Indian Journal of Dermatology
EDITORIAL
Year
: 2021  |  Volume : 66  |  Issue : 3  |  Page : 229--230

COVID-19 and dermatology


Anupam Das 
 From the Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India

Correspondence Address:
Anupam Das
From the Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal
India




How to cite this article:
Das A. COVID-19 and dermatology.Indian J Dermatol 2021;66:229-230


How to cite this URL:
Das A. COVID-19 and dermatology. Indian J Dermatol [serial online] 2021 [cited 2021 Aug 5 ];66:229-230
Available from: https://www.e-ijd.org/text.asp?2021/66/3/229/321317


Full Text



While I write this editorial on coronavirus disease of 2019 (COVID-19) in May 2021, India is under the grip of the second wave of this pandemic with an exponential increase in the number of cases as well as deaths. As on May 27, 2021, there are 169,071,178 cases and 3,512,023 deaths globally. India reported 211,553 fresh COVID-19 infections on May 26, 2021, taking the caseload tally to 27,367,935. The death toll stands at 315,263. The second wave of the pandemic has emerged as a more destructive one, attributable to relaxed control measures, declining risk perception, and the understandable desire to return to normalcy.[1]

The pathogenesis of the disease has been attributed to a multitude of propositions. Recent updates have hypothesized that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) likely targets and perturbs cellular PDZ proteins (postsynaptic density protein, Drosophila disk large tumor suppressor, and zonula occludens-1 protein). Two major determinants include SARS-CoV-2 proteins—E and Orf3a—which contain a protein-binding domain at their carboxyl termini that is predicted to target a family of cellular PDZ proteins. This interaction facilitates viral replication, dissemination, and transmission.[2]

The impact of the pandemic on the physical, mental, and psychosocial well-being of the patients has been immense. Each aspect of the medical field, including dermatology, is facing the consequences and the aftermath is going to last long.

The skin is believed to act as a mirror of the underlying systemic pathologies. A gamut of cutaneous manifestations in the background of COVID-19 have been described, some of which have been “claimed” to be highly indicative of the disease. However, many of the reported manifestations could be explained by the “Baader–Meinhof phenomenon.” Also known as frequency illusion, Baader-Meinhof phenomenon is a cognitive bias in which, after noticing something for the first time, there is a tendency to notice it more often, leading someone to believe that it has a high frequency (a form of selection bias). COVID toes (presence of purple or bluish lesions on the patient's feet and toes) were reported from different parts of the globe as a specific sign of COVID-19 disease. However, in the subsequent months, this phenomenon or “epiphenomenon” has been reported from many other centers. I believe that it is difficult to qualify COVID toes as a direct manifestation of the disease because the rate of the COVID-19 antigen test positivity among the affected patients has been found to be low.[3] Akin to other viral infections, some of the frequently reported cutaneous manifestations include morbilliform rash, urticaria, erythema multiforme like lesions, and others. In the pediatric population, one interesting condition (multisystem inflammatory syndrome in children) is being increasingly reported; wherein the cutaneous manifestations have been found to simulate Kawasaki disease.[4]

The impact of the pandemic on dermatology practice has been significant with the physicians resorting to teledermatology and reducing the procedural practice to a major extent. Even though teledermatology has ushered in a considerable amount of satisfaction among both the patients and physicians;[5] it should be remembered that online (software-based) consultation has its own negative aspects, most important being the inability to have a three-dimensional morphological assessment of the dermatological conditions.[6] Besides, management of almost all the dermatological conditions including inflammatory, immunobullous, and malignant diseases, needs to be modified as per the demand of the situation. Guidelines have been issued through various task forces and expert statements, most of which have been summarized in the symposium.

Last, but not least, with the engagement of dermatology residents in COVID duties; medical education, training, completion of dissertation, and performing research work have been jeopardized massively. This impact calls for a revision of the existing curriculum followed by the adoption of technology in medical education programs by the regulatory authorities (National Medical Commission, Medical Council of India, and National Board of Examinations).[7]

This symposium on COVID-19 and dermatology has been designed to cover all the aspects of this pandemic, which has a bearing on the discipline of dermatology, either directly and indirectly. The first article discusses the basics of virology along with the pathomechanism of the disease, with a special focus on the cutaneous implications. The second article reviews the dermatological manifestations of the disease and provides extensive coverage of all the cutaneous signs and symptoms, which have been reported till now. The subsequent two articles deal with the challenges faced while practicing clinical and procedural dermatology, amidst the pandemic. The guidelines and recommendations with regards to practicing dermatology, proposed by national and international expert groups, have been highlighted in both the articles. The last article of the symposium deals with a sensitive aspect of the pandemic, i.e., the impact on the physical and mental well-being of the health care workers, and the way forward.

References

1Kasai T. From the “new normal” to a “new future”: A sustainable response to COVID-19. Lancet Reg Health West Pac 2020;4:100043.
2Rice AP, Kimata JT. SARS-CoV-2 likely targets cellular PDZ proteins: A common tactic of pathogenic viruses. Future Virol 2021. doi: 10.2217/fvl-2020-0365.
3Deutsch A, Blasiak R, Keyes A, Wu J, Marmon S, Asrani F, et al. COVID toes: Phenomenon or epiphenomenon? J Am Acad Dermatol 2020;83:e347-8.
4Naka F, Melnick L, Gorelik M, Morel KD. A dermatologic perspective on multisystem inflammatory syndrome in children. Clin Dermatol 2021;39:163-8.
5Hamad J, Fox A, Kammire MS, Hollis AN, Khairat S. Evaluating the experiences of new and existing teledermatology patients during the COVID-19 pandemic: Cross-sectional survey study. JMIR Dermatol 2021;4:e25999.
6Dovigi E, Lee I, Tejasvi T. Evaluation of teledermatology practice guidelines and recommendations for improvement. Telemed J E Health 2021. doi: 10.1089/tmj.2021.0011.
7Das A, Sil A, Chakrabarti A. An observational survey to appraise the influence of COVID-19 pandemic on dermatology training programs in India: Residents' standpoint. Indian Dermatol Online J 2021;12:423-8.