cord-011451-nnunjora	2020	title: "Considerable unreimbursed medical care is delivered through electronic patient portals: a retrospective review" We conducted a retrospective review to assess patient-initiated messages on the online portal 37 used in the dermatology clinic at UT Southwestern Medical Center called "MyChart. The message type was verified, and medical advice requests 50 were reviewed independently by each author. Encounters where physicians managed the entire 51 patient complaint through the MyChart portal were considered as separate electronic E&M 52 services of the patient''s concern utilizing the CMS guidelines and thus potentially eligible for 53 provider reimbursement. Contact 56 hours and patient clinic encounters also rose during this same time period, but the rise in 57 messages outpaced the time spent in face-to-face care (Figure 2 ). In our sample, 58% of the 58 messages were medical advice requests and 30.75% of all messages met criteria for separate 59 E&M services via the portal.
cord-034195-yiv8rp7y	2020	authors: Guhan, Samantha M.; Nathan, Neera R.; Raef, Haya; Cavanaugh-Hussey, Margaret; Tan, Jennifer K. title: COVID-19 and healthcare disparities: Innovative ways to meet the dermatologic needs of patients experiencing homelessness COVID-19 and healthcare disparities: Innovative ways to meet the dermatologic needs of 1 patients experiencing homelessness 2 3 We hypothesized that dermatologists can further aid this population by mobilizing 57 critical supplies commonly found in our offices and using the generosity of local companies to 58 create COVID-19 care kits, which contain items necessary to protect PEH from disease. 61 62 Prior to supply collection, local shelters were contacted to identify the most useful items to 63 patients. 76 77 Building upon relationships we already have as dermatologists, we were able to create a COVID-78 19 kit donation program that provided PEH with necessary supplies to minimize the spread of 79 disease.
cord-252521-m7asfqva	2020	Division of Dermatology, Department of Medicine 12 1 In addition to preventing the spread of infection, the role of the dermatologist is also to provide 33 appropriate care to patients with skin disease to prevent complications, and to lower the burden on the consulted with ED physicians for HS symptoms (of which, 36% consulted with more than 10 ED 45 physicians), and 30% made 10 or more trips to the ED in the pre-diagnosis stage. Virtual visits also allow us to counsel patients 68 regarding maintenance regimens for the prevention of disease flares, HS action plans informing steps to 69 take during HS exacerbations and when to contact a provider, and methods to improve overall mental 70 health, including maintaining a healthy diet, utilizing warm compresses and engaging in support groups 71 through the CSPA. Health Care Utilization Patterns and Costs for Patients 80 Increased Suicide Risk in Patients with 86
cord-256565-59bnifxm	2020	
cord-261929-x688qqdr	2020	key: cord-261929-x688qqdr title: Perspectives on the Recommendations for Skin Cancer Management During the COVID-19 Pandemic cord_uid: x688qqdr Therapy-related travel for the high-risk category (high-risk cSCC, invasive, thick and 56 ulcerated melanoma, MCC, tumors with aggressive histology or in sensitive areas) must be 57 weighed against each patient''s risks. For rapidly growing cSCC, particularly of the head and 58 neck (eyes, ears, lips, mouth) and symptomatic lesions, more immediate treatment may be 59 considered. MMS may be utilized for high-risk SCC and rare cancers (including undifferentiated 60 pleiomorphic sarcoma and adnexal tumors with concern for rapidly developing metastasis). To Telemedicine visits should be prioritized, limiting in-person visits for biopsies of highly 71 suspicious lesions and for in-office therapies for the highest-risk cancers. This pandemic presents 72 evolving challenges, and we must continue to provide optimal treatment for our patients while 73 preventing global spread of the disease and preserving resources. Managing Cancer Care During the COVID-79 19 Pandemic: Agility and Collaboration Toward a Common Goal
cord-262311-vdbk50pl	2020	title: Response to "Risks of Hydroxychloroquine use for COVID-19 prophylaxis" A recent Wall Street Journal article reported data compiled from the Global Rheumatology Alliance (a coalition of rheumatologists) that more than five dozen "people taking hydroxychloroquine and other treatments for chronic rheumatologic diseases have become infected with Covid-19, according to an analysis of emerging data that is a sign the drugs may not protect people from the new coronavirus." 8. Risks of Hydroxychloroquine use for COVID-19 prophylaxis Hydroxychloroquine in the management of critically ill patients with COVID-19: the need for an evidence base Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: an observational study Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial
cord-263664-isgcm4lj	2020	
cord-266589-oj76ol8v	2020	title: The risk of respiratory tract infections and symptoms in psoriasis patients treated with IL-17-pathway inhibiting biologics: A meta-estimate of pivotal trials relevant to decision-making during the COVID-19 pandemic 4 12 To test this hypothesis, we calculated a meta-estimate from the placebo-controlled period 13 of phase 3 pivotal IL-17 trials of terms consistent with RTI of secukinumab, ixekizumab, and 14 We found an increased risk of RTIs in the IL-17 groups as 19 compared to placebo (odds ratio 1.56, 95% Confidence Interval 1.04-2.33; Table 1 ). Since 20 prescribing information is not inclusive of all respiratory AEs from the pivotal trials that 21 supported approval of interleukin-17 inhibitors, we conducted a summary risk estimate using 22 data from the placebo-controlled period of these studies obtained from clinicaltrials.gov. This 23 more detailed analysis yielded similar findings to our meta-estimate of prescribing information 24 data (odds ratio 1.31, 95% Confidence Interval 1.05-1.62; Table 2 ).
