The 29th European Academy of Dermatology and Venereology (EADV) congress took place virtually between October 29-31 looking at new frontiers in dermatology and venereology. Ed Brown reports on the latest clinical trials presented at the congress.
Long Covid dermatological symptoms can last up to 150 days
A study of Covid-19 patients who fit into the category of long Covid has analysed the broad spectrum of dermatological manifestations and has estimated their duration. These findings were announced at the European Academy of Dermatology and Venereology (EADV) Virtual 2020 Congress.
A collaboration between the International League of Dermatological Societies and the American Academy of Dermatology have collected data from 990 cases from 39 countries, and have shown that the average duration of dermatological symptoms related to Covid-19 is 12 days, but in more acute cases symptoms may last up to 150 days.
Dermatological symptoms were shown to vary in duration due to the condition – hives (urticaria), last for an median of 5 days; the widely publicised Covid toes (pernio/chilblains), usually last 15 days but can last up to 150 days; and papulosquamous eruptions are known to present for an average of 20 days.
Data showed that symptom duration were also causally related to the severity of the infection and resultant hospitalisation. With some dermatological symptoms, such as retiform purpura, being heavily associated with acute symptoms, since 100% of patients that had retiform purpura were already hospitalised.
Analysis demonstrated overall that Covid toes/pseudo-chilblains are associated with relatively mild infections and are allegedly more commonly expressed in children and young adults. Additionally, researchers deduced that often the inflammation is a late manifestation of the Covid-19 infection and can appeared a few weeks to a month after the initial infection.
On the other hand, the study also highlighted a unique subset of Covid toes patients that experience long-term symptoms, usually after an acute presentation of the virus. And interesting researchers said that this may provide further insights into the long-lasting inflammatory responses of those patients.
Commenting of the registry Dr Ester Freeman, Principal Investigator of the International Covid-19 Dermatology Registry, said that: “This data adds to our knowledge about how Covid-19 can affect multiple different organ systems, even after patients have recovered from their acute infection. The skin can provide a visual window into inflammation that may be going on elsewhere in the body.”
Concluding the seminar Dr Asja Prohic, of the Medical Faculty University of Sarajevo, also presented findings from a fascinating on-going study that is seeking to understand the relationship between androgenetic alopecia (pattern hair loss) in men and heightened risk of hospitalisation from Covid-19
Biologics increase risk of Covid-19 infection but does not determine prognosis
An Italian study of 1193 psoriasis patients has found that treatment with drugs derived from human or animal proteins do not increase the risk of Covid-19.
Psoriasis is a skin disorder that causes the skins cells to multiply at an accelerated rate, causing red patches of skin to build up. The condition is treated with biologics which work by blocking reactions in the body.
Dr Giovanni Damiani, a dermatologist at the University of Milan, said that: “Although biologics, since they suppress the immune system, increased patients’ risk of being infected with COVID-19 compared with the general population, we were pleasantly surprised to see that they did not increase their risk of severe disease and death.”
Compared with the population of the Lombardy region (which at the time of the study had the highest confirmed Covid-19 cases), the patients that were receiving biologics or a small molecule agent under the care of the San Donato Hospital in Milan were at higher risk of testing positive for Covid-19, and therefore more likely to be self-isolating, or be hospitalised. But conversely no significant statistical relationship was found between treatment with biologics and ICU treatment and mortality.
Challenging preconceptions of pruritus and prurigo
EADV-funded European Prurigo project has recommended that new guidelines and related treatments need to be drawn up for the management of chronic nodular prurigo.
Chronic prurigo an inflammatory dermatosis characterised by lesions that range from small papules to large plaques or linear lesions. While pruritus is the medical term for an itch and is a symptom of several different diseases associated with skin disorders – and that in severe and persistent cases can lead to disturbed mental states.
Historically chronic prurigo has been underrepresented in medical research, but the conference heard that this is beginning to change. Professor Sonja Ständer, a dermatologist at the Center for Chronic Pruritus, University Hospital Münster, reviewed the latest clinical trial data on chronic prurigo.
Professor Ständer said that: “The first Guidelines for Prurigo have just been accepted for publication, and offer a laddered approach to treatment, reflecting disease severity, treatment efficacy and disease time course. These guidelines are a first step to standardising the treatment of this burdenful [sic] disease.”
Dr Manuel Pedro Pereira, a dermatologist at the Centre for Chronic Pruritus, also presented the findings of an international survey of 406 chronic nodular prurigo patients which showed that overall, they were dissatisfied with their treatments when they were not treated with potent systemic agents.
Additionally, findings of a research paper were announced, that identified the ‘elusive’ cause of uraemic pruritus, a daily bout of itching that worsens at night. The cause of that this research paper indicated was changes in the peripheral opioid system – opioid receptors are proteins that extend onto the surface of cell membranes that act as communicators for the external environment.
Although the paper concluded that further research into this area is still required to fully understand the cause of the condition.
Novel allergen-depleted fragrance ‘could be a game changer for dry skin sufferers’
Fragrances are a frequent cause of allergic contact dermatitis, but a new non-allergenic, anti-inflammatory fragrance has been developed without any of the 26 commonly known allergens, or any of the 60+ potential allergens currently under evaluation.
