Authors of a recently published study in JAMA Dermatology found that chilblains do not appear to be directly associated with COVID-19 in their case series. The authors hypothesize that the skin lesions may be caused by lifestyle changes brought on by containment and lockdown measures.
Thirty-one patients were enrolled in the study between April 10 and April 17, 2020. All the patients had purplish red chilblain lesions on toes and/or fingers and underwent reverse transcriptase-polymerase chain reaction (RT-PCR) analysis by nasopharyngeal swab to detect for SARS-CoV-2 RNA. The IgM and IgG antibody titers were negative for COVID-19 in all patients.
The association between chiliblains and COVID-19 is an emerging area of study; other studies have supported the connection. Watch for coverage of a new JAAD study in next week's issue ofDWW.
When it comes to medications that I never prescribe, I learn from my patients who present with findings that compel me to do my homework. Such was the case of a middle-aged woman with chronic lymphocytic leukemia (CLL) who developed a peculiar macular ecchymotic eruption on her extensor extremities. That was my introduction to ibrutinib (Imbruvica) associated adverse reactions. Tyrosine kinase is a cytoplasmic enzyme essential for B-lymphocyte survival, by regulating tracking, homing, and adhesion of CLL cells. Ibrutinib is a Bruton tyrosine kinase inhibitor utilized for CLL, mantle cell lymphoma (MCL), marginal zone lymphoma (MZL), Waldenstom macroglobulinemia (WM), and refractory, chronic graft-versus-host disease. If you have not yet seen any adverse reactions to ibrutinib, it will not be long before you do.
From a dermatologist’s vantage point, there are several presentations, related to unique aspects of ibrutinib’s mechanism and the underlying condition for which it is being prescribed. Keep reading!
How to treat nail lichen planus during the COVID-19 pandemic
In a letter to the editor published in Dermatologic Therapy, dermatologists provided guidelines for treating nail lichen planus (NLP) in the context of COVID-19. While immunosuppressants, like triamcinolone acetonide (TAC), are considered first-line treatment for NLP, it is unknown whether this may increase the risk for COVID-19-related mortality.
Since TAC administration necessitates an office visit, the authors recommend avoiding TAC injections if possible. Retinoids, a second-line NLP treatment, can be prescribed without an in-person visit and are emphasized as a therapeutic alternative to TAC injections.
The Centers for Medicare & Medicaid Services (CMS) has published Open Payments data for the 2019 program year. The data is accessible via the Open Payments website. For 2019, CMS published $10.03 billion in payments and ownership and investment interests made by applicable manufacturers and group purchasing organizations (GPOs) to physicians and teaching hospitals. This amount is comprised of 10.98 million total records attributable to 614,910 physicians and 1,196 teaching hospitals.
Payments in the three major reporting categories for the 2019 program year are:
$3.56 billion in general (i.e., non-research related) payments
$5.23 billion in research payments
$1.24 billion of ownership or investment interests held by physicians or their immediate family members
Open Payments is a national disclosure program that promotes transparency and accountability by making information about the financial relationships between applicable manufacturers and group purchasing organizations (GPOs) and physicians and teaching hospitals available to the public.
Being there
DW Weekly talked to Diana Bartenstein, MD, a PGY-2 dermatology resident at Massachusetts General Hospital, about her work as a responding physician on an inpatient COVID-19 ward.
For too many COVID-19 patients, the end has not only come quickly, but in a difficult, chaotic, environment. Some patients who do not survive are also forced to be isolated in hospital rooms in their final days, kept at a distance from professional caregivers at times, and worse, left to face death alone without family at their bedside. It’s a heartbreaking scenario. It’s also a scenario that has been rare for dermatologists. Until now.
Diana Bartenstein, MD, a PGY-2 dermatology resident at Massachusetts General Hospital, is one of many (along with providers from many different specialties) who were re-deployed to work as a responding physician on an inpatient COVID-19 ward, facing tragic, life and death situations. Just last year, she had been an intern at Brigham and Women's Hospital during her first year of residency, before starting in dermatology. Because she had been an intern so recently, she said it was easy for her to swap back into this role. “I think we're all looking for ways that we can help in this crisis,” she said, “and I felt really grateful that I could give back so readily with a needed skillset.”
Seeing a steady, mounting toll of human suffering and human loss has the potential to sap one’s spirit, particularly in situations that sometimes appear to be insurmountable. Still, Dr. Bartenstein is a positive individual, determined to face life and death situations with courage and compassion.
“I was thinking about how I would want someone in my family to be taken care of if they were hospitalized,” she said. “I’ve lived in the Boston area my entire life, so patients often feel like they could be my grandmother, or someone from my own family.” Read more.
FDA, M-CERSI to host virtual workshop on topical drug development
The FDA along with the University of Maryland Center for Excellence in Regulatory Science (M-CERSI) will host a virtual workshop on Topical Drug Development – Evolution of Science and Regulatory Policy, July 23-24, 2020. This workshop will highlight the advances in the recent assessment of dermal penetration using in vivo, in vitro, and in silico models. It will build upon a similar workshop sponsored by M-CERSI in July 2019. Learn more and register here.
Paycheck Protection Program deadline extended to Aug. 8
Congress has again extended the deadline for applications for the Paycheck Protection Program, which offers small businesses forgivable loans to cover payroll and other expenses during the COVID-19 pandemic. Dermatologists can learn more about the program, including its rules and other deadlines, in the AAD Coronavirus Resource Center.
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