cord-267357-7aap2cte	2020	
cord-268072-pt2u6608	2020	title: Reply to: "Skin damage among health care workers managing coronavirus disease-2019" Reply to: ''''Skin damage among health care workers managing coronavirus disease-2019'''' 1 The main skin problems in health care managing COVID-19 and using medical devices are the hand eczema and the skin damage affecting the nasal bridge, cheek, and forehead. Lan et al 1 reported that the health care workers who wore medical devices for more than 6 hours showed higher risks of skin damage, with desquamation in more than 60% of cases, and other signs, such as erythema, maceration, and ulcers, in a smaller percentage of cases. 4 These products are also useful to prevent the development of pressure injuries and may be used after removing the medical devices as well the nonadherent dressings (soft silicone/paraffin). Some authors described the use of thin hydrocolloid dressing to prevent pressure injuries on the nasal bridge in case of acute noninvasive ventilation. Skin damage among health care workers managing coronavirus disease-2019
cord-273493-xsroivzj	2020	title: A Dermatologic Manifestation of COVID-19: Transient Livedo Reticularis We present two cases of transient unilateral livedo reticularis (LR) in COVID-19-positive non-ICU subjects to bring awareness to a dermatologic manifestation. Seven days into his symptoms, he noted a transient non-pruritic blanching unilateral livedoid patch on the right anterior thigh resembling LR ( Figure 1 ). Ten days after testing positive, and with complete clinical convalescence of COVID-19 symptoms, she was sitting outside in long pants under direct sunlight for approximately 20-30 minutes. The rash lasted approximately 20 minutes and did not recur upon re-challenge with sun exposure the following day. 3 We hypothesize that the microthromboses that manifest in other organs (e.g. cardiopulmonary) 4 for 20 minutes; and did not recur upon rechallenge with re-exposure to the sunlight the next day.
cord-274517-9lewc581	2020	2 The purpose of this study was to determine the magnitude of 33 the initial impact of COVID-19 on US dermatology outpatient care. Although by 3/16 there were only 24.6k cases 45 nationally 3 , the early-phase decrease in patient volume and office days suggests the magnitude of 46 disease concern impact was greater than actual prevalence. 66.3% of respondents estimated a >50% 48 decrease in patient volume in the coming 2 weeks (18.9% completely closing practices). 50 A greater negative impact was found in US "hotspot" regions 4 (36% of respondentsFigure S1 ) for week 51 3/16-20 for practice days (3.0 hotspots vs. No significant differing telemedicine usage (39.5% hotspots vs 37.2% non-hotspots) or 53 overall for the next 2 weeks was 37.8%. Our findings demonstrate the significant early impact of COVID-19 on US dermatologic care and can help 66 better understand national trends.
cord-274696-h7kihj9w	2020	title: Acral findings during the COVID-19 outbreak: Chilblain-like lesions should be preferred to acro-ischemic lesions The authors report a case series of 132 patients with acute acro-ischemic lesions affecting nonhospitalized patients during the COVID-19 outbreak. In their paper, Fernandez-Nieto et al repeatedly use the appellative "acro-ischemic" for this cutaneous manifestation. As the authors state, true ischemic lesions have been reported in severely-ill patients with proven coronavirus infection 3 . Although the comparison between acral lesions in asymptomatic patients and ischemic lesions in severe cases is important, we find the term "acute acro-ischemic lesions" not accurate. The term chilblain-like lesions, in our opinion, therefore would be preferable for the lesions that present in these patients rather than acro-ischemic lesions. Characterization of acute acroischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients COVID-19) infectioninduced chilblains: a case report with histopathological findings
cord-274750-fynxciwg	2020	Based on these 51 considerations, we believe there is insufficient evidence to recommend continuing JAK inhibitors in 52 patients who are acutely infected with SARS-CoV-2. 53 54 Napolitano et al suggest that baricitinib and upadacitinib might be useful in treating the cytokine 55 release syndrome (CRS) that can occur in SARS-CoV-2 infection. Furthermore, there is 58 evidence in both rhesus macaques and mice infected with the original SARS virus, SARS-CoV, that a 59 suboptimal early anti-viral type I interferon response may predispose to this late manifestation. In summary, we believe there is insufficient evidence to recommend that JAK inhibitors be continued in 70 all patients taking these medications who are acutely infected with SARS-CoV-2. While JAK inhibitors 71 may prove useful in the treatment of SARS-CoV-2-associated CRS, this is a separate consideration of a 72 relatively uncommon manifestation of this viral infection that occurs late in disease course.
cord-276147-30buoweg	2020	authors: Avancini, Joao; Miyamoto, Denise; Arnone, Marcelo; Villas-Boas Gabbi, Tatiana; Ferreira, Paula Silva; Neta, Cyro Festa; Sanches, Jose Antonio title: Absence of specific cutaneous manifestations of SARS-Cov-2 in a reference center in Brazil cord_uid: 30buoweg Contents of the manuscript have not been previously published and are not currently submitted elsewhere. All listed authors have seen and approved of the manuscript and will sign off on any subsequent manuscript revisions. To the editor: We read with interest the letters from the New York City report regarding the absence of COVID toes lesions on their patients and the recommendation of caution when concluding that cutaneous findings are specifically due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases
cord-278754-vy5c7411	2020	Our study aimed to evaluate early practice patterns to identify any variations in the quality of and access to teledermatology service. Prior to the pandemic, 32% of patients seen in person were older than 65 years and 7% of patients seen in person were non-English speaking, those defined as necessitating interpreter service (Table 1) . During the pandemic, 23% of patients seen in teledermatology were older than 65 years and 3% of patient seen in teledermatology were non-English speaking ( Table 1 ). The two most common diagnoses seen in teledermatology, other than a lesion of concern, were acne and dermatitis at 52% and 49% of total visits, respectively ( Table 2 ). Our study suggests that elderly patients and non-English speaking patients may be experiencing unequal access to teledermatology care during the pandemic. Lastly, our study found that longer visits were more likely to be conducted by telephone, rather than video.
