Acrocyanosis: The Least Known Acrosyndrome Revisited With a Dermatologic Perspective.

Background and AimThe COVID‐19 pandemic has significantly impacted human lives across the world. In a country like India, with the second highest population in the world, impact of COVID‐19 has been diverse and multidimensional. Under such circumstances, vaccination against COVID‐19 infection is claimed to be one of the major solutions to contain the pandemic. Understanding of Knowledge, Attitude and Practice (KAP) measures are essential prerequisites to design suitable intervention programs. This paper examines the different KAP factors in Indians towards their decision of vaccine uptake.MethodAn online questionnaire was administered to Indian respondents. (Pilot study: n = 100, Main study: n = 221) to assess their existing knowledge on COVID‐19 infections and vaccination, attitude and intentions towards COVID‐19 vaccines and their decision towards COVID‐19 vaccine uptake.ResultThe findings highlighted that existing knowledge on COVID‐19 infections and vaccination directly impacted their attitude and intention towards vaccination. The attitude and intention towards COVID‐19 vaccines directly impacted their practice of undergoing COVID‐19 vaccination. Further, there was a statistically significant and considerably large indirect effect of existing knowledge on COVID‐19 infections and vaccination on the practice of undergoing COVID‐19 vaccination through attitude and intention towards the vaccine. There was no direct effect of Knowledge (existing knowledge on COVID‐19 infections and vaccination) on Practice (decision to undergo COVID‐19 vaccination). Therefore, Attitude and intention towards COVID‐19 vaccine is the primary mediator between Knowledge (existing knowledge on COVID‐19 infections and vaccination) and Practice (decision to undergo COVID‐19 vaccination).ConclusionParticipants decision towards COVID‐19 vaccination decisions are strongly related to their attitude and intentions that confirms the strong role of attitude towards success of COVID‐19 vaccination programme. Therefore, ‘person‐centric’ attitude based positive intervention strategies that links their prior knowledge on COVID‐19 infections and vaccination must be designed for greater vaccine acceptance amongst Indians.

Patient-Reported Association Between COVID-19 Infection or Vaccination and Onset of Allergic Contact Dermatitis®.

Herpes zoster (HZ) has been observed to occur after COVID-19 infection and vaccination; however, knowledge regarding the demographic data, clinical presentations, and treatment outcomes of HZ is limited. To compare the demographic data, clinical manifestations, treatments, and outcomes of patients with and without HZ within 14 days of COVID-19 infection or vaccination. This prospective cohort study involving patients diagnosed with cutaneous HZ was conducted at a dermatology clinic from October 2021 to January 2023. Among a total of 232 patients with HZ, the median age was 62.0 years and 59.1% were female. HZ developed in 23 (9.9%) and four (1.7%) patients after COVID-19 vaccination and infection, respectively. The mean duration from vaccination and the median duration from infection to HZ onset were 5.7 and 8.5 days, respectively. The proportion of female patients was significantly higher in the group of patients with COVID-19 vaccination or infection than in those without such a history (P = 0.035). Patients who developed HZ following the recent COVID-19 infection had a median age of 42.5 years, which was lower than that of the other groups. Dissemination occurred in 8.7% of the patients after COVID-19 vaccination. HZ recurrence was reported in five cases, of which 80% had been vaccinated or infected with COVID-19 during the previous 21 days. All patients had similar durations of antiviral treatment, crust-off time, and duration of neuralgia. HZ after COVID-19 vaccination is more frequently observed in females, while HZ after COVID-19 infection tends to occur in younger patients. Disseminated HZ is more common in patients recently vaccinated against COVID-19. COVID-19 vaccination or infection may trigger recurrent HZ infection.

