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Diabetes is a serious, chronic disease with a rising prevalence worldwide. Its complications are a major cause of morbidity and mortality and contribute substantially to health care costs. In this article the authors review the most common and sensitive skin manifestations that can be present on patients with diabetes and prediabetes. The prompt recognition of these frequently underestimated entities is extremely important as it may trigger not only an adequate metabolic evaluation but also a timely referral and appropriate treatment, minimizing the secondary effects of long-term diabetes and improving the prognosis of diabetic patients.

Introduction: A growing body of evidence suggests that bipolar disorder (BD) is a progressive disease according to clinical, biochemical and neuroimaging findings. This study reviewed the literature on the relationship between specific biomarkers and BD stages. Methods: A comprehensive literature search of MEDLINE and PubMed was conducted to identify studies in English and Portuguese using the keywords biomarker, neurotrophic factors, inflammation, oxidative stress, neuroprogression and staging models cross-referenced with bipolar disorder. Results: Morphometric studies of patients with BD found neuroanatomic abnormalities, such as ventricular enlargement, grey matter loss in the hippocampus and cerebellum, volume decreases in the prefrontal cortex and variations in the size of the amygdala. Other studies demonstrated that serum concentrations of neurotrophic factors, inflammatory mediators and oxidative stress may be used as BD biomarkers. Conclusions: The analysis of neurobiological changes associated with BD progression and activity may confirm the existence of BD biomarkers, which may be then included in staging models that will lead to improvements in treatment algorithms and more effective, individually tailored treatment regimens. Biomarkers may also be used to define early interventions to control disease progression.

Introduction: The hair cycle is especially susceptible to endogenous and exogenous stimuli, including febrile states and emotional stress, which are a constant in this pandemic era. In this case series, we describe the clinical characteristics of patients recently diagnosed with SARS-CoV-2 infection who developed acute telogen effluvium. Material and Methods: We performed a registry of patients with laboratory-confirmed SARS-CoV-2 infection who developed acute telogen effluvium and actively sought medical care at the Hair Unit of Dermatology Center of CUF Descobertas Hospital, from March 2020 to October 2020. Patient demographics, the month of SARS-CoV-2 infection diagnosis, COVID-19 associated symptoms, latency of telogen effluvium, duration of hair loss, and associated scalp symptoms were recorded. Results: Twenty-seven patients recently diagnosed with SARS-CoV-2 infection presented with acute telogen effluvium. Of them, 5 (18.5%) patients mentioned trichodynia. The median time of latency of increased hair loss since SARS-CoV-2 infection diagnosis was 10 weeks. In a third of cases (n=9, 33.3%), hair loss occurred early (with a latency period of 3 weeks or less). The resolution of telogen effluvium was documented in 16 (59%) cases with a median duration of hair loss of 24.5 days. The most common symptoms of COVID-19 were fever (n=17, 63%), ageusia (n=8, 30%), cough (n=6, 22%), myalgia (n=5, 18.5%), anosmia (n=4, 15%), and thoracalgia (n=3, 11%). Four patients (15%) with SARS- -CoV-2 infection were asymptomatic for COVID-19. Discussion: Acute telogen effluvium corresponds to a delayed consequence of an abnormal shift in the hair cycle from anagen to telogen, which is responsible for premature hair shedding, occurring approximately two to three months after a triggering event. Viral illnesses and febrile states are known causes. Regarding SARS-CoV-2 infection, we hypothesize that viral cytopathic effects and inflammatory or immune responses may affect hair follicles and explain hair loss and trichodynia. Conclusion: Our case series presents the first comprehensive collection of patients with acute telogen effluvium following SARS-CoV-2 infection. Interestingly, in a third of our cases, telogen effluvium developed within the first 3 weeks of SARS-CoV-2 infection. Based on these data, we propose that this finding should be considered in COVID-19, especially at the convalescent phase.