cord-282355-urys21ry	2020	title: Reply to "Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients": discussing specificity Title: Reply to "Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients": discussing specificity Daniel Ortega-Quijano, MD 1 , Juan Jimenez-Cauhe, MD 1 , Patricia Burgos-Blasco, MD 1 , Natalia Jimenez-Gomez, MD 1 , Diego Fernandez-Nieto, MD 1 . The positive predictive value, that is, the probability that a person with a varicella-like rash has COVID-19, is much more relevant, as a high value would justify SARS-CoV-2 testing. For us, the main contribution of the study by Marzano and colleagues is that, with all exanthems currently having a high positive predictive value for COVID-19, that of varicella-like rash is probably the highest since vesicular rash is more specific for viral disease than others 3 . Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients
cord-285030-ecsa83kf	2020	key: cord-285030-ecsa83kf authors: Jimenez-Cauhe, Juan; Ortega-Quijano, Daniel; Prieto-Barrios, Marta; Moreno-Arrones, Oscar M.; Fernandez-Nieto, Diego title: Reply to "COVID-19 can present with a rash and be mistaken for Dengue": Petechial rash in a patient with COVID-19 infection date: 2020-04-10 journal: J Am Acad Dermatol DOI: 10.1016/j.jaad.2020.04.016 sha: doc_id: 285030 cord_uid: ecsa83kf nan Dermatologists have a unique opportunity to study COVID-19 cutaneous manifestations during this pandemic, and illustrative images are the first step for other colleagues to start looking for them. A golden principle of medicine becomes now more important: "the more you see, the more you know; and the more you know is the more you see". COVID-19 can present with a rash and be mistaken for Dengue Cutaneous manifestations in COVID-19: a first perspective
cord-285691-pceenwb6	2020	key: cord-285691-pceenwb6 title: Advances in skin science enable the development of a COVID-19 Vaccine cord_uid: pceenwb6 expressing adenovectors and adjuvant in the same MNAs resulting in a vaccine that induced both antibody responses and enhanced cytotoxic cellular immunity that is likely important for "universal" vaccines and cancer immunotherapies. Taken together, these and studies by others demonstrate the potential for the development of cutaneous immune engineering strategies to control systemic immune responses including the potential for developing novel vaccine strategies and immunotherapies, and even negative immunization strategies to treat systemic allergy and autoimmune diseases. Advances in skin biology are making important contributions to the fight against the COVID-19 pandemic demonstrating once again that dermatology is more than skin deep. Microneedles for drug and vaccine delivery Microneedle array delivered recombinant coronavirus vaccines: Immunogenicity and rapid translational development Improved cutaneous genetic immunization by microneedle array delivery of an adjuvanted adenovirus vaccine
cord-286132-ag2l1xa7	2020	Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the treatment of patients with moderate to severe psoriasis with randomized withdrawal and retreatment: Results from the phase III, double-blind, placebo-and active comparator-controlled VOYAGE 2 trial an anti-interleukin-23 monoclonal antibody, for the treatment of moderate to severe plaque-type psoriasis in Japanese patients: Efficacy and safety results from a phase 3, randomized, double-blind, placebo-controlled study Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: Results from the phase III, double-blinded, placebo-and active comparator-controlled VOYAGE 1 trial Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1) Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1)
cord-294262-yvbufnf4	2020	All 15 patients presented typical clinical lesions and symptoms of herpes 39 simplex/zoster. In spite of performing PCR tests for SARS-CoV-2 from the 42 content of the vesicles in only three patients, the results were all negative. Regarding vesicular rashes or varicella-like COVID-19 exanthems 3 , we previously 44 reported four cases in which we performed both PCR multiplex for herpesvirus and rt-45 PCR for SARS-CoV-2, directly from the content of the vesicles. This reasonably rules out a role of herpes 47 viruses 3 , and a potential infective ability of SARS-CoV-2 through the vesicles. In our current experience, the diagnosis of 55 herpesvirus infection in COVID-19 patients does not usually involve diagnostic doubts, 56 due to the clinical presentation and reported symptoms being typical of the disease, 57 even when lesions are extensive (Figure 1) .
cord-294871-bqw48zi5	2020	title: Androgenetic alopecia in COVID-19: compared to age-matched epidemiologic studies and hospital outcomes with or without the Gabrin sign For example, our Indian colleagues, in a 56 pilot observational prospective study (raw data available at doi.org/10.17632/jdkx76y8fz.1), 57 examined outcomes in admitted COVID-19 patients by AGA severity. To further exemplify that, we present in this reply letter one of our 71 unpublished patients from Brazil: a previously healthy 37-year-old physician (HNS=5, depicted 72 in Fig1), with no previous co-morbidities; he required hospitalization for 21 days, which 73 included 16 days in the ICU (ventilator for 10 days and hemodialysis for 5 days). 5 It is remarkable that severe outcomes 81 such as requirement for ventilator and/or fatalities have occurred in men with this phenotype 82 without other known co-morbidities at younger age groups, such as 35-45 years.