Beiersdorf researchers reported the findings of two tests at the EADV Congress, which they said proved that the fragrance is anti-inflammatory while also retaining the property of a pleasant scent. Therefore, the moisturiser is suitable for people with abnormally dry, xerotic skin who may also be allergic to fragrant moisturisers.
Analysis of skins cells in the research found that the anti-inflammatory ingredients reduced inflammatory expressions prostaglandin E2 and interleukin-8 after a stressor was applied. While another test involved volunteers repetitively shaving the skin under their arms to induce irritation and concluded that inflammation was significantly reduced by the moisturiser.
Dr Julia Gallinger, a senior scientist working on the project at Beiersdorf AG Research and Development department said that: “The long-standing paradigm of fragranced moisturisers considered as allergenic risk in the treatment of xerotic dermatoses may soon become obsolete. The fragrance has been integrated into two new Eucerin UreaRepair PLUS products for dry skin to provide skin care with a pleasurable experience.”
Positive results were also found in a patient preference study of 86 people with dry skin, that found that after a use of two weeks: 97% said that they enjoyed applying it to their skin; 91% replied that the lotion made their skin care routine more pleasant; and 71% preferred this fragrant lotion over their usual unscented one.
Thai military combat smelly feet
Socks coated in zinc oxide nanoparticles have been developed by the Royal Thai Airforce, that prevent foot odour caused by bromodosis, and the superficial bacterial skin infection pitted keratolysis.
Double-blinded trials were conducted with 148 cadets at the Thai Naval Rating School, and found that the socks’ coating had an significantly effective antibacterial effect, as well as being dermatologically safe, which researchers said made it the perfect compound to prevent foot odour.
Dr Punyawee Ongsri, a naval officer and final year resident at the Department of Dermatology at Siriraj hospital, said that: “I saw a high number of foot infections in military personnel. I wanted to find a way to prevent and treat these fungal and bacterial infections and those conditions associated. Previous studies had demonstrated zinc oxide nanoparticles’s antibacterial properties therefore … [we] wanted to test the efficacy of this new technology in a real-life setting.”
Dr Ongsri also said that the team that he working with was continuing to research with other textiles to replicate these findings with other fungal and bacterial infections: “These socks could provide a new primary prevention option for both military personnel and those susceptible to these embarrassing and unpleasant conditions.”
Successful study raises hope of a treatment of GPP
A successful study, conducted by Boehringer Ingelheim, was called attention to, at the EADV Virtual conference, that showed promising signs from its phase one trials treating the rare skin condition generalised pustular psoriasis (GPP).
GPP is a rare immune response genetic skin disease that is characterised by episodic widespread eruptions of sterile fluid filled pustules and erythematous, sometimes causally related to pregnancy. There is currently no cure for GPP and there are scarce reliable biologic therapy options available for this potentially life-threatening illness. Typically, symptoms are managed by various prescriptions such as retinoids, methotrexate and corticosteroids, which contain a low likelihood of solving the recurring lesions.
Often GPP is confused with pustular psoriasis, but it can co-occur with it – and as GPP is so rare, misdiagnosis is frequent. Also living with GPP is difficult due to pain, fevers, persistent itching, fatigue, systemic problems, and the mental health implication of an extremely widespread and therefore visible skin condition – even though the condition is not contagious, social interactions can become difficult as it is not well understood.
The phase one trials showed that treatment with Spesolimab, a humanised monoclonal anti-body, was successful against the IL-36R response – suspending and eradicating pustular skin presentations within one week and sustaining that state for up to 20 weeks.
Professor Hervé Bachelez, of the Department of Dermatology, St. Louis University Hospital, said that: “In this phase one proof of concept study conducted on seven patients with an acute GPP flare, and single intravenous dose of Spesolimab was well tolerated… This was the first study conducted on GPP to show very rapid skin and pustular clearance.”
Vitamin B3 protects skin from effects of UV exposure
A form of vitamin B3 could protect skin cells from the effects of ultraviolet (UV) exposure: the main risk factor for non-melanoma skin cancers, according to research presented at the EADV.
Researchers in Italy isolated cells (human primary keratinocytes) from the skin of patients with non-melanoma skin cancers. These cells were treated with three different concentrations of nicotinamide (NAM), a form of vitamin B3, for 18, 24, and 48 hours and then exposed to UVB.
Results show that pre-treatment with 25µM of NAM 24 hours before UV irradiation protected the skin cells from the effects of UV-induced oxidative stress, including DNA damage. NAM enhanced DNA repair, demonstrated by decreased expression of the DNA repair enzyme OGG1. Furthermore, it decreased antioxidant expression and blocked local inflammation by showing decreased nitric oxide (NO) release and reactive oxygen species (ROS) production, and reduced iNOS protein expression.
Lara Camillo, a research student from the Dermatological Unit of AOU Maggiore della Carità, Novara, Italy says: “Our study indicates that increasing the consumption of vitamin B3, which is readily available in the daily diet, will protect the skin from some of the effects of UV exposure, potentially reducing the incidence of non-melanoma skin cancers. However, the protective effect of vitamin B3 is short-acting, so it should be consumed no later than 24 to 48 hours before sun exposure.”