Dear Editor, Reports concerning cutaneous manifestations in coronavirus disease 2019 (COVID-19) have been mostly from temperate regions, namely Western countries and China, with prevalence rates of 0.20-20.45%. 1 Information on other races, ethnicities and locales is lacking. Thailand is located in the tropical region; thus, we hypothesize that different patterns of skin manifestations may ensue. From 9 March to 18 April 2020, 187 patients with COVID-19 were diagnosed at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. We conducted a retrospective chart review and telephone interview to investigate the epidemiology of skin findings in COVID-19. This study was approved by the institutional review board of the Faculty of Medicine, Chulalongkorn University (IRB 291/63).

<b><i>Background:</i></b> Ablative fractional carbon dioxide laser (AFCO2) resurfacing causes transient skin barrier disruption characterized by decreased skin hydration and increased transepidermal water loss (TEWL). Snail Soothing and Repairing (SSR) cream, containing several glycoproteins with potential antimicrobial and antioxidant effects, may benefit skin hydration promotion after the laser treatment. <b><i>Objective:</i></b> To evaluate the efficacy and safety of SSR cream in skin hydration promotion after AFCO2 resurfacing. <b><i>Method:</i></b> The study was a double-blinded, split-face, placebo-controlled trial in participants aged 18–50 years with atrophic acne scars on both cheeks. After AFCO2 resurfacing, participants applied the product or placebo on either cheek twice daily for 14 days. Corneometry, TEWL, colorimetry, and clinical assessments (edema, erythema, crusting, pruritus, and tightness score) were evaluated at baseline, day 7, and day 14 after AFCO2 resurfacing. <b><i>Results:</i></b> From 22 participants in the study, the SSR cream-treated sides showed significantly higher corneometry levels than placebo-treated sides at day 14 (<i>p</i> = 0.033), while TEWL and colorimetry levels were not different at any study visits. Pruritus and tightness scores of the SSR side were lower, but not significant, than the placebo. Other clinical assessments (edema, erythema, and crusting) showed similar results. No significant adverse events took place. <b><i>Conclusion:</i></b> The SSR cream significantly improved skin hydration, highlighting skin barrier restoration after AFCO2 resurfacing, with a good safety profile.

Introduction: Seborrhea or oily skin has been one of the most common complaints affecting both men and women physically and psychologically. Chitosan is a biopolymer obtained from the alkaline deacetylation of chitin. Due to its positively charged nature, chitosan can effectively bind to lipids. Therefore, chitosan nanoparticle (CN) formulation may benefit in the reduction of skin sebum. Objective: The aim of this study was to evaluate the efficacy and safety of CN formulation in the reduction of skin sebum. Method: The study was a randomized, double-blinded, placebo-controlled trial in 24 participants aged 18–40 years with clinical seborrhea. Participants were randomly assigned to apply the CN and gum (CN-G) or placebo (gum alone) twice daily for 4 weeks. Sebum level, corneometry, transepidermal water loss (TEWL), and clinical seborrhea grading were evaluated at baseline and week 2 and 4. Results: In the T-zone, sebum levels in the CN-G group were significantly lower than the placebo group at week 4 (p = 0.043), while for the U-zone, sebum levels were not different between groups. There were no statistical differences in corneometry and TEWL at any visit. Although the clinical seborrhea grading in CN-G was lower, it was not significantly different from the placebo. A few cases reported mild and self-limiting scaling and acneiform eruption. Conclusion: The CN-G gel could significantly reduce sebum levels on seborrhea patients with acceptable safety profiles.

BackgroundAt present, no predictive models are available to determine the probability of in‐hospital mortality rates (HMRs) in all phenotypes of severe cutaneous adverse reactions (SCARs).ObjectivesOur study explored whether simple clinical and laboratory assessments could help predict the HMRs in any phenotypes of SCAR patients.MethodsFactors influencing HMRs in 195 adults diagnosed with different SCAR phenotypes were identified, and their optimal cut‐offs were determined by Youden's index. Predictive equations for HMRs for all SCAR patients and Stevens‐Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) patients were determined using the exact logistic regression models.ResultsAcute generalized exanthematous pustulosis (AGEP) patients were significantly older, with a short time from drug exposure to reaction, and higher neutrophil count compared to SJS/TEN and drug reaction with eosinophilia and systemic symptoms (DRESS, p < 0.001). Peripheral blood eosinophilia, atypical lymphocytosis and elevated liver transaminase enzymes were significantly higher in DRESS. SJS/TEN phenotype, age ≥ 71.5 years, neutrophil‐to‐lymphocyte ratio ≥ 4.08 (high NLR) and systemic infection were factors predicting in‐hospital mortality in all SCAR subjects. The ALLSCAR model developed from these factors demonstrated high‐diagnostic accuracy for predicting HMRs in all SCAR phenotypes (area under the receiver‐operator curve (AUC) = 0.95). The risk of in‐hospital death was significantly increased in SCAR patients with high NLR after adjusting for systemic infection. The model derived from high NLR, systemic infection and age yielded higher accuracy than SCORTEN (AUC = 0.77) for predicting the HMRs in SJS/TEN patients (AUC = 0.97).ConclusionsBeing older, having systemic infection, having a high NLR and SJS/TEN phenotype increases ALLSCAR scores, which in turn increases the risk of in‐hospital mortality. These basic clinical and laboratory parameters can easily be obtained in any hospital setting. Despite its simple approach, further validation of the model is warranted.

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