The aftermath of COVID‐19 in dermatology practice: What's next?

The rapidly increasing number of COVID‐19‐infected patients and evidence of human‐to‐human transmission even within the asymptomatic incubation period prompted the attention of the entire world. The field of dermatology and procedural dermatology is not exempt from this global issue. We cannot deny the fact that this situation will have a lasting impact on the health‐seeking behaviors of our patients. It is necessary for dermatologists and dermatologic surgeons to be aware of the potential risks and precautions when re‐emerging their practices after COVID‐19.     

Nursing research: what is it and how can dermatology nurses use it?

The International Council of Nurses (2007) defines nursing research as a systemic inquiry that seeks to obtain new nursing knowledge for the benefit of patients, families, and communities and includes all aspects of health that are of interest to nursing including health promotion, disease prevention, and care during illness and recovery or towards a peaceful death. There is an increased amount of clinical research available to nurses and now we are challenged to utilize this knowledge to improve patient care. Just like Florence Nightingale, nurses today need to make observations, collect data, and use the analysis of that data to support and guide current nursing care.     

Human herpesvirus 7 in dermatology: what role does it play?

Human herpesvirus 7 (HHV-7) was discovered in 1989 as a new member of the beta-herpesvirus subfamily. Primary infection occurs early in life and manifests as exanthema subitum, or other febrile illnesses mimicking measles and rubella. Thus, HHV-7 has to be considered as a causative agent in a variety of macular-papular rashes in children. In addition, HHV-7 was found in some cases of other inflammatory skin disorders, such as psoriasis. There are controversial data on the detection of HHV-7 in pityriasis rosea, but so far there is not enough evidence for a pathogenetic association of HHV-7 with this exanthematic skin disease. Although HHV-7 can be found in some cases of Hodgkin's disease, there are no data supporting a direct causative role in this lymphoma type nor in other nodal or primary cutaneous lymphomas. In various epidemiologic forms of Kaposi's sarcoma, infection of monocytic cells with HHV-7 was demonstrated, which may indirectly influence tumor biology. In the context of immunosuppression, HHV-7 has recently been identified as an emerging pathogen in transplant recipients and may exacerbate graft rejection in renal transplant recipients. The ability of HHV-7 to induce cytokine production in infected cells could make HHV-7 an important pathogenetic co-factor in inflammatory and neoplastic disorders. Moreover, the restricted cellular tropism of HHV-7 may render this virus an interesting vector for gene therapy. Thirteen years after the discovery of HHV-7, there has been considerable progress in characterizing its genetic structure, virus-induced effects on infected host cells and in the development of diagnostic tools. Nevertheless, the role of HHV-7 in various skin diseases and the clinical manifestations of reactivation of HHV-7 infection have still to be defined.     

“Contrast nephropathy” in renal transplantation: Is it real?

The risk of contrast-induced nephropathy (CIN) in renal transplant recipients is increased in diabetics, patients with impaired basal kidney function, patients in shock, patients presenting with acute emergency and in old age recipients. Approximately one-third of all hospitalized patients with acute kidney injury is attributed to CIN. In the United States, it is the third leading cause of hospital-acquired renal failure. Therefore, efforts should be directed to minimize CIN-related morbidity and mortality as well as to shorten hospital stay. While the role of peri-procedural prophylactic hydration with saline is unequivocal; the use of acetyl cysteine is not based on robust evidence. The utility of theophylline, aminophylline, calcium channel blockers, natriuretic peptide, and diuretics does not have proven role in attenuating CIN incidence. We aim to analyze the evidence for using various protocols in published literature to limit CIN-associated morbidity and mortality, particularly during surveillance of the renal allograft survival.     

Change of the diagnostic distribution in applicants to dermatology after COVID‐19 pandemic: What it whispers to us?

We aim to evaluate the change in the diagnostic spectrum in dermatology outpatient applications compared to before COVID‐19. All patients were enrolled from the Department of Dermatology between February 12 and May 8, 2020, the duration of 4 weeks before COVID‐19 and 8 weeks after were analyzed in three parts consisting of 4 weeks. Data obtained from the database such as age, gender, diagnoses were anonymized. Repeated applications with the same diagnosis in 10 days after the first presentation were ignored. Compared to the pre‐outbreak, there was a 3.5‐fold decrease in dermatology applications in the first month after COVID‐19 and an 8.8‐fold in the second month. We found a significant increase in the frequency of diagnoses such as generalized pruritus, pityriasis rosea, alopecia areata, bacterial skin/mucosa diseases, and zona zoster after COVID‐19. The frequency declined in diseases such as verruca vulgaris, hyperpigmentation, skin tag, melanocytic nevus, and seborrheic keratosis/solar lentigo. It has been found that the frequencies of most diseases, including acne (?25% of patients), did not change. We think that many factors, such as affecting the quality of life, risk perception, increased stress burden may cause a change in the diagnostic distribution of the dermatology applications.     

How big is your hand and should you use it to score skin in cutaneous T‐cell lymphoma?

Assessing burn surface area is essential to triage patients and determine fluid resuscitation. The three commonly used methods are: (i) the palmar method, where palmar surface area is assumed to equal 1% of body surface area (BSA); (ii) the rule of nines; and (iii) the Lund and Browder method, where body parts are assigned a percentage surface area. Calculation of BSA involvement in dermatological disease is used to measure disease severity and treatment responses. The grid‐point counting method may also be used. Mycosis fungoides (MF), a form of cutaneous T‐cell lymphoma, typically presents with patches and plaques with progression to tumours and erythroderma in advanced disease. Quantifying skin involvement in MF requires assessment of both BSA involvement and lesion type. The severity‐weighted assessment tool (SWAT) was designed for this purpose, using grid‐point counting, and weighting patch as × 1, plaque as × 2 and tumour as × 3. The SWAT was modified in an international consensus paper to use Lund and Browder charts, and the weighting of tumours was increased to × 4. The patients' palm or hand is frequently the method of choice for skin scoring. However, both the definition of the palm and whether this includes the fingers or even the thumb, and the percentage BSA assigned to the palm, vary in the literature. A review of published planimetry studies found that the most consistent measure across age and race was the palm without fingers reflecting 0·5% total BSA. We recommend the use of the patient's palm to represent 0·5% BSA as the most convenient and reliable tool to measure surface area, and we introduce an iPhone application to record BSA electronically and calculate modified SWAT.     

Alopecia areata: Support groups and meetings – how can it help your patient?

Many people with alopecia areata find the fellowship of the support groups provides them with the help they need to cope. They find that they are not alone, how others have coped, what doctors and treatments have been tried, and what the results have been. The National Alopecia Areata Foundation offers support groups throughout the world to refer patients.