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    Cutaneous hyperesthesia: A novel manifestation of COVID

    To the Editor,

    We have read the article by Liguori et al. (2020) with great interest. The authors evaluated the prevalence and listed the most common subjective neurological symptoms (sNS) in patients suffering from SARS-Coronavirus-2 (SARS-CoV-2) infection. We deeply understand the importance of the search for additional symptoms of COVID-19 in the era of coronavirus pandemic. Therefore, we would like to share our experience and complete the list of sNS with cutaneous hyperesthesia. The abnormal sensitivity of the skin was reported by two of our patients with confirmed SARS-CoV-2 infection. Both of them were treated with hydroxychloroquine (200 mg twice a day) and were asymptomatic after 10 days of the therapy.

    The first patient was a 40-year-old male doctor. The first observed symptoms were general malaise and fever of 38 °C. On the same day, the patient reported burdensome cutaneous hyperesthesia, which he described also as abnormal hypersensitivity. The sensation started abruptly and affected whole body; however, it mostly concerned his abdomen and back. He stated that this feeling was aggravated by any kind of touch (clothing, furniture, bed) and alleviated by warm baths, which he would take before going to bed to be able to fall asleep. The intensity of cutaneous hyperesthesia did not vary throughout the day, although, started to decrease after five days of infection. The sensation persisted for 10 days, the same period of time as his general symptoms.

    The second patient was a 40-year-old woman. The first symptoms included fever and dry cough. As her husband, the woman also reported skin hypersensitivity on the first day of symptoms. She stated, that any contact with clothing was unbearable. In this case, the cutaneous hyperesthesia also affected mostly the abdomen and the back. The only alleviating factor was a therapy with diclofenac pills, from which she was advised against by infectiologist. On the fifth day, the patient reported itchy rash (fine papular, fine scaly pink exanthema) of the mammary area, which would later spread to the abdomen and neck. The cutaneous hyperesthesia was absent in the areas affected by the rash. According to the woman, she experienced similar rash and hyperesthesia with previous influenza-like virus infections. Both the exanthema and the hypersensitivity disappeared along with the general symptoms on the 10th day. During the infection the patient developed pneumonia, reported dysgeusia and anosmia. She was treated with a 3-days course of azithromycin (500 mg).

    Cutaneous hyperesthesia is defined by the International Association for the Study of Pain as increased sensitivity to stimulation (Merskey, 2002). The pathogenesis is yet to be fully understood, however, peripheral and central nervous system injury, reorganization in dorsal horns and diminished number of C fibers in the affected zone (Hadley et al., 2016) may play the vital role. To the best of our knowledge, cutaneous hyperesthesia in patients suffering from SARS-CoV-2 infection has not been reported so far. However, the similarity of the symptoms to those reported in Herpes Virus infections (Yamada et al., 2019) may favor the possible intrinsic neurotropic properties o SARS-CoV-2 suggested by the authors (Liguori et al., 2020).

    Cutaneous hyperesthesia: A novel manifestation of COVID

    Source : www.ncbi.nlm.nih.gov

    Self

    Self-Reported Skin Sensation by People Who Have Experienced Containment During COVID-19 Pandemic

    Efforts to curb the spread of the new coronavirus (SARS-CoV-2) have led to an unprecedented simultaneous containment of almost two-thirds of the world’s population. The excessive use of hand washing and hand disinfection has been associated with an increased incidence of irritant and allergic contact eczema in health care workers.1 Face masks and headgear worn tightly for prolonged hours are also responsible for various cutaneous conditions, such as contact allergies, irritation, friction dermatitis, abrasions and aggravation of chronic dermatoses.2 Some authors also suspect that chilblains (“COVID toes”), which were widely reported in spring 2020, could be related to the containment rather than to direct SARS-CoV-2 infection.3 In addition, sensitive skin is a frequent condition in Western countries, ranging from 26 to 57% of the population, depending on the country.4 Sensitive skin is defined by the occurrence of unpleasant sensations in response to stimuli that should not normally provoke such sensations. The causative factors of skin sensitivity include physical (heat, cold, wind, or ultraviolet radiation), chemical (cleansers, cosmetics, water, or pollutants), psychological (emotional change or stress), or hormonal (menstrual cycle) factors.4,5