cord-295371-ccqne6nu	2020	title: Dermatology residents and the care of patients with coronavirus disease 2019 (COVID-19) Additionally, there is an American Academy of Dermatology Code of Medical Ethics that states, ''''It is .unethical for a dermatologist .to refuse the management of a patient because of medical risk, real or imagined (page 18, section 1C).'''' 4 Subsequently, in the current pandemic, it is a dermatologist''s duty to treat patients in the clinic, in the hospital, in the emergency room, and in the intensive care unit if called upon. The current COVID-19 pandemic is a public health crisis that requires physicians, of all specialties, to step up and help. The bottom line is that to fulfill your obligation as a professional in the house of medicine, ensure medical care is delivered to those in need (distributive justice), help patients, and do no harm (beneficence and nonmaleficence,) and for your own dignity, do not call a lawyer!
cord-296013-6ej3pd0u	2020	key: cord-296013-6ej3pd0u title: Telemedicine for Inpatient Dermatology Consultations in Response to the COVID-19 Pandemic cord_uid: 6ej3pd0u 3 Inpatient 46 dermatology services will continue to provide impactful care throughout the COVID-19 crisis 47 with a particular need to help allocate scarce resources. Outpatient 55 teledermatology services have the potential to increase access to dermatology care, and to 56 address health care disparities for urban-underserved and rural populations. 5 Dermatologists are poised to 58 utilize teledermatology to increase access to dermatologic care for hospitalized patients, reduce 59 the risk of infection of patients, trainees and staff, and reduce the use of precious resources such 60 as personal protective equipment (PPE) and medical supplies. Characterisation and diagnosis of ulcers in 108 inpatient dermatology consultation services: A multi-centre study Improved patient access and outcomes with the 111 integration of an eConsult program (teledermatology) within a large academic medical 112 center
cord-301478-j4b2534p	2020	key: cord-301478-j4b2534p title: Risk of hospitalization and death from COVID-19 infection in patients with chronic plaque psoriasis receiving a biological treatment and renal transplanted recipients in maintenance immunosuppressive treatment cord_uid: j4b2534p Manuscript words: 493 13 We performed a retrospective observational study in order to determine whether Hospital and compared to the Verona population (n=257,353) ( Table 1 ). The overall study 60 population is resident in Verona, so that its reference Hospital is the same. As of April 10, 2020, the total number of COVID 19-positive patients (including 65 those that did not require hospitalization or die) in Verona was 3,199 (1.2% of population). -Legend: * asymptomatic individuals were not tested so the true number of COVID-19 positive patients is unknown; CNI: calcineurin inhibitors; mTORi mammalian target of rapamaycin; PsA: psoriatic arthritis; PsO: psoriasis Data of psoriasis and transplant patients are derived from electronic medical record of the Hospital. Should patients stop their biologic treatment during the 95 COVID-19 pandemic
cord-302993-t4quwfva	2020	title: COVID-19 and its impact on medical student education in dermatology Teledermatology offers a potential solution to medical student education during the COVID-19 67 Herein, we discuss methods of implementing teledermatology in order to optimize 68 medical student learning. Optimizing teledermatology for medical student education 71 Although many dermatology appointments have been transitioned to virtual visits, medical 72 students can still participate in these encounters. This allows medical 74 students to learn fundamental dermatologic concepts while participating in patient care, which 75 Although telemedicine is useful, it is also important to recognize that there are elements of 85 dermatology education that cannot be replaced virtually, such as the ability to assess texture, 86 perform biopsies, or use tools such as dermoscopy, Wood''s lamp, and KOH scraping. For the time being however, it is important to 88 optimize tele-education and to involve medical students as much as possible. Optimizing teledermatology visits for dermatology resident 100 education during the COVID-19 pandemic
cord-303800-h3lvbldz	2020	title: Reply to "Treatment considerations for patients with pemphigus during the COVID-19 pandemic" In particular, rituximab should be considered 43 for patients with severe disease and without active COVID-19 illness after discussion of specific 44 individual-level risks (age, comorbidities, occupation) and benefits of rituximab. We would also 45 consider rituximab for younger patients without comorbidities and with less severe disease. We have limited data directly 47 comparing adverse events in those treated with rituximab versus other therapies but compared to 48 prednisone alone, individuals treated with rituximab plus short-term prednisone had decreased 49 cumulative exposure to prednisone and fewer adverse effects, 2 including known risk factors for Conversely, physicians should discuss that rituximab may reduce immune response to 63 vaccination, 5 which may decrease the ability of patients to effectively receive a COVID-19 64 vaccine. Treatment considerations for patients 80 with pemphigus during the COVID-19 pandemic
cord-304330-egvdvvtx	2020	William Damsky MD, PhD 1,* , Danielle Peterson MD 1 Brett King MD, PhD 1,* 4 5 has suggested that SARS-CoV-2 infection is sometimes characterized by a muted anti-40 viral Type I and III interferon (IFN) response, 6,7 which may explain progression to 41 severe clinical manifestations in some patients; a robust Type I IFN response was 42 associated with rapid viral clearance and bland disease course. Together, these data suggest that COVID toes may be a 46 marker of patients that are able to mount a robust anti-viral immune response to SARS-CoV-2 and prognosticate a milder course of COVID-19. 6,7 Therefore, we hypothesize that pernio-like lesions, which can 81 occur with elevated Type I IFN signaling, are the result of a robust anti-viral response in patients with COVID-19, and, therefore, are associated with a favorable disease course, 83 as observed in these patients. Pernio-like skin lesions associated 101 with COVID-19: a case series of 318 patients from 8 countries