PCR158 Hungarians' Attitudes Toward the COVID-19 Disease and Vaccination: An Online Survey

Purpose To report and compare the incidence, prevalence, and presentation of herpetic eye disease (HED) before and during the COVID-19 pandemic in an urban hospital system and assess related COVID-19 infection or vaccination prior to presentation. Methods A retrospective chart review of patients with herpes simplex virus (HSV) keratitis and HSV uveitis based on ICD-10 diagnosis codes at the University of Illinois Hospitals from before the COVID-19 pandemic (May 1, 2018, to February 29, 2020) and during the COVID-19 pandemic (March 1, 2020, to December 31, 2021) was performed. For each patient, demographic and clinical information was recorded. For patients seen during the pandemic, any history of COVID-19 infection or vaccination prior to HED presentation was recorded. For patients who presented with a history of COVID-19 infection or vaccination, further chart review was performed. Results Seventy-one patients (0.024%) out of 299,201 patients seen at the University of Illinois Hospitals presented with active HED in the period before the pandemic. Sixty-four patients (0.008%) out of 841,173 patients seen at the University of Illinois Hospitals presented with active HED in the period during the pandemic. Seventeen (26.6%) patients who presented during the pandemic had a history of COVID-19 infection or vaccination within 60 days prior to presentation. Conclusion Understanding the potential relationship between new presentations and recurrences of HED following COVID-19 exposure is important to consider with future COVID-19 infections and booster vaccinations. Providers should be aware of possible development of HED after COVID-19 vaccination or infection and should counsel patients accordingly.

Background & Aim: Hungary started to administer several COVID-19 vaccines; however, attitudes toward COVID-19 and vaccination are still poorly understood. This study aimed to explore how the attitudes toward COVID-19 disease are associated with the attitudes toward COVID-19 vaccination in Hungary and compare the attitudes of health and non-health workers toward COVID-19 disease and vaccination in Hungary. Methods & Materials: Using a descriptive, cross-sectional design, we recruited a sample of 1820 persons through an electronic survey. In addition to the sociodemographic questions, the attitudes towards COVID-19 disease and vaccination were assessed through self-developed, literature-based questionnaires. Principal component analysis, Spearman's correlation, linear regression, and the Mann-Whitney test were used in the data analysis. Results: The mean age for the study participants (n=1735) was 43.8 ± 6.2 years, and females were the majority (84.6%). Overall, participants showed good attitudes toward COVID-19 disease (mean score= 3.48, SD= 0.43) as compared to their attitudes toward COVID-19 vaccination (Mean score= 2.67, SD= 0.44). A positive correlation was found between the attitudes toward COVID-19 disease and attitudes toward vaccination in Hungary (r= 0.247, p< 0.01). Nurses and other health workers showed more positive attitudes toward COVID-19 vaccination than non-health workers. Conclusion: Hungarian decision-makers should intervene to improve the public's willingness to be vaccinated against COVID-19 or future pandemics. Health workers' knowledge and positive attitudes should be utilized in the media to encourage the general population to be vaccinated. The suggested questionnaires need to be validated for future pandemics' use.

Background Monitoring coronavirus disease (COVID-19) infection and vaccination during pregnancy is vital because of the increased susceptibility to severe disease. This article outlines the available data sources on COVID-19 infection and vaccination rates during pregnancy in Northern Ireland (NI) and the Republic of Ireland (ROI) and describes the processes, strengths, and weaknesses of available data. Methods Three data sources on COVID-19 vaccination and infection were identified in the ROI: the national computerized infectious disease reporting (CIDR) system used for reporting notifiable infectious diseases, the national dataset of all COVID-19 vaccinations for all residents (COVAX), and a regional Maternal and Newborn Clinical Management System (MN-CMS), which includes data on COVID-19 vaccination and infection. Four data sources were identified in NI: the NI maternity system (NIMATS) records maternity data, including COVID-19 infection and vaccination during pregnancy; datasets of COVID-19 antigen testing performed in hospitals (Pillar 1) and in the community (Pillar 2); and the NI Vaccine Management System dataset of COVID-19 Vaccinations. Results In the ROI, the CIDR database allows for the calculation of COVID-19 infection rates in women of reproductive age; however, pregnancy status remains largely unreported. The COVAX dataset includes pregnancy status, although the accuracy depends on whether the pregnancy is known at the time of vaccination. The MN-CMS tracks COVID-19 infection and vaccination during pregnancy. However, there are uncertainties regarding its reliability. In NI, COVID-19 data are available for all pregnant women using Health and Care numbers to link the NIMATS data to testing and vaccination databases. Conclusions Both countries track COVID-19 infection and vaccination rates, but the strength of the NI system is the use of unique identification numbers that allow linkage of maternal records to infection and vaccination databases. Both countries face delays in data access, underscoring the need for real-time systems to support future pandemic preparedness.

