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September 23, 2020

IN THIS ISSUE / September 23, 2020

Nail manifestation and COVID-19: The red half-moon sign

While multiple cutaneous dermatologic manifestations have been reported in patients with COVID-19, nail manifestations have been scarcely reported. In a recent correspondence in the International Journal of Dermatology, researchers discuss the case of a patient infected with COVID-19 who developed changes in the nail bed two days after symptoms began. The nail changes were characterized by a red-violet band above the nail lunule that lasted for one week before gradually resolving.

Neri et al reported a similar case referred to as the “red half-moon nail sign.” While the pathophysiology of this nail manifestation remains elusive, the authors hypothesize that this phenomenon could be secondary to vascular inflammation.

View a summary of evidence the Academy has gathered from dermatologists regarding skin manifestations of COVID-19.

Related content:

Dr. Warren Heymann photo
DermWorld Insights and Inquiries: The profound dermatologic manifestations of COVID-19: Part VII — Who was that masked man?

Strategies targeting susceptible populations, notably social distancing, hand hygiene, and face masks may help contain the COVID-19 pandemic. Even though nonmedical masks may not prevent the mask-wearing person from infection, such masks reduce the spread of droplets and infectious aerosols, thereby protecting others from the virus.

Christen Mowad ably reviewed the dermatologic risks of personal protective equipment last month, focusing on allergic and irritant contact dermatitis for masks and gloves.

Upon reviewing pathology reports from patients I had seen over the past week, it dawned on me that the most significant adverse effect of wearing masks may not be on the skin, but rather on the patient-physician relationship. I reached this epiphany because I could not recall some of the (mostly new) patients upon reading their results. This was never an issue for me pre-COVID, nor (I hope!) is it a harbinger of senility — I realized that I have not “seen” these patients, in the same way my iPhone does not recognize me with my mask on. Keep reading!

Derm Coding Consult: E/M utilization in dermatology

As part of its advocacy and educational efforts with the upcoming 2021 E/M coding changes, the AAD encourages dermatology practices to take a moment to understand their E/M code utilization.

The AAD coding team has reviewed Medicare’s 2019 national E/M code utilization data (previously known as ‘BESS Data’) for claims submitted by all specialties. The data includes information on how dermatology compares to other specialties nationally in Medicare E/M service codes utilization. Read more in Derm Coding Consult.

Dermatology resident develops face masks from recycled medical supplies

DermWorld Weekly talks with Aditi Sharma, MD, a third-year resident in the department of dermatology at the University of California, Irvine, about how she produced a new type of protective face mask made from recycled sterilization wraps. She is also the first dermatology resident to be the recipient of the 2020 Association of American Medical Colleges (AAMC) Organization of Resident Representatives (ORR) Community Service Recognition Award, which recognizes those who have made contributions above and beyond the rigors of residency training to improve the local communities surrounding their training institution.

DermWorld Weekly: How did you come up with the idea to use sterilization wraps to create face masks?

Dr. Sharma: The University of Florida anesthesiology team had initially hypothesized that the wrap we use for sterilizing surgical equipment has a high particle filtration efficiency as reported by the manufacturer, and therefore, could have the potential to be used in the setting of mask shortages. However, at that time, there was no data to corroborate this hypothesis. This inspired me to start researching the material as a viable alternative. What intrigued me most was that the wraps are made from polypropylene, which is the same material used to make N95s and surgical masks. Even more interesting is that in exploring how the material is prepared, the polypropylene material is melted down and blown out into a thin fibrous meshwork, creating a mechanical filtration. It is then treated with an electrostatic charge, which results in an electric filtration. This combined processing is what makes the surgical sterilization wrap and the N95 good for filtration.

Our team at the University of California, Irvine, sent several samples of surgical sterilization wrap, along with cloth masks, surgical masks, and N95s for comparative testing to be done by Greg Rutledge, PhD, professor of chemical engineering at Massachusetts Institute of Technology (MIT).

The results showed that two layers of the Halyard H600 sterilization wrap material filtered up to 86.5% of the particles, while two layers of the Gemini Medline sterilization wrap material filtered up to 73.5%. While not quite as efficient as the N95 masks, which have a filtration efficiency of at least 95%, they were far superior to the four-layered cloth masks that we tested, which had a filtration efficiency of 26.5%. Keep reading!

Therapeutic potential of cannabinoid-based therapy in dermatology

At AAD VMX, the Academy’s virtual meeting experience, Adam Friedman, MD, professor and interim chair of dermatology at George Washington School of Medicine and Health Sciences, discussed the unique anti-inflammatory properties of cannabinoids, which could make them an exciting new potential therapeutic pathway for the management of several dermatologic conditions.

In his presentation, Dr. Friedman explored the endocannabinoid system (the inherent system that responds to endogenous and exogenous cannabinoids) and reviewed the, mostly preclinical, evidence supporting the use of phyto, endogenous, and synthetic cannabinoids in multiple inflammatory skin diseases, such as lupus, chronic pruritus, psoriasis, acne, and more.

“We need bench to bedside investigations supporting the hype. For example, I co-developed and am studying a nanoparticle formulation of anandamide, an endocannabinoid, for the treatment of cutaneous lupus. I am fortunate to have a diverse and talented collaborative group that has facilitated detailed evaluation from cell culture to mouse model and now hopefully to human studies. We need others to get on board with doing good science to both ensure therapeutic efficacy and understand the mechanism,” Dr. Friedman said. Register for AAD VMX on-demand to watch Dr. Friedman’s presentation.

Learn more about the current research on the effects of CBD and its potential dermatologic uses in DermWorld.