cord-304874-pjdedw7w	2020	title: Invited response to the comment on "Dermatology Residents and the Care of COVID-19 Patients" I am greatly appreciative to Dr. Basil Patel for his comments 1 on the dermatoethic''s piece entitled "Dermatology Residents and the Care of COVID-19 Patients" 2. As someone who is intimately involved with dermatology residents at two universities, I am personally very aware of residency concern and fear over this pandemic. The risk of returning home after caring for infectious patients is something I did not mention but was acutely aware of. This implies that attendings are not fulfilling their obligation to care for these infectious patients. Comment on Dermatology Residents and the Care of COVID-19 Dermatology Residents and the Care of COVID-19
cord-305119-y3a1qyi9	2020	The authors provided a pertinent overview of infection risk associated with commonly used biologics to treat psoriasis in light of the current coronavirus disease 2019 (COVID-19) outbreak. We agree that this time has been particularly concerning for patients taking immunomodulators/immunosuppressants who are unsure of their risk for severe disease. In response to the previous commentary, the goal of this letter is to expand and provide the latest information about COVID-19 along with considerations for addressing patient concerns surrounding dermatology-related immunomodulator/immunosuppressant use. Theoretical data from previous coronavirus outbreaks has suggested a strong role for type I interferon, B-cellereleased antibodies, tumor necrosis factor-, and other cytokines in the viral immune response (Fig 1) . Immunosuppressants decrease cytokines that recruit and differentiate immune cells needed to clear the infection. Currently, there are no data describing the benefits or risks of stopping immunomodulators/ immunosuppressants during the COVID-19 outbreak.
cord-305234-nclk7bbo	2020	key: cord-305234-nclk7bbo authors: Do, Mytrang H.; Minkis, Kira; Petukhova, Tatyana A.; Lipner, Shari R. title: Strategies to prevent SARS-CoV-2 transmission during dermatologic head and neck surgery date: 2020-06-27 journal: J Am Acad Dermatol DOI: 10.1016/j.jaad.2020.06.983 sha: doc_id: 305234 cord_uid: nclk7bbo nan . Furthermore, the patient''s mouth and nose are often exposed We hope that these suggestions provide the best possible protection for dermatologic efficiency particle air, RT-PCR, reverse transcription-polymerase chain reaction, SARS-CoV-2, 81 severe acute respiratory syndrome coronavirus 2 Head and neck surgery is a high-risk procedure for COVID-19 87 transmission and there is a need for a preventive strategy to protect professionals Detection of SARS-CoV-2 in Different Types of Clinical 4. American College of Surgeons. COVID-19: Considerations for Optimum Surgeon 19/clinical-guidance/surgeon-protection American Academy of Dermatology. Reopening the dermatologic surgery office in the
cord-308212-l8flyso7	2020	title: Applying the ethical principles of resource allocation to drugs in limited supply during a public health crisis Applying this principle to antimalarials, severe 47 COVID-19 patients as well as patients with malaria or severe rheumatologic disease, for whom 48 other effective treatments are unavailable, should be favored. In contrast, for systemic lupus erythematosus (SLE) 58 patients, a RCT showed that discontinuing hydroxychloroquine leads to a 2.5x increased 59 relative risk of clinically-relevant flares and a 6x increased relative risk of severe exacerbation 60 compared to placebo 4 . Under normal 63 circumstances, if a reasonable patient prefers antimalarials for skin disease, and the treatment 64 is indicated, then the drugs should be prescribed. However, patient autonomy is diminished in 65 public health emergencies, as healthcare ethics shifts priority to populations over individuals 5 . "Application of ethical principles of resource allocation in the COVID-19 pandemic" 107 (adapted from Emanuel et al. Hydroxychloroquine and azithromycin as a 86 treatment of COVID-19: results of an open-label non-randomized clinical trial
cord-309230-4f5frlr5	2020	title: Occupational Dermatitis to Facial Personal Protective Equipment in Healthcare Workers: A Systematic Review Articles were included if they reported occupational dermatoses caused by surgical/procedure masks and/or N95 respirators. Allergic contact dermatitis was reported to the elastic straps, glue, and formaldehyde released from the mask fabric. Conclusions This systematic review from members of the American Contact Dermatitis Society highlights cases of occupational dermatitis to facial protective equipment including potential offending allergens. Personal protective equipment (PPE), including medical face masks, is essential to the safety of 29 healthcare workers (HCWs). 76 Two studies on HCWs not in epidemics or pandemics described facial contact dermatitis 6 and 77 facial skin concerns, some of which may have been related to masks. A review of non-glove personal 450 protective equipment-related occupational dermatoses reported to EPIDERM between 451 1993 and 2013 Allergic contact dermatitis from formaldehyde textile 457 resins in surgical uniforms and nonwoven textile masks
cord-309914-1lpl26eo	2020	During the time of the SARS-CoV-2 pandemic, questions arise regarding patients being treated with 37 immunomodulatory therapies. In particular, is there an increased risk of acquiring the infection or 38 experiencing a worse outcome from SARS-CoV-2? we can look at safety data from clinical trials to try to understand patient susceptibility to different 40 infections. In light of the 42 growing off-label use of JAKi in dermatology in addition to pharmaceutical industry sponsored clinical 43 trials of JAKi for alopecia areata, atopic dermatitis, vitiligo, etc, dermatologists need data to better 44 understand the risks of JAKi treatment in order to best manage and counsel our patients during this 45 unique time. We analyzed and collated Adverse Events data from JAKi clinical trials. We also collated pulmonary 53 toxicities of JAKi to identify potential risks of worsening severe respiratory disease from SARS-CoV-2, and 54 such toxicities are all but absent.
