Impacts of COVID-19 on Dermatology Clinical Trials - An Overview

Introduction

COVID-19 (coronavirus) is a viral disease caused by SARS-CoV-2 called the severe acute respiratory syndrome coronavirus 2. The coronavirus is a respiratory pathogen causing severe respiratory problems. The transmission of coronavirus is restricted by using sanitizers and using personal protective equipment, PPE kit. Besides skin-related issues, mental and social stress are also affected by COVID-19. COVID-19 is manifested in multiple skin conditions.

What Is the Impact of COVID-19 on Dermatology?

COVID-19 is a viral disease caused by a coronavirus, causing lower respiratory disorder, which can lead to pneumonia. The various modes of transmission of the COVID-19 virus include aerosols, droplets, and contact with any COVID-19 virus-contaminated surface. The systemic symptoms of COVID-19 are fever, dry cough, fatigue, throat pain, and shortness of breath. The rare systemic symptoms of COVID-19 also include headache, myalgia, gastrointestinal problems, and joint pain. The skin manifestations shown in patients with coronavirus are mentioned below.

• Maculopapular rash.

• Vesiculobullous rash.

• Pseudo chilblain.

• Necrosis.

• Livedo reticularis.

• Urticaria.

• Purpuric skin rashes.

• Morbilliform rashes.

• Acral ischemia.

• Dengue-like rash.

• Petechial rashes.

• Androgenic alopecia.

• Neonatal rashes.

• Pigment-related disorders.

Erythematous Rashes: Erythematous rashes are also known as morbilliform rashes. The coronavirus also causes maculopapular rashes on the skin, and symptoms like pruritus are also present. The most commonly involved areas of the erythematous rash are the trunk and extremities.

Urticaria: The maculopapular rash, along with urticaria, is present in most patients with urticaria. The differential diagnoses of urticaria in people with the COVID-19 virus are urticarial vasculitis, neutrophilic dermatosis, and idiopathic plantar hidradenitis. The biopsy is taken, and the lesions are resolved with an improved immune response.

Vesicles: Another cutaneous manifestation of the COVID-19 virus is the blisters commonly present predominantly in the trunk. Vesicle is diffuse polymorphic and resembles hand and mouth disease. Vesicles are a common clinical feature, particularly in children with COVID-19. The histopathological findings reveal the presence of viral infections.

Acral Ischemia: Acral ischemia is the erythematous bluish discoloration of the skin present on the digits. The clinical features of acral ischemia include several macules, papules, itching, and a burning sensation is also present.

Chilblain-Like Lesions: Chilblains are also known as perniosis. Perniosis-like lesions are present in the absence of cold conditions termed "covid toes." The covid toes are cutaneous lesions with various clinical features, including pain, itching, and firmness. The covid toes are most commonly observed in the areas like toes and soles.

Dengue and Petechiae-Like Rash: Occasionally dengue-like rash is present in people with COVID-19 patients. This is because the drug intake during treatment was considered to trigger skin lesions. The systemic symptoms include respiratory problems and arterial hypertension. Petechial rashes are red and merge to form macules.

Livedo-Like Rashes: Livedo reticularis is the reddish-blue skin discoloration in a net-like or lace-like pattern. The term livedo indicates the violet discoloration of the skin due to disturbances in the blood supply. Reticularis refers to a net-like or lace-like pattern of cyanotic discoloration. Livedo reticularis occurs in various conditions, including both physiologic and pathologic conditions. Young and middle-aged women are most prone to affect by Livedo Reticularis.

Androgenic Alopecia and Neonatal Rashes: Androgenic alopecia is an androgen-mediated condition that is treated with antiandrogen therapy. COVID-19-affected children usually present with skin rashes with other skin conditions. The cutaneous features in COVID-19-affected children are the maculopapular rash and ulcers on the face. The associated systemic symptoms include Kawasaki, an inflammatory disease characterized as acute vasculitis.

Pigment Disorders: The exact etiology for the incidence of pigment disorders like diffuse melanoderma is unknown. The suspected etiology for diffuse melanoderma includes hormonal imbalance, liver disorders, and the adverse effects of the drugs.

What Are the Skin Problems for Healthcare Professionals?

Handling the coronavirus is a challenging job. Healthcare professionals face many challenges in caring for patients with coronavirus. Personal protective equipment or PPE worn by doctors will exhibit severe adverse effects on the skin, such as itching, dermatitis, and erythema. The healthcare professionals' risk of skin conditions in treating COVID-19 patients is given below.

• A highly contagious virus increases the spread of infection from the patient to the doctor via sneezing, aerosols, cough, contaminated surface contact, and blood.

• The doctor and patient's financial, personal, and social lives are also affected.

• Personal protection equipment or PPE kits can cause skin problems like redness, scaling, itching, and irritation.

• Continuous wearing of masks causes contact dermatitis, itching, and urticaria.

• Seborrheic dermatitis, itching, and folliculitis in the scalp can occur due to protective caps.

• Protective goggle wear for a long time will affect the nasal bridge.

• Wearing latex gloves causes blisters, and contact dermatitis can occur.

• Frequent hand washing might cause skin dryness and irritation.

What Is the Skincare Routine to Avoid COVID-19?

Skin is the natural defense barrier of the human body. Therefore, some protective measures must be followed to avoid the spread of COVID-19. The skin care guidelines for healthcare professionals and other communities to prevent the risk of skin problems are given below.

• Moisturizers like vaseline and petroleum jelly can be applied to the skin to avoid skin dryness and irritation.

• Always wear a properly fitted mask.

• Lip dryness can be reduced by the application of paraffin balm and petroleum jelly.

• Regular mouth rinsing can be done with either normal saline or water.

• Well-fitted goggles are used to avoid skin damage.

• Always use lukewarm water for washing your face and avoid hot water.

• Moisturizers with anti-acne effects are applied in the acne-prone area.

• High-quality gloves are used to avoid glove damage. Sometimes cotton gloves can be used inside the latex gloves to protect the skin from irritation and damage.

• Mild topical steroid creams are used to relieve hand dermatitis.

• Always use hand sanitizers.

• Body shower and hand wash will avoid the risk of infection by reducing excessive sweating.

• Touching the eyes and other parts of the body with contaminated gloves and hands should be strictly avoided.

Conclusion

COVID-19 is a viral disease causing numerous cutaneous problems. COVID-19 does not follow any age, gender, and race preference. The spread of COVID-19 is rapid and needs special attention. Skin problems are common among healthcare professionals and patients facing COVID-19. The various protective measures like wearing the mask, regular hand washing, and social distancing will reduce the spread of COVID-19 from person to person. However, people must follow the skin care guidelines to avoid the cutaneous and systemic symptoms of COVID-19.