key: cord-277693-6lrawta5
authors: Wang, Yuanzhuo; Fang, Rouyu; Zhang, Hanlin; Tang, Keyun; Sun, Qiuning
title: Contributions of dermatologists to COVID‐19 research: a brief systematic review
date: 2020-05-30
journal: Dermatol Ther
DOI: 10.1111/dth.13713
sha: 
doc_id: 277693
cord_uid: 6lrawta5

Coronavirus Disease 2019 (COVID‐19) has been declared a pandemic. We conducted a systematic review to reveal the contribution of dermatologists in COVID‐19 research. 298 articles were included and classified into cutaneous manifestations of COVID‐19, operating experience against COVID‐19, mechanisms and treatment of COVID‐19, disinfection and personal protective equipment(PPE)‐related skin diseases and other topics. The value of these articles and their impact on clinical impact were discussed and we hope that dermatologists can have a better understanding of these areas from this study. This article is protected by copyright. All rights reserved.

Coronavirus Disease 2019 (COVID-19), first emerged in Wuhan, China, rapidly spread all over the world. Up to now, the number of confirmed cases has reached over 4 million. Dermatologists have contributed a lot to COVID-19, such as cutaneous manifestations of COVID-19, teledermatology, and management on patients with inflammatory skin diseases. 1, 2 Here, we systematically reviewed what dermatologists contributed to COVID-19 research.

The literature search was conducted on PubMed database on May 14, 2020.

The searching strategy was (COVID* or coronavirus*) and (dermatol* or skin* or cutaneous*), and language was restricted to English. The inclusion criteria were (1) Articles published in dermatologic journals based on InCites Journal Citation Reports Accepted Article OR (2) Articles published in journals of other categories with the first author from the department of dermatology.

529 articles were identified in PubMed. After independent selection by two authors, 298 articles were included in the systematic review. 70 articles focused on cutaneous manifestations of COVID-19 (n=70), followed by the management on patients with common skin diseases (n=68), operating experience against COVID-19 (n=49), mechanisms and treatment of COVID-19 (n=34), disinfection and personal protective equipment(PPE)-related skin diseases (n=27) and other topics(n=50). The detailed classification was shown in Table 1 . 212 articles were comments, 73 were case reports or case-series, 12 were reviews and only 1 was case-control study 3 .

The included studies were published in 36 different journals. 12 journals had more than three articles, all of which were dermatologic journals. 78 articles were published in Journal of the American Academy of Dermatology, followed by Spain, and 63 from other countries.

The current pandemic of COVID-19 aroused great public concern. The number of publications had rapid growth over time, as the plague of COVID-19 spread rapidly all over the world, and dermatologists contributed some precious experience to the community, especially those from the frontline in the "red-zone" area.

Cutaneous manifestations of COVID-19 has gained much attention. It has been pointed out that a common pattern of cutaneous symptoms may facilitate early diagnosis of COVID-19 4 . Although the cutaneous signs were highly variable and heterogeneous, a recent study reviewed the literature to summarize common features 5 , including vascular complications, maculopapular eruptions, urticarial rash, vesicular eruption, petechiae/ purpuric eruptions, erythema multiforme-like rash, palmar erythema, perifollicular eruption, pruritus, mucosal lesions, and androgenetic alopecia.

A systematic investigation is warranted as most studies were derived from case reports and case series under the heavy burden of the pandemic. Of note, these articles supported the important role of dermatologists working side by side with their staff from other departments. Severe cutaneous manifestations suggested poor prognosis for patients and were beneficial for risk stratification at the early stage of the disease 5 .

The management of patients with common skin diseases also attracted much attention, such as psoriasis, skin cancer, pemphigus and atopic dermatitis. Long-term