cord-316793-clshw9v2	2020	key: cord-316793-clshw9v2 title: Cling film for mobile phone to prevent cross-infection during COVID-19 pandemic cord_uid: clshw9v2 Mobile phone has become an inseparable part of dermatology practice and dermatologists use mobile phones in various ways while clinically examining the patients. In this COVID-19 pandemic era, mobile phones are more likely to be contaminated with the virus in health-care settings, need to be sanitized properly after use as it can be a possible carrier of the virus. 1 However, it''s practically not feasible to sanitize mobile phones with alcohol-containing sanitizer or chlorine solutions as there may be an ill effect of these chemical solutions on the mobile screen. Cling film roll can be a better solution for this challenge. These are thin transparent plastic wraps with smooth surfaces, can be used to wrap mobile thoroughly before reaching the hospital Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1
cord-318033-vlwlgp82	2020	title: Expansion of asynchronous teledermatology during the COVID-19 pandemic Meanwhile, 1564 virtual visits were conducted in April 2020 compared to 0 in April 2019. Asynchronous teledermatology visits also increased, driven primarily by eVisits. Despite significant nationwide reductions in ambulatory visits 5 , provider-to-provider dermatology eConsults increased by more than 20% from April 2019 to April 2020. Importantly, the growth of eVisits and eConsults resulted in asynchronous teledermatology accounting for 1 in 5 of all dermatology visits conducted at our institution in April 2020 ( Figure 1 ). More specifically, our experience shows that asynchronous teledermatology has the potential to facilitate routine dermatology care and thus open in-office availability for more urgent issues. Dermatology practices as vectors for COVID-19 transmission: A call for immediate cessation of nonemergent dermatology visits Teledermatology in the Era of COVID-19: Experience of an Academic Department of Dermatology
cord-322435-c88tkbnz	2020	title: Mucocutaneous Disease and Related Clinical Characteristics in Hospitalized Children and Adolescents with COVID-19 and MIS-C Objective To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C. [1] [2] [3] [4] [5] In addition to fever and respiratory symptoms, pediatric patients infected with 74 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen in COVID-19, also 75 develop eruptions and mucositis. The purpose of this study was to estimate prevalence of integumentary findings in hospitalized 81 patients with COVID-19 and MIS-C, to characterize their morphologic patterns, to evaluate whether rash 82 Criteria for confirming the diagnosis of MIS-C included age <21 years, fever for ≥24 hours, clinically 89 severe illness requiring hospitalization, multisystem organ involvement, no alternative plausible 90 diagnosis, and exposure to a suspected or confirmed COVID-19 case or positive SARS-CoV-2 infection 91 by PCR/serology testing. Clinical and epidemiological features of 36 children 219 with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study
cord-322798-5r3kf9wa	2020	title: Creating Dermatology Guidelines for Covid-19: The Pitfalls of Applying Evidence Based Medicine to an Emerging Infectious Disease To the Editor: We recently co-authored a piece in the JAAD about modifications the American Academy of Dermatology (AAD) implemented to enhance the rigor of evidence-based clinical practice guidelines. Due in part to these concerns, the AAD Covid-19 taskforce published interim guidance that did not distinguish among biologic classes. 4 In the face of uncertainty, societies including the American College of Cardiology took a stance to keep patients on ACE-inhibitors while they await more evidence. These changes to dermatology guidelines do not exist in a vacuum; important ethical implications include patient outcomes such as missed melanomas and the loss of employment for practice staff. We should acknowledge the shift from evidence based medicine to reliance on expert guidance, and appreciate the potential for guideline reversal.
cord-323241-1twnqr4k	2020	title: Sexual transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A new possible route of infection? 2, 3 In addition, SARS-CoV-2 RNA identification and intracellular staining of viral nucleocapsid protein in rectal epithelia demonstrated that the virus infects such epithelial cells. [2] [3] [4] Moreover, SARS-CoV-2 can also be transmitted through the saliva, and ACE2 has been detected on the mucosa of oral cavity, which is rich in epithelial cells. 4 Therefore, if saliva and feces are both capable of carrying the virus and ACE2 is expressed both in the glandular cells of rectal epithelia and oral mucosa, how can we be sure that sexual intercourse does not represent another way of contagion? 5 This means that the gastrointestinal tract may continue shedding the virus and that fecal-oral, or eventually sexual, transmission may be possible despite the apparent recovery.
