This month's news from across the specialty
What's hot
August 1, 2021
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Journalists at Kaiser Health News and The Guardian have collaborated on a program called “Lost on the Frontline” with demographics and personal stories of those who died after contracting COVID-19 on the job. This is currently the most comprehensive count of U.S. health care worker deaths from COVID. Researchers at Harvard compared this data with complaints to OSHA about personal protective equipment (PPE). Alarming findings include the following: (1) The medical PPE chain seems to have catered to groups, like hospitals, that buy supplies by the ton. Thus, lapses in PPE are most likely to be reported by those in home health, nursing homes, behavioral and substance abuse care, and small practices; (2) Spikes in work-safety complaints to OSHA predict a spike in health care worker deaths 16 days later; (3) Health care worker deaths secondary to COVID-19 are likely underreported due to fears of stigma and OSHA reporting rules being vague enough that many employers choose not to report outbreaks in their workplaces. The authors note that many prefer to say that health workers mainly get COVID in the community. However, one shouldn’t discount the risks we are asked to take attending to patients in small rooms with just a surgical mask and goggles.
Practicing during a pandemic
Read more about how COVID-19 has impacted dermatologists and their patients.
Patients often ask if dietary modifications could lower their chances of developing melanoma. Generally, I have recommended a balanced diet rich in fruits and vegetables and emphasized that ultraviolet radiation exposure is the most important modifiable risk factor. However, a growing body of evidence, including a recent article in British Journal of Dermatology, supports a possible link between citrus consumption and melanoma risk (doi: 10.1111/bjd.19896). The hypothesis is that dietary psoralens in citrus are photocarcinogenic and increase melanoma risk. This particular study used the U.K. BioBank, a population-based cohort of adults 40-69 years of age who were prospectively recruited from 2006-2010. The authors identified a 63% increased risk of melanoma among individuals with >2 servings of citrus daily compared to those with no consumption, after adjusting for confounders. Risk varied by skin type and was greatest in fair to very fair skin types. Notably, prior studies investigating the link between citrus consumption and melanoma risk have yielded conflicting results. So, what message should we give to patients? First, we should not forget the clear benefits of fruit intake on lowering overall and cancer-specific mortality (Circulation. 2021; 143:1642-54); thus, recommendations to avoid or decrease citrus intake would probably lead to more harm than good. Instead, the tried-and-true message of avoiding excessive UVR exposure seems more prudent.
What can be done to minimize surgical site infections (SSI) in the postoperative period after cutaneous surgery? Surgical infections are rare after dermatologic procedures, but they can be very distressing to patients causing pain and unfavorable cosmetic outcomes. A recent study in Facial Plastic Surgery & Aesthetic Medicine evaluated published data from 37 articles regarding appropriate perioperative considerations to decrease SSI. In the review, the two most common antiseptic agents used were chlorhexidine and povidone iodine. The authors conclude that the preferred antiseptic is chlorhexidine; however, chlorhexidine should be avoided in the periocular region or near the external auditory canal due to potential keratitis and ototoxicity. Addressing colonization is important and consideration should be given to decolonizing known carriers of Staphylococcus aureus with mupirocin. The suggested regimen is nasal mupirocin twice daily for 3-5 days before surgery, and it is important to note this short course of topical mupirocin has not been shown to alter bacterial antibiotic resistance. Regarding topical antibiotic use, the review showed there is no role for postoperative use of topical antibiotics, and they pose a risk of adverse effects. A question often asked in practices is the need for sterile gloves. According to this review, surgeons may consider nonsterile gloves instead of sterile gloves for clean or outpatient superficial cutaneous procedures. They cited a sequential study of 1,883 patients and a systematic review and meta-analysis of 12,275 patients both of which showed no difference in SSI complications in Mohs micrographic surgery when nonsterile gloves were used instead of sterile gloves.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup at the DermWorld homepage.
Dermatologists played a vital role in identifying cutaneous manifestations associated with the SARS COVID-19 virus infection. Now, we are tasked with reassuring patients regarding the cutaneous side effects of the vaccines.
The information needed for appropriate patient counseling on cutaneous reactions is well outlined in a registry-based study of 414 cases reported between December 2020 and February 2021 (J Am Acad Dermatol. 2021; 85:46-55). This study examined the morphology, timing, and duration, as well as treatments of cutaneous reactions after mRNA COVID-19 vaccines. The most common cutaneous morphologies reported were delayed large local reactions, local injection site reactions, urticaria, and morbilliform eruption. Less common cutaneous reactions to both vaccines include erythromelalgia, swelling at the site of cosmetic fillers, pernio/chilblains, varicella zoster, herpes simplex flares, and pityriasis rosea-like reactions.
Most of the reactions were in general minor and self-limited, with a median time from first vaccination to onset of cutaneous symptoms of seven days. Second-dose reactions were less common and less severe. The overall most reported reaction after the vaccination was a delayed large local reaction mostly after Moderna (94%). The affected patients responded well to topical corticosteroids, oral antihistamines, and/or pain-relieving medications, and the reactions generally resolved after about three to four days.
This analysis should provide reassurance to health care professionals counseling patients who have had or suspect a cutaneous reaction to either Moderna or Pfizer vaccine. With the declining rates of COVID-19 vaccinations in the United States, it is just as important to also counsel patients on the potential benefits of receiving a COVID-19 vaccine.