This article is protected by copyright. All rights reserved. use of immunosuppressants or biologics was common in these patients. Given that these drugs were critical in the treatment and may stimulate the progress of COVID-19 as well, it is a dilemma to make a decision. Studies in March, early April were comments based on expert opinions 6 , and studies of case-series in May provided additional evidence to guide the usage of these drugs 7 . The dermatologists are recommended to read these publications to weigh and judge the risks and benefits, for discontinued usage of biologics may decrease the infection risk of COVID-19 and lead to the aggravation of primary diseases at the same time 8,9 . Dermatologists also focused on measures on quarantine, triage, and resumption, and tricks of wearing masks, and performing dermoscopy. Many studies also focused on the personal protective equipment (PPE) and the need for disinfection of public places. A long time of wearing masks or other PPEs had reached consensus in causing related skin diseases like dermatitis, and the medical workers should be educated to use them properly to avoid damage. 10 These articles also included the operating experience of dermatology clinics or hospitals, such as the area of telemedicine and emergency management. Procedural dermatology was significantly influenced in the pandemic, including surgical and cosmetic techniques, laser, and the photodynamic therapy 11 . The experience facilitates the resume of outpatient dermatologic surgery with efficiency and safety 12 . There still exist some topics having little to do with dermatology were also discussed in dermatologic journals, such as mechanisms and treatment of COVID-19 13 , COVID-19 and racial disparities 14 , COVID-19 and economy 15 .

Most articles were comments, personal perspectives with low level of evidence.

Due to the epidemiologic feature of COVID-19, cohort study, case-control study, and randomized controlled trial were difficult to conduct to further reveal cutaneous manifestations of COVID-19 and disinfection and personal protective equipment-related skin diseases. Studies with larger population are warranted to further evaluate the current findings. National or international studies are also needed for further research. A growing trend was observed in the number of articles, which means COVID-19 has been increasingly attracting the attention of dermatologists.

Most articles were from epidemic countries, and as the pandemic was declared, dermatologists should have more understanding of COVID-19, and its relation with dermatology.

We would like to suggest our advice as a healthcare worker in the "red-zone" area. Services of the dermatology outpatient department and surgery were postponed except for emergency treatment. At the same time, we prioritize the use of telemedicine consultation, particularly for patients receiving biologics treatment. To minimize the risk of exposure, we also conveyed medical knowledge about usage of PPE, skincare, household cleaning, and the coronavirus to protect the dermatological patients.

This study systematically reviewed contributions of dermatologists to COVID-19 research. Research topics, journals, publication time, and country of origin were Accepted Article identified, and the value of these articles and their influence on the clinical practice were discussed in detail. We hope this study may help dermatologists to have a better understanding of the mechanisms, management, and the cutaneous manifestations of COVID-19, the operating experience of dermatology clinics in the " red-zone" area, and to use disinfectant and personal protective equipment properly.

How Dermatologists Can Learn and Contribute at the Leading Edge of the COVID-19 Global Pandemic

Challenges of COVID-19 pandemic for dermatology. Dermatologic therapy

Biologics increase the risk of SARS-CoV-2 infection and hospitalization, but not ICU admission and death: real-life data from a large cohort during RED-ZONE declaration

Cutaneous manifestations of the Coronavirus Disease 2019 (COVID-19): a brief review. Dermatologic therapy

Cutaneous Signs in COVID-19 Patients: A Review. Dermatologic therapy

COVID-19 and the use of immunomodulatory and biologic agents for severe cutaneous disease: An Australian/New Zealand consensus statement. The Australasian journal of dermatology

Novel Coronavirus Disease (COVID-19) and Biologic Therapy in Psoriasis: Infection Risk and Patient Counseling in Uncertain Times

Biologic therapy for psoriasis during the COVID-19 outbreak: the choice is to weigh risks and benefits. Dermatologic therapy

A challenging case of psoriasis flare-up after COVID-19 infection

Personal Protective Equipment Recommendations Based on COVID-19 Route of Transmission

Phototherapeutic approach to dermatological patients during the 2019 Coronavirus pandemic: Real-life Data from the Italian Red Zone. The British journal of dermatology

To resume outpatient dermatologic surgery safely during stabilized period of coronavirus disease-2019: experiences from Wuhan, China. Dermatologic therapy

What does androgenetic alopecia have to do with COVID-19? An insight into a potential new therapy. Dermatologic therapy

COVID-19 and Racial Disparities

Atomic dermatitis 3Others 24Mechanisms and treatment of COVID-19Hydroxychloroquine 7Anti-cytosine therapy 5Biologics 3

Infection possibly mediated by androgen 3

Operating experience against COVID-19Telemedicine 10 Dermatologists' perspective in the pandemic 9Measures conducted for outpatient clinic visits 9Impact of COVID-19 outbreak on dermatologic clinics 6Procedural dermatology 6Others 9Others -50Accepted Article
