Figure 3 - uploaded by M. Badawy Abdel-Naser
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(A) Chilblain (pernio)-like lesions (COVID toes) involving most of the toes in a confirmed COVID-19. (B) Vesicular lesions in addition to chilblain (pernio)-like lesions in the same patient. (C) Vesicular lesion on the scalp that is covered by a crust in the same patient.
Source publication
The COVID-19 pandemic overwhelmed the hospitals and patients' access to health care facilities is limited. Telemedicine including teledermatology emerged as practical tool in providing medical services for mild cases. Teledermatology in low-income countries is not well organized and is realized on an individualized basis. Patients provide history a...
Contexts in source publication
Context 1
... alopecia and erythema multiforme are mostly observed in hospitalized cases. However, chilblains (pernio)-like lesions were seen in mildly symptomatic cases ( Figure 3A). In almost all of these cases, there were fatigue, loss of smell and taste sensation, mild fever (38-39°C), and sore throat but no cough or difficulty in breathing. ...
Context 2
... almost all of these cases, there were fatigue, loss of smell and taste sensation, mild fever (38-39°C), and sore throat but no cough or difficulty in breathing. Some cases also showed vesicular lesions on the extremities ( Figure 3B), scalp ( Figure 3C), and to a lesser extent on the trunk. The patients responded well to a combination of vitamin C (500 mg every 8 hours), nifedipine (30 mg twice daily), and pentoxifylline (400 mg every 8 hours) for 10 days. ...
Context 3
... almost all of these cases, there were fatigue, loss of smell and taste sensation, mild fever (38-39°C), and sore throat but no cough or difficulty in breathing. Some cases also showed vesicular lesions on the extremities ( Figure 3B), scalp ( Figure 3C), and to a lesser extent on the trunk. The patients responded well to a combination of vitamin C (500 mg every 8 hours), nifedipine (30 mg twice daily), and pentoxifylline (400 mg every 8 hours) for 10 days. ...
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Citations
... the practice of telemedicine may have contributed to the underestimation of the true magnitude of the pandemic. (Abdel-Naser, 2021) Though the key manifestations of COVID-19 patients were fever, and sometimes respiratory symptoms, many case reports showed different percentages of patients having gastrointestinal symptoms and altogether the range varies from 2% to 79.1% (Guan Wei-Jie et al., 2020, Lin et al., 2020, Wang et al., 2021, Zhang Jin-Jin et al., 2020. These symptoms can emerge anytime during the COVID-19 infection, in beginning or after the onset of fever or even later. ...
Background
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of the coronavirus disease 2019 (COVID-19), has recently posed a threat to global health by spreading at a high rate and taking millions of lives worldwide. Along with the respiratory symptoms, there are gastrointestinal manifestations and one of the most common gastrointestinal symptoms is diarrhea which is seen in a significant percentage of COVID-19 patients.
Literature review
Several studies have shown the plausible correlation between overexpressed angiotensin converting enzyme 2 (ACE2) in enterocytes and SARS-CoV-2, as ACE2 is the only known receptor for the virus entry. Along with the dysregulated ACE2, there are other contributing factors such as gut microbiome dysbiosis, adverse effects of antiviral and antibiotics for treating infections and inflammatory response to SARS-CoV-2 which bring about increased permeability of gut cells and subsequent occurrence of diarrhea. Few studies found that the SARS-CoV-2 is capable of damaging liver cells too. No single effective treatment option is available.
Limitations
Confirmed pathophysiology is still unavailable. Studies regarding global population are also insufficient.
Conclusion
In this review, based on the previous works and literature, we summarized the putative molecular pathophysiology of COVID-19 associated diarrhea, concomitant complications and the standard practices of management of diarrhea and hepatic manifestations in international setups.
... The coronavirus disease 2019 (COVID-19) pandemic catalyzed the adoption of telehealth across specialties including dermatology, not only in the United States but all over the world [1]. In response, guidance on FDA Risk Evaluation and Mitigation Strategy (REMS)-required testing was updated [9], permitting patients on isotretinoin to complete monthly visits via telehealth and undergo pregnancy testing at home instead of at the provider's office [7]. ...
Systemic isotretinoin is a highly effective treatment for severe and refractory acne but carries risk for serious adverse effects such as teratogenicity. The risk mitigation system used in the United States, iPLEDGE, requires all patients on isotretinoin therapy to complete monthly tasks including follow-up visits with their prescriber, and patients with childbearing potential must additionally undergo monthly pregnancy testing. Female patients seeking isotretinoin are disproportionately affected by iPLEDGE-related barriers and have historically been prescribed isotretinoin less than male patients. The onset of the COVID-19 pandemic and updated regulations permitting at-home pregnancy testing and telehealth for monthly follow-up visits presented an opportunity to study the impact of these changes on the isotretinoin gender gap. We performed a single-center analysis to determine whether gender differences in isotretinoin prescription changed at our institution at the beginning of the pandemic. We found that male predominance of isotretinoin prescriptions was greater during the pandemic compared to pre-pandemic (odds ratios: 4.13 vs. 2.86). Furthermore, male patients were more likely to utilize telehealth compared to in-person visits for isotretinoin follow-up relative to female patients (odds ratios: 6.00 vs. 3.62). Despite the newly introduced flexibilities of telehealth and remote pregnancy testing, gender inequity in receiving isotretinoin treatment persists.
