Corpus overview


MeSH Disease

Human Phenotype


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    The Impact of COVID-19 on Medical Practice: A Nationwide Survey of Dermatologists and Healthcare Providers

    Authors: Mohammed Shanshal; Hayder Saad Ahmed; Hayder Asfoor; Raad Ibrahim Salih; Shehab Ahmed Ali; Yusif k. Aldabouni

    doi:10.1101/2020.07.26.20156380 Date: 2020-08-04 Source: medRxiv

    Background: The COVID-19 pandemic has dramatically changed medical practice worldwide. It posed a significant impact on different health services, including dermatology. Methods and objectives: Two online surveys were conducted to determine the prevalence SERO of personal protective equipment-related skin complications (200 healthcare providers were included) and to demonstrate the outbreak s impact on dermatology practice (100 dermatologists were included). Results: In the first survey, the response rate was 72.46%. PPE- related dermatoses were reported by 147 (73%) participants, including frictional dermatitis MESHD (51.9%), mechanical acne HP (33.1%), contact dermatitis MESHD contact dermatitis HP (29.9%), nonspecific rash (17.5%), urticaria MESHD urticaria HP (9.1%) and skin infections MESHD (3.2%). The response rate of the second survey was 64%. COVID-19 emerging cutaneous manifestations were recognized by 20% of dermatologists, including maculopapular rash (41.67%), urticaria MESHD urticaria HP (37.50%), chilblain MESHD chilblain HP (25%) and vasculitis MESHD vasculitis HP (16.67). Telemedicine was provided by 73% of the dermatologists. The relapse rates of psoriasis MESHD, atopic dermatitis MESHD atopic dermatitis HP, rosacea MESHD, vitiligo MESHD vitiligo HP and alopecia areata MESHD alopecia areata HP were noticeably increased as observed by 62%, 50%, 20%, and 4% of dermatologists, respectively. Most dermatologists (89%) reported minimal use of immunosuppressive drugs amid the pandemic. Conclusions: This article highlights the pivotal role of dermatologists in the leading edge during the current health crisis and how they adapt to these unfamiliar circumstances to meet the challenges. It documents the emergence of PPE-related dermatoses among healthcare providers and the impact of COVID-19 on different aspects of dermatology practice.

    Cutaneous manifestations associated with COVID-19 in children TRANS: A Systematic Review

    Authors: Seema Shah; Kiran Akhade; Satyaki Ganguly; Rachita Nanda; Eli Mohapatra; Anil Kumar Goel

    doi:10.21203/ Date: 2020-07-18 Source: ResearchSquare

    Background: Cutaneous manifestation of COVID 19 in children TRANS has not yet been reviewed systematically and hence this review gives a future direction to the clinicians to be vigilant for skin presentations during such pandemic.Methodology: The review was done as per the guidelines of PRISMA and literature search was done on PubMed database using keywords as COVID-19, children TRANS and skin in different combinations. Articles published in English with cases of age TRANS 1 month to 18 years were eligible. The outcome included varied aspects of cutaneous and COVID-19 infection MESHD. The review protocol was not registered.Results: Of 51 publications identified, 13 studies containing 149 children TRANS met the eligibility criteria. Acrally located erythematous maculopapular lesion was the most common finding in 138 children TRANS. Erythema multiforme MESHD Erythema HP, varicella like exanthem and Kawasaki disease MESHD like presentations were reported in the rest of the cases. The duration of the skin lesion was 1-2 weeks in 43%. Skin biopsy done in 18 cases revealed superficial & deep perivascular and peri-eccrine lymphocytic infiltrate & lymphocytic vasculitis MESHD vasculitis HP. RT-PCR was positive in 13.8% cases. Serological markers for HSV, parvovirus B19 analyzed across various studies, were found negative, except for mycoplasma pneumoniae MESHD pneumoniae HP in 2 of 20 cases tested.Discussion: Clinicopathologic analysis established chilblains MESHD chilblains HP like lesion in 43% cases with no confirmed TRANS etiology like cold exposure, autoimmune dysfunction, drug reaction, or viral infection MESHD. The usual cephalo-caudal spread of a viral exanthem was also missing. However, a low number of discussed cases was a limitation of the study.Conclusion: In the absence of any confirmed etiology for such cutaneous manifestations, the possibility of COVID-19 should be explored and evaluated thoroughly during such pandemic.

