Summary
Background
The cutaneous manifestations of COVID‐19 disease are poorly characterized.
Objectives
To describe the cutaneous manifestations of COVID‐19 disease and to relate them to other ...clinical findings.
Methods
We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis.
Results
The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo‐chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo‐chilblain pattern frequently appears late in the evolution of the COVID‐19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID‐19. The severity of COVID‐19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo‐chilblain and vesicular).
Conclusions
We provide a description of the cutaneous manifestations associated with COVID‐19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms.
What is already known about this topic?
Previous descriptions of cutaneous manifestations of COVID‐19 were case reports and mostly lacked illustrations.
What does this study add?
We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID‐19, using a consensus method to define morphological patterns associated with COVID‐19.
We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition.
Linked Editorial: Hay et al. Br J Dermatol 2020; 183:3–4.
Plain language summary available online
The value of case reports in pharmacovigilance Garcia‐Doval, I.; Segovia, E.; Hunter, H. ...
British journal of dermatology (1951),
November 2020, 2020-11-00, 20201101, Letnik:
183, Številka:
5
Journal Article
Summary
Case reports and case series remain an important part of journals and are often first to document medical breakthroughs. This article reviews their characteristics, aims and limitations. It ...provides information on how to increase the validity of the bedside decision‐making process that these studies report, using tools such as validated outcomes and split‐body or n‐of‐1 trials. A section describing tools to improve writing of case reports and case series provides suggestions for detailed reporting and good evaluation of novelty, validity and relevance. It includes general and British Journal of Dermatology‐specific guidance.
What's already known about this topic?
Case reports and case series are frequent in the dermatology literature.
Case reports have intrinsic methodological weaknesses, but they are often first to document medical breakthroughs.
What does this study add?
This article provides suggestions for detailed reporting and increasing the validity of case reports.
It also gives advice on how to discuss the novelty and relevance of case reports.
Background
Few reported studies compare drug survival in moderate‐to‐severe psoriasis vulgaris.
Objectives
To describe and compare drug survival of systemic drugs, including biologic agents ...(infliximab, etanercept, adalimumab and ustekinumab) and classical drugs (acitretin, ciclosporin and methotrexate) in moderate‐to‐severe psoriasis.
Methods
This was a multicenter, prospective, cohort study of patients receiving systemic therapies between 2008 and 2013 in 12 hospitals in Spain. Baseline data and drug discontinuation were collected. Drug survival is presented using Kaplan–Meier survival curves. We compared adjusted risk ratios of serious adverse events (AEs) with results of survival analysis for AEs.
Results
A total of 1956 patients were included for analysis (1240 exposed to biologics during follow‐up and 1076 to classic therapies). Median follow‐up time was 3.3 years (0.0–5.1 years). There were 2209 discontinuations out of 3640 therapy cycles started. The main reason for discontinuation was lack of efficacy (36.4%) and remission (27.2%). Biologics showed a higher drug survival than classics and the pattern of survival results for all outcomes (positive or negative) were very similar. Adjusted risk ratios of serious AEs did not agree with results of survival analysis.
Limitations
A limitation is that this is an observational study with potential selection bias.
Conclusion
Survival as a proxy measure of drug safety in psoriasis is inadequate.
This evidence‐ and consensus‐based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The first part of the ...guideline includes general information on the scope and purpose, health questions covered, target users and strength/limitations of the guideline. Suggestions for disease severity grading and treatment goals are provided. It presents the general treatment recommendations as well as detailed management and monitoring recommendations for the individual drugs. The treatment options discussed in this guideline are as follows: acitretin, ciclosporin, fumarates, methotrexate, adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab and ustekinumab.
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