cord-325992-qik2w1f1	2020	key: cord-325992-qik2w1f1 title: Notes and Comments on "Proposed Approach for Re-using Surgical Masks in COVID-19 Pandemic" cord_uid: qik2w1f1 Angeli Eloise Torres, MD, DPDS 1 its effect on N95 respirator integrity rather than a quantification of its virucidal activity. 2 This 24 makes it difficult to compare its virucidal advantage over ultraviolet C (UVC) and other 25 methods. For N95 respirators, failure of fit-testing after 30 decontamination would have potential catastrophic effects on healthcare providers. Proposed approach for reusing surgical masks in COVID-19 51 pandemic Other Methods of Decontamination of Filtering Facepiece N-95 Respirators during the COVID-54 The importance of form 56 fit testing in decontamination of N95 respirators: a cautionary note Ultraviolet 59 germicidal irradiation: possible method for respirator disinfection to facilitate reuse during 60 COVID-19 pandemic Ultraviolet 65 germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators
cord-329353-0pwgzeec	2020	title: Male balding as a major risk factor for severe COVID-19: a possible role for targeting androgens and transmembrane protease serine 2 to protect vulnerable individuals Keywords: COVID-19; SARS-CoV-2; Gabrin sign; vulnerability; androgen receptor; androgenetic 29 alopecia; anti-androgen therapy; transmembrane protease serine 2; TMPRSS2; Dutasteride; 7. 4 Recently, results of a study using 58 J o u r n a l P r e -p r o o f bromhexine hydrochloride, a common cough over-the-counter medication only available 59 outside the United States were reported. 4 Results of our recent COVID-19 prospective cohort study 67 involving 77 hospitalized men were also particularly encouraging: Only 1 out of 12 individuals 68 were admitted to the ICU (8%) in the cohort of men using 5-alpha-reductase inhibitors or other 69 anti-androgen drugs (dutasteride=9, finasteride=2, and spironolactone=1), versus 38 out of 65 70 men (58%) not taking anti-androgens (p=0.0015). Medications that target TMPRSS2 have demonstrated improved COVID-19 outcomes in clinical 73 studies, and have the potential to protect vulnerable individuals during the pandemic.
cord-332859-j10n38ah	2020	title: Dear Dermatoethicist: Medical Student Dermatology Rotations in the Context of COVID-19 We frequently have medical students rotate through our department but, due to the COVID-19 pandemic, we are hesitant to accept rotating students at this time. Dear Program Director, Deciding whether to accept medical students in your department is challenging. Beneficence is at play as rotating through dermatology benefits medical students as it is an excellent way for students to learn more about the field and help them determine if dermatology is in fact the specialty they would like to pursue. Since the start of the pandemic, medical students rotating in dermatology have been temporarily sidelined as clinics have closed and are only seeing emergencies. With the COVID-19 pandemic, there is a risk that medical students may become infected themselves and subsequently infect their patients and fellow health care workers if allowed to participate in clinical rotations. The role of medical students during the COVID-19 pandemic
cord-336450-2ndan331	2020	title: Response to "Patient preference for cellulitis treatment: at-home care is preferred to hospital-based treatment" preference of patients for at-home treatment of cellulitis rather than hospital-based care. Our findings highlight a similar pattern observed by our cardiology 2 and neurology 3 colleagues -63 namely, that fewer patients sought hospital-based care for acute dermatologic problems like 64 These results suggest that some patients 65 with SSTIs may have avoided hospital-based evaluation and treatment due to fear of COVID-19. While we can neither comment on whether these patients sought evaluation elsewhere (such as in 67 an outpatient or telemedicine setting) nor on the outcomes of patients who may have foregone 68 hospital evaluation for SSTIs, the findings of Gabel et al 1 have proven prescient. Patient preference 79 for cellulitis treatment: at-home care is preferred to hospital-based treatment
cord-338597-aq80vius	2020	The BIOBADADERM project is promoted by the Fundación Piel Sana Academia Española de Dermatología y Venereología, which receives financial support from the Spanish Medicines and Health Products Agency (Agencia Española de Medicamentos y Productos Sanitarios) and from pharmaceutical companies (Abbott/Abbvie, Almirall, Janssen, Leo Pharma, Lilly, Novartis and UCB). • Dr Sahuquillo has served as a consultant and/or paid speaker for and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis, including AbbVie, Celgene, Janssen-Cilag, LEO Pharma, Lilly, Novartis and Pfizer. The main analysis examined hospitalization, ICU and death in PCR-confirmed patients included in Biobadaderm as compared to PCR-confirmed cases published by the Spanish Ministry of Health [2] . • Dr Herrera-Ceballos has served as a consultant and/or speaker for and/or participated in clinical trials as IP and sponsored by companies that manufacture drugs used for the treatment of psoriasis, including AbbVie, Janssen-Cilag, LEO Pharma, Lilly, Novartis and Pfizer.