Monitoring coronavirus disease (COVID-19) infection and vaccination during pregnancy is vital because of the increased susceptibility to severe disease. This article outlines the available data sources on COVID-19 infection and vaccination rates during pregnancy in Northern Ireland (NI) and the Republic of Ireland (ROI) and describes the processes, strengths, and weaknesses of available data. Three data sources on COVID-19 vaccination and infection were identified in the ROI: the national computerized infectious disease reporting (CIDR) system used for reporting notifiable infectious diseases, the national dataset of all COVID-19 vaccinations for all residents (COVAX), and a regional Maternal and Newborn Clinical Management System (MN-CMS), which includes data on COVID-19 vaccination and infection. Four data sources were identified in NI: the NI maternity system (NIMATS) records maternity data, including COVID-19 infection and vaccination during pregnancy; datasets of COVID-19 antigen testing performed in hospitals (Pillar 1) and in the community (Pillar 2); and the NI Vaccine Management System dataset of COVID-19 Vaccinations. In the ROI, the CIDR database allows for the calculation of COVID-19 infection rates in women of reproductive age; however, pregnancy status remains largely unreported. The COVAX dataset includes pregnancy status, although the accuracy depends on whether the pregnancy is known at the time of vaccination. The MN-CMS tracks COVID-19 infection and vaccination during pregnancy. However, there are uncertainties regarding its reliability. In NI, COVID-19 data are available for all pregnant women using Health and Care numbers to link the NIMATS data to testing and vaccination databases. Both countries track COVID-19 infection and vaccination rates, but the strength of the NI system is the use of unique identification numbers that allow linkage of maternal records to infection and vaccination databases. Both countries face delays in data access, underscoring the need for real-time systems to support future pandemic preparedness.

Since the worldwide spreading COVID-19 pandemic from early 2020 onwards, several cutaneous manifestations of SARS-CoV2 infection have been described. Similarly, with the start of the global vaccination campaign, reports of new onset or exacerbation of inflammatory dermatoses have been reported. In particular, numerous case reports of psoriasis flares after COVID-19 infection and/or vaccination have recently been published. Our study aimed to evaluate the effectiveness and safety of anti-interleukin (IL) biologic drugs for the treatment of severe flares of psoriasis following COVID-19 infection or vaccination. Twenty-eight patients with a diagnosis of moderate-to-severe psoriasis following COVID-19 infection or vaccination or patients with a severe flare of previously untreated mild plaque psoriasis, all treated with biologics, were enrolled in this study. After 16 weeks of treatment, the mean Psoriasis Area and Severity Index decreased from 13.65 to 0.77, with 16 patients (57.14%) achieving complete skin clearance. In our study, we underline a high-effectiveness profile of different biological drugs in treating psoriasis flares induced by COVID-19 vaccination and/or infection. Our data support the role of biologics in preventing severe flares of psoriasis despite possible concomitant inflammatory triggers, such as infections or vaccines.