    Perceived consequences of containment on skin conditions have not been addressed to date in large-sized populations and in individuals suffering from sensitive skin. We performed an international online survey on a representative sample of people over 18 years of age from five countries (Brazil, France, Russia, China and the United States). The data collection procedure was identical to that in previous studies.6–9 For each country, a representative sample of the adult general population aged ≥18 years was recruited using a stratified proportional sampling with replacement design. Based on a database with the e-mail addresses of Internet users in each country, who agreed to participate in surveys (Megabase, Kantar Health, New York, NY, USA), fixed quotas of subjects fulfilling predefined sociodemographic criteria were decided. These quotas were based on the following aspects: sex, age, socio-professional status and regional distribution, thereby ensuring accurate representation of the sample population. Proportional quota sampling was used to make the study population representative of each country. Each selected participant was contacted by e-mail. If contact was not achieved, another potential participant with the same characteristics was randomly selected. Each participant agreed to complete a digital questionnaire.

    A total of 11,100 individuals (2,000 each in Brazil, France and Russia, 3050 in China and 2050 in the United States) participated between April and May 2020.

    We first inquired about socio-demographics, sensitive skin, and self-reported changes observed during containment (dry skin, skin rash, redness, and itching). The second part addressed facial skin sensitivity. The subjects were requested to rate their skin as “very sensitive,” “sensitive,” “slightly sensitive,” or “not sensitive.” Subjects with “sensitive” or “very sensitive” skin were considered to belong to the “sensitive skin” group, and those having “not very sensitive” or “not sensitive at all” skin belonged to the “non sensitive skin” group, as previously published elsewhere.4,10–12

    We did not inquire whether respondents had been diagnosed with COVID-19. As this study did not involve any patient contact and was completely anonymous, approval from the ethical review board was not necessary.

    A total of 64% (n=7170) of the respondents reported that they complied with the containment procedures (Table 1), ranging from 39% in China to 85.3% in Brazil (Table 2).

    Table 1 Characteristics of the Respondents

    Table 2 Detailed Characteristics of the Respondents by Country

    The prevalence of skin changes ranged from 16.2% in Russia to 28% in Brazil. Women were more likely than men to report a change in their skin condition (24.7% vs 16.6%, respectively, p<0.00001). There was a positive correlation between the age and skin complaints (Spearman’s rho r=0.202, p<0.01). Drier skin was the main complaint in all five countries. Overall, the three main reported complaints during containment were drier skin (44.5%), skin rash (29.3%), and greasier skin (27%). Women were more likely than men to report drier skin (48.4% vs 37.9%, respectively, p=0.0007) and skin rash (31.7% vs 25.4%, respectively, p=0.0007).

    A total of 40.9% of the men (n=2246) and 50.2% of the women (n=2817) reported having a “sensitive” skin (Table 1). The difference between the 2 sexes was significant (p < 0.001).

    Among those, 20.9% (n=1500) reported a modification of their skin in relation to containment.

    Patients with sensitive skin were more likely to report skin changes during containment (27.7% vs 14.8%, p<0.00001). The difference was significant for both sexes (p<0.00001). Patients with sensitive skin were more likely to report skin rash, itch and redness (Table 1).

    Our study shows that women and individuals who reported sensitive skin perceived that containment was responsible for their subjective skin changes. In the current context, dryness of the skin, exacerbation of pruritus and rashes may be attributed to frequent use of soap and/or hydroalcoholic solutions, as well as to the use of facial masks outside of home.13–15 Stress of containment and uncertainty of the global situation, as well as an exacerbation of preexisting dermatoses, cannot be excluded. Geographic and seasonal climatic variations, as well as the way of life, may also have an impact. The limitations of our study include the declarative nature of the responses. In daily practice, dermatologists must integrate the notion of containment in the anamnesis over the next months as a possible clue to cutaneous symptoms.

    Funding

    Funding source: La Roche Posay.

