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Many COVID-19 treatments, in addition to infection, would possibly be related to adverse skin reactions and would be considered a differential diagnosis, according to a journal published in the Journal of the American Academy of Dermatology.
SARS-CoV-2 infection has been linked to a variety of skin conditions, wrote Antonio Martinez-Lopez, MD, of the Virgen University Hospital in Nies Nieves, Granada, Spain, and their colleagues, who gave a review of the skin effects related to medications. used to treat COVID-19 infection.
“Skin manifestations have recently been reported in patients with new coronavirus infection, such as skin lesions occurring in non-unusual viral infections,” they said. Infected Americans had a maculopapular rash, pseudo-frozen lesions, hives, monomorphic disseminated vesicular lesions, vesicular-pustulous acrales lesions, and a delight or necrosis, they noted.
Diagnosis of skin manifestations in patients with COVID-19 remains a challenge, as it is not known whether skin lesions are related to the virus, the authors said. “Non-coronavirus skin diseases, other seasonal viral infections and drug reactions should be taken into account in differential diagnosis, especially in patients with nonspecific manifestations such as hives or smears,” they wrote.
However, “hive injuries and maculopapular rashes in SARS-CoV-2 infections sometimes seem at the same time as systemic symptoms, while adverse drug reactions are likely to occur hours or days after treatment begins,” they said.
Reviewers observed several skin appearance effects related to several of the medications occasionally prescribed for COVID-19 infection. Hydroxychloroquine and chloroquine antimalarials had been legal for COVID-19’s remedy through the Food and Drug Administration, but this emergency authorization was revoked in June. They noted that up to 11.5% of patients taking these medications would possibly revel in the effects on skin appearance, and added some that “would possibly be with SARS-CoV-2 skin manifestations, especially those with a maculopapulous rash or exetatinous reactions”. Another aspect effect is the exacerbation of psoriasis, which has been described in patients with COVID-19, the authors said.
The mixture of oral antiretrovirals lopinavir / ritonavir, which is being studied in clinical trials on COVID-19, has been linked to rashes in up to 5% of adults in HIV studies. The pruriginous maculopapular rash, which usually occurs after initiation of treatment, is “generally well tolerated,” they said. There have been reports of Stevens-Johnson syndrome. Alopecia areata is one of the other side effects reported.
Reemployment has also been legal for the COVID-19 emergency remedy, and limited knowledge is recommended that skin manifestations may be rare, critics said. In a recent review of 53 patients treated with remdesivir for 10 days, about 8% developed a rash, but the test did not include any data “on the morphology, distribution or time of rashes in relation to remdesivir that may also help doctors.” differentiate yourself from skin manifestations. COVID-19, ” they said.
Other possible remedies for COVID-19 headaches include imatinib, tocilizumab, anakinra, immunoglobulins, corticosteroids, colchicine and low molecular weight heparins; all have prospects for skin reactions, but knowledge about COVID-19-related skin manifestations is limited, the authors wrote.
In particular, knowledge of the use of systemic corticosteroids for patients with COVID-19 is controversial; initial knowledge showed relief in mortality in COVID-19 patients receiving respiratory assistance, they noted. “With regard to the differential diagnosis of COVID-19 skin manifestations, vascular fragility related to corticosteroid use, especially in elderly patients, would possibly be similar to the thrombotic headaches of COVID-19 infection.”
Knowledge of COVID-19 virology continues to evolve and the number of drugs studied as the remedies develop, the authors noted.
“When looking at the adverse effects of drugs on differential diagnosis, dermatologists can be helpful in helping treat these patients,” they wrote. Medications, rather than infection, can cause skin reactions in some COVID-19 patients, and “management is symptomatic, but it is rarely mandatory to modify or discontinue treatment, and some situations may even be life-threatening,” they concluded.
He didn’t win outside funding. Investigators had no monetary conflict to reveal.
SOURCE: Martinez-Lopez A et al. J Am Acad Dermatol. 2020 doi: 10.1016 / j.jaad.2020.08.006.
This article was originally published on MDedge.com.
Medscape Medical News © 2020
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