A systematic review on treatment-related mucocutaneous reactions in COVID-19 patients

Most of drugs could have certain mucocutaneous reactions and COVID-19 drugs are not an exception that we focused. We systematically reviewed databases until August 15, 2020 and among initial 851 articles, 30 articles entered this study (20 case reports, 4 cohorts, and 6 controlled clinical trials). The types of reactions included AGEP, morbiliform drug eruptions, vasculitis, DRESS syndrome, urticarial vasculitis, and so on. The treatments have been used before side effects occur, included: antimalarial, anti-viral, antibiotics, tocilizumab, enoxaparin and and so on. In pandemic, we found 0.004 to 4.15 of definite drug-induced mucocutaneous reactions. The interval between drug usage and the eruption varied about few hours to 1 month; tightly dependent to the type of drug and hydroxychloroqine seems to be the drug with highest mean interval. Antivirals, antimalarials, azithromycin, and tocilizumab are most responsive drugs for adverse drug reactions, but antivirals especially in combination with antimalarial drugs are in the first step. Types of skin reactions are usually morbilliform/exanthematous maculopapular rashes or urticarial eruptions, which mostly may manage by steroids during few days. In the setting of HCQ, specific reactions like AGEP should be considered. Lopinavir/ritonavir is the most prevalent used drug among antivirals with the highest skin adverse reaction; ribarivin and remdisivir also could induce cutaneous drug reactions but favipiravir has no or less adverse effects. Logically the rate of dermatologic adverse effects among anivirals may relate to their frequency of usage. Rarely, potentially life-threatening reactions may occur. Better management strategies could achieve by knowing more about drug-induced mucocutaneous presentations of COVID-19. © 2020 Wiley Periodicals LLC

Histopathologic changes and cellular events of organs systems in COVID-19

A better understanding of histopathologic and cellular events of COVID-19 can help us to choose more proper management strategies and treatments. There are several ways to cellular and histopathologic evaluations; including, tissue sampling from living people as biopsies or dead people as autopsies or necropsies. In this study, we tried to evaluate the histopathologic concordance between findings of various tissue samplings derived from different sites that may work as a mirror of each other, especially mucocutaneous findings which may be indicative of similar events of other parts. Based on the main keywords, we searched databases of PubMed, Scopus, Google Scholar, Medscape, and CEBD coronavirus dermatology resource of Nottingham University and included the most relevant and well-designed studies with a higher level of pieces of evidence and higher sample size. In this study, selected pathological samples from different tissues of patients with COVID-19, including skin and mucosa, lungs, gastrointestinal tract, and kidneys were studied and summarized. Cellular changes and pathological findings in these patients were included by organ and listed by prevalence. Tissue sampling in patients with COVID-19 may help understand the pathophysiology of the disease as much as possible. Although most of these samples are taken after dying the patients, sampling before the more advanced stages of the disease could also show signs of tissue involvement before appearing the full systemic symptoms. © 2021 Journal of Cellular and Molecular Anesthesia. All rights reserved

Rare clinical features of the Ellis van Creveld syndrome: A case report and literature review

Ellis van Creveld syndrome (EVC) is a rare autosomal recessive disorder also called chondroectodermal dysplasia. This study reports on a 40-year-old woman from Iran with a syndromic appearance consisting of a coarse face, conical anterior teeth, dental agenesis and permanent teeth at birth, several small extralabial, nonmidline frenula with a high-arched palate, and a large maxillary labial frenulum. The patient had cyanosis on her lips since childhood and a history of adenoid tonsillectomy surgery. She also had androgenic alopecia, an elongated trunk with excessive lordosis and pectus excavatum, polycystic ovarian syndrome, and a history of two periods in a month. She also had multiple fibrocystic cysts in her breasts, lower extremity deformity, dysplastic genu valgum, and short limb dwarfism; she had undergone left knee surgery four times and had severe osteoporosis in some of her bones and some hyperpigmented patches on the dorsal of the left hand. Her hands and feet were also wide and markedly deformed with hypoplastic fingernails and toenails, and she had bimanual hexadactyly on the ulnar side of the hands. She also had a history of severe hypotension and cyanosis during surgery and suffered from congenital heart failure and had undergone open heart surgery for correcting her atrial heart defect. In this study pectus excavatum, Phrygian cap gallbladder, liver hemangioma, polycystic ovarian disease, and breast fibrocystic cysts was reported for first time in this case of EVC syndrome. This case was reported and all articles regarding common, uncommon, rare, and extremely rare presentations of this syndrome were reviewed. © 2020 Wiley Periodicals LLC

Therapeutic options and hot topics in vitiligo with special focus on pediatrics' vitiligo: A comprehensive review study

Vitiligo is a common skin disorder with an estimated worldwide prevalence to 2.28 which is connected with selective melanocytes loss which leads to depigmentation and chalky-white macules. Vitiligo may be dismissed as a cosmetic problem and may have psychologic impacts on patients. It is occurring in both children and adults and is considered as the most common depigmenting skin disorder in the world. There are still many unknown topics about this disease regarding to its treatment in pediatrics, curable drugs and manifestations. Therefore, we decided to evaluate the recent studies about its therapeutic strategies in pediatrics. Topical therapies should be considered as first line treatment in children, but phototherapy especially NBUVB may be used after topical treatment modalities failure or in extensive or rapidly progressive disease. Our suggestion for the treatment of this disease in children is to use combine treatment modalities with observing safety according to the patient's age. © 2020 Wiley Periodicals LLC

The healing effects of facial BOTOX injection on symptoms of depression alongside its effects on beauty preservation

Background: Beauty is closely associated with a sense of calm, confidence, and hope for a better life. Therefore, it is expected that improving the appearance or even correcting one's view of appearance can prevent depression and even improve different degrees of depression in individuals. Aims: Investigation of whether using botulinum injections (a common method of improving facial esthetics) can improve the degree of depression in clients. Methods: This prospective interventional before-after study was conducted on 121 consecutive individuals referred for beautifying the face. Before performing the interventional procedure by facial botulinum injection as well as one month later, the depression status was examined by the Beck Depression Inventory II (BDI) questionnaire. Results: The mean baseline depression score dropped from 18.9 ± 4.8 to 10.6 ± 2.9 during the follow-up time (P <.001). Using the multivariable linear regression modeling and with the presence of baseline parameters, the main determinants of improving depression score included young ages (beta = �0.541, P =.001), higher educational level (beta = 0.595, P =.015), and previous experiences of botulinum toxin use (beta = 1.072, P =.036). Conclusion: The improvement in people's moods along with correction of their facial defects following botulinum toxin injections would be expected. © 2021 Wiley Periodicals LL