adjustment of the approach to im/m medications, phototherapy, skin cancer medications, in addition to the routine clinical care. The impact of immunosuppressive therapy (im/m) for dermatologic lesions on risk for developing SARS-CoV-2 infection and risk for COVID-19 sequela still uncertain. The decision to continue or to commence im/m therapy for dermatologic disease during pandemic era should be currently individualized. Examples of important factors to consider include the ptn's infectious state, the im/m under consideration, and the impact of therapy cessation on the dermatologic diseases and other co-morbidities. In view of the lack of evidence indicating benefit of im/m withdrawal in ptns without COVID-19, continuation of im/m agents for dermatologic disease can be considered a safe & appropriate option in this cohort. The option to commence a new im/m agent should include careful consideration of potential risk & benefit of therapy. In ptns with risk for severe COVID-19 disease, it may be wise to defer im/m agents in favor of other therapies.
Infection activity is a crucial indication for withdrawal & avoidance of start of im/m agents, and some professional institutes, including the American Academy of Dermatology, have provided statements that recommend withdrawal of im/m drugs for skin disease in ptns developing COVID-19 infection. In view of the paucity of evidence on risks & benefits of discontinuation, our decision to continue or discontinue an im/m agent in ptns with presumed/confirmed COVID-19 infection may be proceeded on an individualized basis. If withdrawn, an im/m agent may be resumed with documented complete recovery form COVID-19. The COVID-19 pandemic has contributed to prevalent use of telemedicine for routine patients’ care. With in-person visit, the appropriate infection control measures should be undertaken.
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