Worldwide Distribution and Extracutaneous Manifestations of Henoch-Schönlein Purpura in Adults: Narrative Review

BackgroundHenoch-Schönlein purpura (HSP), a leukocytoclastic small vessel vasculitis, exhibits both cutaneous and systemic manifestations. While predominantly observed in childhood, it may manifest in adults with more pronounced systemic involvement. Furthermore, HSP is a global phenomenon showcasing epidemiological and systemic variances. ObjectiveThis study aims to scrutinize extracutaneous manifestations in adults with HSP, discerning distinctions according to geographical regions on a worldwide scale. MethodsA comprehensive search encompassing PubMed, Embase, Cochrane Library, and Web of Science was executed, covering papers published from January 1, 1970, to December 1, 2019. Keywords used included “Henoch-Schönlein purpura,” “henoch schonlein purpura+adult,” “IgA vasculitis+adult,” “HSP+adult,” and “IgAV.” A total of 995 publications were identified, from which 42 studies encompassing 4064 patients were selected, with a predominant focus on cases reported in Asia, Europe, and the Americas. ResultsAmong adults afflicted with HSP, European patients exhibited a higher propensity for male predominance (P<.001), gastrointestinal involvement (P<.001), and musculoskeletal complications (P<.001). Conversely, patients from the Americas were least likely to experience genitourinary involvement (P<.001). ConclusionsHSP demonstrates a variance in distribution and extracutaneous manifestations within distinct geographical boundaries. In the adult population, European patients exhibited a higher prevalence of male gender and gastrointestinal and musculoskeletal involvement. Asian patients were more predisposed to genitourinary involvement when compared to their American counterparts. The establishment of prospective studies using standardized reporting measures is imperative to validate the relationships unveiled in this investigation

Response to Assessing a Paradigm Shift: Perceptions of the USMLE Step 1 Scoring Change to Pass/Fail .

We commend Wei et al1 for highlighting the fundamental shift that dermatology program directors (PDs) and students alike will experience following the change of the USMLE Step 1 to pass/fail

Teledermatology application use in the COVID-19 era

Owing to the COVID-19 outbreak, the use of telemedicine applications has increased throughout the United States. Using an algorithm to analyze mobile application rankings, we were able to examine how applications with telemedicine services have increased in prevalence and rank pre- and post- COVID-19. Telemedicine apps saw an increase of 210.92 ranked positions on average. Within US telehealth, skin conditions have become the fifth most common diagnosis. Widespread use of teledermatology has been well-accepted. Dermatologists and patients report high satisfaction using teledermatology during COVID-19 and intend to continue using these services in the future. COVID-19 has assisted in reducing physician concerns previously preventing some dermatologists from utilizing teledermatology in their services. Additionally, the geographical and socioeconomic barriers preventing some patients from receiving dermatologic care have been minimized through the use of teledermatology. Addressing these obstacles for dermatologic care improves healthcare equity

Teledermatology application use in the COVID-19 era

Owing to the COVID-19 outbreak, the use of telemedicine applications has increased throughout the United States. Using an algorithm to analyze mobile application rankings, we were able to examine how applications with telemedicine services have increased in prevalence and rank pre- and post- COVID-19. Telemedicine apps saw an increase of 210.92 ranked positions on average. Within US telehealth, skin conditions have become the fifth most common diagnosis. Widespread use of teledermatology has been well-accepted. Dermatologists and patients report high satisfaction using teledermatology during COVID-19 and intend to continue using these services in the future. COVID-19 has assisted in reducing physician concerns previously preventing some dermatologists from utilizing teledermatology in their services. Additionally, the geographical and socioeconomic barriers preventing some patients from receiving dermatologic care have been minimized through the use of teledermatology. Addressing these obstacles for dermatologic care improves healthcare equity

Global Burden of Skin Disease Representation in the Literature: Bibliometric Analysis

BackgroundThe global burden of skin disease may be reduced through research efforts focused on skin diseases with the highest reported disability-adjusted life years. ObjectiveThis study evaluates the representation of dermatologic conditions comprising the highest disability-adjusted life years in dermatology literature to identify areas that could benefit from greater research focus. MethodsThe top 10 skin disorders according to their respective disability-adjusted life years as per the 2013 Global Burden of Disease were identified using previous studies. The top 5 dermatology journals ranked by the 2019 h-index were also identified. A PubMed search of each journal was performed using individual skin disease terms. From 2015 to 2020, all indexed publications pertaining to each disease were recorded and compared to the total number of publications for each journal surveyed. ResultsA total of 19,727 papers were published in the 5 journals over the span of 2015-2020. Although melanoma ranked as the eighth highest in disability-adjusted life years, it had the highest representation in the literature (1995/19,727, 10.11%). Melanoma was followed in representation by psoriasis (1936/19,727, 9.81%) and dermatitis (1927/19,727, 9.77%). These 3 conditions comprised a total of 29.69% (5858/19,727) of the total publications, while the remaining 7 skin conditions were represented by a combined 6.79% (1341/19,727) of the total publications. ConclusionsThis research identifies gaps in the literature related to the top skin diseases contributing to the global burden of disease. Our study provides insight into future opportunities of focused research on less-studied skin diseases to potentially aid in reducing the global burden of skin disease

Nirmatrelvir-ritonivir, COVID-19, and possible adverse cutaneous reactions

Nirmatrelvir-ritonivir (Paxlovid) recently received emergency use authorization for the treatment of coronavirus disease 2019 (COVID-19). Literature has linked numerous cutaneous adverse effects to nirmatrelvir and ritonavir, the copackaged tablets within Paxlovid. A review and comparison of these adverse effects to the common cutaneous manifestations of COVID-19 is provided. Numerous drug-to-drug interactions exist between nirmatrelvir-ritonivir and commonly-used medications within dermatology