VARICELLA LIKE DERMATOLOGICAL MANIFESTATION FOLLOWING SARSCOVID-19 INFECTION :A DIAGNOSTIC DILEMMA

The infection caused by the novel SARS-CoV-2 is a public health emergency of international concern. Although, COVID-19, mainly affects the lungs, the infection can spread to extrapulmonary tissues, causing multiorgan involvement in severely ill patients. The infectivity of SARS-CoV-2 is related to the pattern of expression of the viral entry factors ACE2 and TMPRSS2 in human tissues. As such, the respiratory and gastrointestinal tracts are at high risk for SARS-CoV-2 infection due to their high expression of ACE2 and TMPRSS2, which explains the clinical phenotype described in the vast majority of infected patients that includes pneumonia and diarrhea. Recently, concern regarding virus to infect the skin has been raised by dermatologists due to the increasing observations of cutaneous manifestations in patients with SARS-CoV-2 infection. Although there is little evidence of the expression of ACE2 and TMPRSS2 in the normal skin, the dermatological ndings observed among COVID-19 patients warrants further investigation to delineate the mechanisms of skin affection after SARS-CoV-2 infection[1]. The frequency of skin lesions in these patients varies between 1.8 % and 20.4 % . The major dermatologic morphologies described in CoVID-19 cases were morbilliform, pernio-like, urticaria, macular erythema, vesicle, papulosquamous and retiform purpura

Disinfectants and Skin Antiseptics for Safe prophylaxis against COVID-19, Review of Literature.

Coronavirus disease 2019 (COVID-19) is currently receiving the whole world's attention. It appeared first in Wuhan city of China and rapidly spread to the world, causing many mortalities and morbidities; the disease is mainly transmitted via respiratory droplets and has a long infectivity period of about 14 days. Science shows that the virus is also transmitted via the skin if the virus by any means finds its way and land on the skin surface. Infection occurs when touching the face, eyes, or nose with the hand after the virus has landed upon it. This is the main reason for the widespread usage of skin antiseptics and disinfectants. We included the most commonly used skin antiseptics, sterilizing methods, and disinfectants, such as household bleach, hydrogen peroxide gas plasma, Formaldehyde, Glutaraldehyde, Alcohol, Chlorohexidine, Povidone-iodine, Chloroxylenol, and alcohol-based hand sanitizer (e.g. Sterlelium). We will discuss their role in preventing acquired infection of COVID-19, as well as discussing the efficacy, costs, and side effects of different sterilizers, including general health hazards, as well as skin affection as irritant contact dermatitis, which is the commonest side effect. After conducting this work, we summarized the results & started sending them to our patients & medical personnel, and we observed 60% decrease in the cases of disinfectants induced allergic contact dermatitis /month compared to the previous two months.

AB0620 EFFECTIVENESS OF RITUXIMAB IN PATIENTS WITH EARLY DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. A MULTICENTER ANALYSIS.

Background:Rituximab (RTX) is effective in improving skin affection in patients with diffuse cutaneous systemic sclerosis (DcSSc). However, there are few data on early use of this drug.Objectives:To evaluate RTX effectiveness for skin disease in patients with DcSSc of less than 3 years of evolution.Methods:Multicenter, observational and retrospective study. Patients with DcSSc starting RTX within 3 years since first non-Raynaud symptom were recruited. Demographic variables, time of disease duration at the beginning of RTX, immune pattern and time on RTX treatment were collected. Effectiveness was defined as modified Rodnan skin score (mRSS) improvement. Evaluations were done by the same experienced rheumatologist. Patients subjective perception of skin hardening and/or tightness was evaluated. mRSS changes from baseline to 6 and 12 months after RTX beginning and, later on, to the last available observation were analysed using Wilcoxon test. Statistical analysis was performed with SPSS 20.0.Results:11 patients (8 women) were recruited from 2 university hospitals. Median age was 48 years (IQR 22). Median time since diagnosis to RTX beginning was 12 months (IQR 8). 5, 3 and 2 patients presented ATA +, RNPIII + and Ro-52 +, respectively. Median duration of RTX treatment was 12 months (IQR 68). Median baseline mRSS was 15.5 (IQR 18). Median mRSS after 6 and 12 months of RTX treatment and at last available mRSS evaluation was 15 (IQR 13), 14.5 (IQR 13) and 11 (IQR 16), respectively. mRSS showed statistically significant improvement at 6 (29%, IQR 37) and 12 months of RTX treatment (35%, IQR 34) and, thereafter, at last available observation (39%, IQR 51), compared to basal mRSS. Most patients reported subjective improvement at 6 (9 of 10 patients) and 12 months (6 of 7), and at last available evaluation (6 of 8); all other patients reported stability.Conclusion:In our experience, patients with DcSSc seem to benefit of early RTX treatment. Improvement may be seen as early as 6 months and seems to reach a plateau at 12 months.Disclosure of Interests:I Vázquez-Gómez: None declared, J. Narváez: None declared, J Lluch Pons: None declared, Marta Aguilar-Zamora: None declared, L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, Eduardo Flores: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, Desamparados Ybañez: None declared, À Martínez-Ferrer: None declared, A Sendra-García: None declared, Inmaculada Torner Hernández: None declared, V Núñez-Monje: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis

Aristolochia trilobata: Identification of the Anti-Inflammatory and Antinociceptive Effects

Aristolochia trilobata, popularly known as “mil-homens,” is widely used for treatment of stomach aches, colic, asthma, pulmonary diseases, diabetes, and skin affection. We evaluated the antinociceptive and anti-inflammatory activities of the essential oil (EO) and the main constituent, 6-methyl-5-hepten-2-yl acetate (sulcatyl acetate, SA). EO and SA (1, 10, and 100 mg/kg, p.o.) were evaluated using chemical (formalin-induced licking) and thermal (hot-plate) models of nociception or inflammation (carrageenan-induced cell migration into the subcutaneous air pouch, SAP). The mechanism of antinociceptive activity was evaluated using opioid, cholinergic receptor antagonists (naloxone and atropine), or nitric oxide synthase inhibitor (L-NAME). EO and SA presented a central antinociceptive effect (the hot-plate model). In formalin-induced licking response, higher doses of EO and SA also reduced 1st and 2nd phases. None of the antagonists and enzyme inhibitor reversed antinociceptive effects. EO and SA reduced the leukocyte migration into the SAP, and the cytokines tumor necrosis factor and interleukin-1 (TNF-α and IL-1β, respectively) produced in the exudate. Our results are indicative that EO and SA present peripheral and central antinociceptive and anti-inflammatory effects.

Trichodysplasia Spinulosa in a Renal Transplant Patient

Background: Trichodysplasia spinulosa (TS) is a rare skin affection seen in immunocompromised patients, mainly those with solid organ tranplants. Objective: To report a case of a patient with classic clinical and pathologic findings for the disease so that physicians caring for this population are aware of the clinical presentation. Method: We report the case of a female patient we saw at our clinic with a diagnosis of TS. Results: The diagnosis of TS was confirmed by pathologic findings. Conclusion: TS should be considered in any immunocompromised patient with a papular facial eruption reminiscent of acne vulgaris and with keratotic spiny papules as a distinctive feature.

Methylprednisolone Therapy in Acute Hemorrhagic Edema of Infancy

We present a case of an 18-month-old boy who showed severe clinical signs indicative of acute hemorrhagic edema of infancy (AHEI) with painful purpuric skin affection primarily of the face and marked edema of the ears. The histological findings were diagnostic for leukocytoclastic vasculitis and thus met the histological criteria for AHEI. Indicative of infection as causative agent for the condition were symptoms of gastroenteritis. High-dose intravenous corticosteroids led to a fast resolution of symptoms and normalization of laboratory parameters. AHEI is usually not described as being very responsive to corticosteroids. The case presented here indicates that severe cases of AHEI can be treated with high-dose intravenous corticosteroids resulting in significant relief and shortening of the symptoms. Clinical followup showed no underlying malignancy or other severe chronic systemic diseases thus confirming earlier reports that AHEI is not associated with such conditions. The differential diagnoses with AHEI are discussed.