    Timing of PCR and Antibody Testing SERO in Patients with COVID-19 associated dermatologic manifestations

    Authors: Esther E Freeman; Devon E McMahon; Lindy P Fox; Marlys S Fassett

    doi:10.1101/2020.07.03.20146134 Date: 2020-07-04 Source: medRxiv

    A recent study from Spain noted 40 patients with chilblain MESHD chilblain HP-like lesions in suspected COVID-19.1 None tested PCR positive for SARS-CoV-2, but 30% had detectable antibodies SERO. The rapid increase in chilblain MESHD chilblain HP/pernio-like cases during the COVID-19 pandemic is likely SARS-CoV-2-associated. The relationship between skin symptom onset TRANS and COVID-19 PCR/ antibody test SERO timing, however, remains uncharacterized. We established an international registry for cutaneous manifestations of COVID-19.2, 3 Providers reported time between dermatologic symptom onset TRANS and positive/negative COVID-19 laboratory results, when available. From 8 April-30 June, 2020, 906 laboratory-confirmed or suspected COVID-19 cases with dermatologic manifestations were reported, 534 of which were chilblains MESHD chilblains HP/pernio.3 Among PCR-tested patients, 57%(n=208) overall and 15%(n=23) of chilblains MESHD chilblains HP/pernio cases were PCR-positive. Antibody SERO positivity was 37%(n=39) overall and 19%(n=15) for chilblains MESHD chilblains HP/pernio. We evaluated 163 patients with timing information on PCR and/or antibody testing SERO (Table 1). For patients with suspected COVID-19 and any cutaneous manifestation, PCR-positive testing occurred median 6 (IQR 1-14) days after dermatologic symptoms started while PCR-negative testing occurred median 14 (IQR 7-24) days later. For patients with pernio/ chilblains MESHD chilblains HP, PCR-positivity was noted 8 (IQR 5-14) days after symptoms and negativity median 14 (IQR 7-28) days later. Antibody testing (IgM or IgG SERO) was positive median 30 (IQR 19-39) days after symptom onset TRANS for all dermatologic manifestations and 27 (IQR 24-33) days after chilblains MESHD chilblains HP/pernio onset. Like Hubiche et al, our data highlight the low frequency of SARS-CoV-2 PCR+ testing in COVID-19 patients with cutaneous manifestations. Positive predictive values SERO for COVID-19 PCR are influenced by viral shedding kinetics, which are difficult to assess in non-respiratory presentations.4 Our data reveal that early PCR testing is more likely to be positive than later testing, even when date-of-onset is defined by cutaneous manifestations rather than systemic symptoms. Most COVID-19 antibody SERO data are from systemically-ill patients; the kinetics of antibody SERO production in mild-to-moderate COVID-19 infections MESHD remain unclear.5 Here, positive antibodies SERO resulted median 30 days from disease MESHD onset, beyond the frequently used 14-21 day testing window. In outpatients with true infection MESHD, many factors influence the likelihood of a positive antibody SERO result: antibody SERO production, test availability, assay sensitivity SERO, and timing of care-seeking in relation to symptom-onset TRANS. These variables influence our interpretation of individual test results and our understanding of the association between pernio and COVID-19. More population-level testing data is necessary to optimize diagnostic test timing. Positive identification of COVID-19 in minimally-symptomatic patients, including patients with skin findings, is critical to the public health effort.

    Cutaneous Manifestations of COVID-19: A Systematic Review

    Authors: Giulia Daneshgaran; Danielle P. Dubin; Daniel J. Gould

    doi:10.21203/ Date: 2020-06-06 Source: ResearchSquare

    Background: The COVID-19 pandemic has affected 4.5 million people and killed over 300,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease MESHD have been reported.Objective: The aim of this review was to collate and categorize the dermatologic findings reported in COVID-19 patients and identify specific lesions that may facilitate diagnosis and prognostication.Methods: A systematic review of the PubMed database was conducted on May 14th, 2020 using the search terms “Covid-19 skin,” “Covid-19 rash,” “Covid-19 exanthem,” and “Covid-19 chilblains MESHD chilblains HP.” Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.Results: The literature search identified 115 records, of which 34 publications describing 996 dermatologic patients were included. Case reports (n=15), case series (n=10) and observational studies (n=7) were the most common publication types. Pseudo- chilblains MESHD chilblains HP (PC) was the most frequent lesion identified (40.4% of cases), appearing in young adults TRANS (mean age TRANS, MA, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes (EMR) affected 21.3% of patients, most frequently impacting middle- aged TRANS adults TRANS (MA 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes (VR) affected 13.0% of patients, appearing in middle- aged TRANS adults TRANS (MA 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes (UR) affected 10.9% of patients, appearing in adults TRANS (MA 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo/ purpura MESHD purpura HP/ necrosis MESHD (LPN) were uncommon (4% of cases), appearing in elderly TRANS patients (MA 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme MESHD Erythema HP-like eruptions (EME), although infrequent (3.7% of cases), affected mostly children TRANS (MA 12.2 years).Conclusions: VR may suggest an initial diagnosis of COVID-19, PC may be most appropriate for epidemiological uses, and LPN may be a useful prognostic marker for severe disease MESHD. As a potential correlate to disease MESHD severity, prognosis, or infectibility, it is critical that all health care professionals be well-versed in these increasingly common cutaneous manifestations of COVID-19.  

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MeSH Disease
Human Phenotype

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