Lichen planus is one of the common adverse reactions after COVID-19 infection and vaccination. Despite it being reported in several case reports, the literature including a large sample of the studied population is lacking. The current study was performed to assess the risk of LP after COVID-19 infection as well as COVID-19 vaccination. The current study was designed as a retrospective cross-sectional hospital-based study of registered patients at the University of Florida (UF) health centers. The diagnoses of LP, COVID-19 infection, and COVID-19 vaccines were detected. The logistic regression model was used to assess the risk of developing LP after COVID-19 infection and vaccination. A total hospital patient of 684,110 attended UF Health centers were included in this study. 181 patients reported LP after COVID-19 vaccination and 24 patients developed LP after COVID-19 infection. The risk of developing LP after COVID-19 vaccination was 1.573 while the risk of developing LP after COVID-19 infection was 1.143. The odds of getting LP after COVID-19 vaccination are significantly developed. The current study showed that COVID-19 infection and vaccination are associated with LP. So, healthcare practitioners should be aware of this reaction for rapid recognition and treatment.

BackgroundThere have been several case reports of herpes zoster (HZ) following COVID-19 disease and vaccination. We conducted a non-systematic literature search to elucidate the global effects of the COVID-19 pandemic on the incidence of HZ.MethodsThe literature search was performed in October 2021 using PubMed and Embase. The search string was herpes zoster AND COVID-19. Publications were manually reviewed; case reports were removed.ResultsThree retrospective studies reported the risk of HZ following COVID-19 disease. One study (Bhavsar, 2021) used two US databases and found higher risk of HZ following COVID-19 disease (relative risk [RR]=1.15) and COVID-19 hospitalisation (RR = 1.21), respectively. A strong association between HZ and COVID-19 disease (RR = 5.27) was also reported in a study of the University of Florida patient registry (Katz, 2021). The third study (Barda, 2021) reported no association between COVID-19 disease and risk of HZ (RR = 0.82). In two of the three observational studies in Israel (Furer, 2021 and Barda, 2021), the incidence of HZ was increased following COVID-19 vaccination. The third study (Shasha, 2021) found no association (RR = 1.07). Other studies included a report in Brazil (Maia, 2021) that demonstrated a 35% increase in HZ diagnoses during the pandemic versus pre-pandemic and a published model (La, 2021) that estimated the declining uptake of recombinant zoster vaccine in the US may result in 63,117 avoidable HZ cases in those who remain unvaccinated in 2021.ConclusionsEmerging data suggest that the COVID-19 pandemic may have increased the risk of HZ and negatively impacted HZ vaccine uptake. Therefore, there is an important need to increase awareness of HZ and HZ vaccination during the pandemic.Key messages• There is a need to increase awareness of HZ and HZ vaccination during the COVID-19 era.• Further studies are needed to fully understand the impact of COVID-19 on the risk of HZ.

Much of the literature involving COVID-19 and chronic inflammatory dermatological conditions have focused on the safety of immunomodulatory therapy in the setting of this highly infectious virus. While general mortality associated with the infection and vaccine has been studied in depth, the effects of the virus and vaccine on inflammatory skin disease states have not been. It is well known that psoriasis can be triggered by stress, infection, certain medications, and, although not as common, vaccinations. Further, existing literature has briefly commented on psoriasis flares after COVID vaccination, but these have not touched on flares among their patients’ current therapy, nor flares after COVID infection. In this case report, we report five cases observed at our institution over the last year of either new-onset psoriasis or flares of previously well-controlled psoriasis shortly after infection with COVID-19 or COVID-19 vaccination, with no other identifiable triggers. These cases can serve to raise awareness of issues related to managing stubborn psoriatic flares and bring to the forefront conversations that are likely to arise with our patients regarding the risks and benefits of COVID vaccination and boosters. While the definitive etiology of the association between COVID and psoriasis remains unclear, it is important that the dermatologic community be aware when evaluating patients with new-onset or worsening psoriasis as we move forward in times of this COVID-19 era.

An asymmetric morbilliform eruption in an adult male

Closing the global vaccine equity gap: equitably distributed manufacturing

Pemphigus vulgaris after COVID-19 infection and vaccination