COVID-19 pandemic and the skin: what should dermatologists know?

Abstract

Journal Pre-proof J o u r n a l P r e -p r o o f 2 Running title: COVID-19 and the skin Conflict of interests: none Funding sources: none Acknowledgements: none Journal Pre-proof J o u r n a l P r e -p r o o f 3 AbstractThe World has changed dramatically since the COVID-19 pandemic began. Together with our social, occupational, and personal life, the new corona virus poses novel challenges for all physicians, including dermatologists. Despite the virus not being dermatotropic, several skin conditions have emerged, mainly as a result of prolonged contact to personal protective equipment and excessive personal hygiene. Pressure injury, contact dermatitis, itch, pressure urticaria, and exacerbation of pre-existing skin diseases, including seborrheic dermatitis and acne, have been described. We have focused on the dermatologic aspects of COVID-19 infection, so that dermatologist may be aware of the skin complications and the preventive measures to be taken in the COVID-19 pandemic. Abbreviations:healthcare workers -HCWs personal protective equipment -PPE Journal Pre-proof identified as the most common entry for the infection, this includes the conjunctiva with the otic canal having the lowest risk of transmission (4); therefore, specific skin changes due to Covid-19 infection have not been described, and one could expect iatrogenic secondary involvement of the skin.Journal Pre-proof J o u r n a l P r e -p r o o f 5 Because diseases with epidermal barrier interruption could enhance the virus acquisition through indirect contact (5), dermatology patients might be at an increased risk for developing the infection. This suggests that dermatology departments and private offices should develop appropriate preventative measures. (5). Use of a sanitary mask itself may not be sufficient protection from the virus transmission, so that goggles should be used to decrease the risk of conjunctival contamination. COVID-19 has a relatively low-resistance to disinfectants. As a result, a variety of regimens have been proven effective, ranging from 75% ethanol, peracetic acid, chlorine, and UV disinfection to a hot water bath at 56°C(132.8°F) for 30 minutes (4).Another important practical concern is the care for patients with autoimmune and chronic inflammatory disorders, such as psoriasis, atopic dermatitis, lupus, scleroderma, and hidradenitis suppurativa, which may require immune-suppressive therapy. It is not clear whether the administration of the biologics should be delayed. Skin problems related to personal protective equipment (PPE) and personal hygiene measuresThe skin complications in COVID-19 infection are mainly due to the hyper-hydration effect of PPE, friction, epidermal barrier breakdown, and contact reactions, all of which may aggravate an existing skin disease. The dermatologic manifestations are far different from those recorded during the Influenza Epidemic of 1918-1919 (6). Erythema, papules, maceration, and scaling are the most commonly reported skin changes due to extended wear of PPE (6) (figure 1).Symptoms have...

Knowledge, attitude and practice of Sari Birth Cohort members during early weeks of COVID-19 outbreak in Iran

“…The COVID-19 infection, as an airborne high consequence of infectious disease, has an incubation period of 0 to 14 days [5]. The symptoms range from mild to severe complications including fever, cough, shortness of breath, pneumonia and respiratory, hepatic, gastrointestinal, renal, cutaneous and neurological complications and nally death occurs in severe cases [5][6][7][8]. The key principles for COVID-19 prevention are to identify potential cases as soon as possible, prevent transmission of the infection to other people and avoid direct contact with respiratory secretions and isolating the patients [9].…”

Localized mid‐face miliaria as a consequence of filtering face piece respirator use during the COVID‐19 pandemic

“…Whilst specific cutaneous sequelae due to COVID-19 itself have not yet been described, skin problems related to PPE worn during the pandemic are emerging, and have recently been recognized in the document published in April 2020 by NHS England which provides advice on how to prevent facial skin damage beneath PPE. [1][2] This document advocates use of a skin protectant if wearing PPE for extended periods, and promotes regular breaks (ideally every 2 h) from wearing a FFP mask to relieve tissue pressure and reduce humidity. The chosen barrier cream or tape should not compromise the integrity or fit of the mask.…”

“…We postulate that the cutaneous complications reported during the COVID-19 pandemic stem from the hyperhidrotic effect of PPE, friction, epidermal breakdown, pressure urticaria and contact dermatoses, all of which may be exacerbated in the context of pre-existing skin disease. 1,3 Experience from previous pandemics has shown skin inflammation and erythema, papules, maceration and scaling to be the most frequently reported adverse cutaneous outcomes of extended PPE use, with the most commonly affected sites being the nasal bridge, cheeks, forehead and hands. 4 Here, we report individual cases of two female theatre nurses working within the same surgical unit within the United Kingdom during the current COVID-19 pandemic, neither with preexisting skin disease.…”

Annoying Skin Reaction Among The Medical Staff Using Personal Protective Equipment During COVID-19

“…6 The skin problems in the COVID-19 infection were originally due to the over hydration effect of PPE, maceration, rubbing, epidermal barrier impairment, and contact response, all of which may exacerbate a present cutaneous disease. 6,7 The most frequently reported adverse cutaneous outcomes of extended PPE use were skin in ammation, redness, papules, and scaling, with the most commonly affected sites being the face especially the nose, cheeks, forehead, and hands. 8 A localized facial miliaria and headache were reported secondary to a facial mask.…”