cord-343704-td1aheay	2020	authors: Rosman, Ilana S.; Schadt, Courtney R.; Samimi, Sara S.; Rosenbach, Misha title: Approaching the dermatology residency application process during a pandemic Approaching the dermatology residency application process during a pandemic 1 Ilana S. Samimi, MD, FAAD, 3 Given the ongoing crisis, we suggest changes to the application and recruitment process for 53 academic dermatology programs around the country to consider. The capacity to conduct 65 remote interviews will be critical moving forward, even beyond the current pandemic 66 situation by reducing student costs (which may aid in recruiting applicants from broader 67 socioeconomic backgrounds), allowing for greater scheduling flexibility, and aligning 68 with environmentally sound practices in light of the climate crisis. However, application season is 73 upon us, and with the likelihood of the pandemic continuing in some capacity for the next 74 5 several months, it is imperative that we take a proactive approach. National Resident Matching Program. Coalition for Physician Accountability Publishes Recommendations on Movement Across 92 Institutional for 2020-2021
cord-344361-amhc0ryh	2020	title: Reply to: "Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak" We read with interest "Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak" [1] . in their letter described an increased number of acro-ischemic lesions in young patients from Spain [1] . In Italy, after the outbreak onset, many general pediatricians reported on our pediatric dermatology network unusual foot injuries, similar to chilblains and without any other symptoms. The Spanish authors found 132 cases in 41 days, while our patients were collected in 10 days. Almost the same number of positive SARS-CoV-2 tests (1 vs 2 patients) was described in both cohorts. Pernio-like" acrolocated lesions onset and COVID-19. Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak
cord-346287-xg176mi7	2020	Letter to the Editor 1 2 To the Editor: We appreciate the interest of Rivera-Oyola, Koschitzky, and Lebwohl 1 in our 3 meta-estimate evaluating the risk of respiratory tract infections (RTIs) and symptoms in patients 4 2 The authors make a 5 cogent case for the importance of not cherry-picking data when evaluating drug safety by 6 selecting a few examples in which perhaps patients treated with IL-17 inhibitors have a lower 7 risk of RTIs compared to placebo. publication, 2 the results demonstrated a statistically significant 31-56% increased risk of RTI in 10 IL-17 targeting biologic treated patients compared to placebo. The risk of respiratory tract infections and symptoms in psoriasis patients treated with IL-17-pathway inhibiting biologics: A metaestimate of pivotal trials relevant to decision-making during the COVID-19 pandemic The Risk of Respiratory Tract Infections in Psoriasis Patients Treated With IL-23-pathway Inhibiting Biologics: A Meta-Estimate of Pivotal Trials Relevant to Decision-Making During the COVID-19 Pandemic
cord-347293-fp8phk0p	2020	With limited real-life data from COVID-19 infection in patients with hidradenitis suppurativa (HS) receiving adalimumab, we can use previous drug trials to extrapolate the potential risk to patients, based upon the change in infection rate when compared to placebo. At the end of period 1, infection developed in 24.8% and 25.2% of those receiving adalimumab QW, compared to 28.3% and 32.5% of patients receiving placebo, in PIONEER 1 and 2, respectively. At the end of period 2, infection occurred in 29.2% and 35.3% of patients receiving adalimumab QW, 25.0 and 35.8 of patients receiving the medication Q2W and 32.7 and 25.5% of patients in the placebo control group, in PIONEER 1 and 2, respectively. However, the findings support the notion that healthy HS patients, without risk factors, who use adalimumab during the COVID-19 pandemic are not predisposed to infection or nasopharyngitis ( Table 1) .
cord-350317-a9qd3xdr	2020	title: If skin is a potential host of SARS-CoV-2, IL-17 antibody could reduce the risk of COVID-19 The expression of ACE2 is associated with the potential risk of making the target tissue susceptible to infection by SARS-CoV-2. Elevated ACE2 expression and detection of SARS-CoV-2 in the skin 4 of COVID-19 patients implied skin was a potential host of SARS-CoV-2. After IL-17 antibody treatment, the skin ACE2 expression was downregulated which meant IL-17 antibody could lower the risk of COVID-19 through lessening the cells which could interact with SARS-CoV-2. Additionally, IL-17 antibody could reverse the deteriorated barrier and inflammatory status in the skin of psoriasis patient which meant less microbe infection.Herein, the specific microbe could be SARS-CoV-2. Thus, whether IL-17 antibody could reduce the COVID-19 risk through reversing the inflammatory skin status with deteriorated barrier and preventing SARS-CoV-2 transmitting should be further discussed. Skin is a potential host of SARS-CoV-2: a clinical, single-cell transcriptome-profiling and histological study
cord-353247-swex393r	2020	With support from the APD, a webinar titled ''The Shifting Landscape of the 2020-51 2021 Dermatology Application Cycle in the Era of the COVID-19 Pandemic'' was developed. During the webinar, panelists 58 collectively addressed this year''s residency application process via questions prompted by 59 physician moderators (Table 2) . Virtual away 68 rotations were described as opportunities to learn more about specific programs but should not 69 be perceived as necessary to match into dermatology. Underrepresented minorities 76 and students without home dermatology programs constituted a significant portion of the 77 webinar audience, demonstrating the need and opportunity to fill gaps in recruitment and 78 mentorship for these groups. 951206e7f726/updated_dermatology_program_director_statement_on_2020-89 the Residency Application Process Amid the COVID-19 Crisis. How should students express interest in specific programs given most dermatology away rotations are cancelled? How should students without a home dermatology program approach away rotations? Questions directed to six dermatology residency program director panelists during the webinar.
cord-354902-t9df8vhc	2020	title: Assessing the risk of dupilumab use for atopic dermatitis during the COVID-19 pandemic 10 Dupilumab, an interleukin 4 alpha receptor antagonist that inhibits IL-4 and IL-13 signaling, is a 11 treatment for patients >12 years with moderate to severe atopic dermatitis (AD). In three randomized, placebo-controlled phase III clinical trials (SOLO 1, SOLO 2, and 18 CHRONOS), adults with moderate-to-severe AD received dupilumab (300 mg) weekly (qw), 19 3 Furthermore, in 28 all three trials, it was concluded that the rate of infection was not increased in dupilumab-treated 29 patients compared to placebo. Two Phase 3 Trials of Dupilumab versus 58 Placebo in Atopic Dermatitis Long-term management of 60 moderate-to-severe atopic dermatitis with dupilumab and concomitant topical 61 corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-62 controlled, phase 3 trial