    Disclosure

    Caroline Le Floc'h, Margot Niore, Véronique Delvigne, and Guénaële Le Dantec are Employees of La Roche Posay. The authors report no other potential conflicts of interest for this work.

    References

    1. Guertler A, Moellhoff N, Schenck TL, et al. Onset of occupational hand eczema among healthcare workers during the SARS-CoV-2 pandemic: comparing a single surgical site with a COVID-19 intensive care unit. Contact Dermatitis. 2020;83(2):108–114. doi:10.1111/cod.13618

    2. Bhatia R, Sindhuja T, Bhatia S, et al. Iatrogenic dermatitis in times of COVID-19: a pandemic within a pandemic. J Eur Acad Dermatol Venereol. 2020;34(10):e563–e566. doi:10.1111/jdv.16710

    3. Herman A, Peeters C, Verroken A, et al. Evaluation of chilblains as a manifestation of the COVID-19 pandemic. JAMA Dermatol. 2020;156(9):998–1003. doi:10.1001/jamadermatol.2020.2368

    4. Kim YR, Cheon HI, Misery L, Taieb C, Lee YW. Sensitive skin in Korean population: an epidemiological approach. Skin Res Technol. 2018;24(2):229–234. doi:10.1111/srt.12418

    5. Misery L, Jourdan E, Huet F, et al. Sensitive skin in France: a study on prevalence, relationship with age and skin type and impact on quality of life. J Eur Acad Dermatol Venereol. 2018;32(5):791–795. doi:10.1111/jdv.14837

    6. Kluger N, Seité S, Taieb C. The prevalence of tattooing and motivations in five major countries over the world. J Eur Acad Dermatol Venereol. 2019;33(12):e484–e486. doi:10.1111/jdv.15808

    7. Kluger N, Misery L, Seité S, Taieb C. Tattooing: a national survey in the general population of France. J Am Acad Dermatol. 2019;81:607–610. doi:10.1016/j.jaad.2018.10.059

    8. Kluger N, Misery L, Seité S, Taieb C. Body piercing: a national survey in france. Dermatology. 2019;235:71–78. doi:10.1159/000494350

    9. Richard MA, Corgibet F, Beylot-Barry M, et al. Sex- and age-adjusted prevalence estimates of five chronic inflammatory skin diseases in France: results of the “OBJECTIFS PEAU” study. J Eur Acad Dermatol Venereol. 2018;32:1967–1971. doi:10.1111/jdv.14959

    10. Brenaut E, Misery L, Taieb C. Sensitive skin in the indian population: an epidemiological approach. Front Med (Lausanne). 2019;6:29. doi:10.3389/fmed.2019.00029

    11. Kamide R, Misery L, Perez-Cullell N, Sibaud V, Taïeb C. Sensitive skin evaluation in the Japanese population. J Dermatol. 2013;40(3):177–181. doi:10.1111/1346-8138.12027

    12. Taieb C, Auges M, Georgescu V, Perez Cullell N, Miséry L. Sensitive skin in Brazil and Russia: an epidemiological and comparative approach. Eur J Dermatol. 2014;24(3):372–376. doi:10.1684/ejd.2014.2367

    13. Lan J, Song Z, Miao X, et al. Skin damage among health care workers managing coronavirus disease-2019. J Am Acad Dermatol. 2020;82(5):1215–1216. doi:10.1016/j.jaad.2020.03.014

    14. Szepietowski JC, Matusiak Ł, Szepietowska M, Krajewski PK, Białynicki-Birula R. Face mask-induced itch: a self-questionnaire study of 2,315 responders during the COVID-19 Pandemic. Acta Derm Venereol. 2020;100(10):adv00152. doi:10.2340/00015555-3536

    15. Choudhary N. Overzealous hand hygiene during the COVID 19 pandemic causing an increased incidence of hand eczema among general population. J Am Acad Dermatol. 2020;83(1):e37–e41. doi:10.1016/j.jaad.2020.04.047

    Self

    Source : www.dovepress.com

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    Main symptoms of coronavirus (COVID

    Source : www.nhs.uk

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