Population health is the backbone of any resilient healthcare system. It can be utilized to improve public health outcomes, simultaneously mitigating risk with a value-based model. It may also facilitate identification of demographic-based disparities, high-risk patients, and possible gaps in medical attention can be enhanced by community outreach. It can become strained by pandemics.
Pandemics have ravished the globe periodically, often beginning with fever and rash, as recorded in the crowded walled city of Athens during the Peloponnesian War as described by Thucydides in 430 BC. As the world now faces the first major pandemic of the 21st century, we view the plague in Athens in 430 BC and the 2 pandemics of the more recent century which killed more than one million, the Spanish flu of 1918 and the Asian flu of 1957. The latter should be linked with successful vaccine development by heroic microbiologist Maurice Hilleman. We now look back and then forward to the viral infection coronavirus disease 2019 presently devastating the modern world.
The novel coronavirus SARS-CoV-2 has caused coronavirus disease-2019, known as COVID-19, now a pandemic affecting millions of individuals worldwide. COVID-19 is a systemic respiratory infection that may have dermatologic signs and systemic sequelae, a devastating public health challenge with parallels to the two great influenza pandemics of the last century. The coronavirus disease 2019 pandemic has had a far-reaching effect on our lives and nations; socioeconomic effects have been profound. Travel and meeting activities, as well as many other undertakings, have been severely restricted. Social unrest has intensified, with evolving political consequences globally.
Dermatological implications fall into four main groupings: cutaneous manifestations of COVID-19, skin changes from COVID-19 lifestyle alterations, cutaneous adverse reactions to COVID-19 medications, and effects of COVID-19 and its therapy on primary skin diseases and their management. COVID-19 has been associated with suggestive skin manifestations which we classify into 6 categories with three distinct patterns: vesicular (varicella-like), vasculopathic, and chilblains-like (COVID toes) plus three less indicative ones: dermatitic, maculopapular, and urticarial morphologies.
Cutaneous adverse reactions to medications used for COVID-19 can be noteworthy too. Generalized pustular figurate erythema (GPFE) and acute generalized eruptive pustulosis (AGEP) both produce widespread sterile nonfollicular pustules. AGEP tends to occur within 48 hours after penicillin or sulfonamide use as severe generalized rapidly developing pustules, whereas GPFE has a later onset 1-3 weeks after first drug ingestion and is most commonly linked with hydroxychloroquine. Its morphology is more varied, beginning with urticarial or edematous plaques studded with pustules that may become targetoid erythema multiforme-like plaques of widespread figurate erythema with pustules. Arcuate and annular patterns may develop, occasionally blisters and erosions.
Population health in the context of COVID-19 can be rendered more efficiently and effectively due to technological advances. One important capability is telemedicine. But there are many more innovations to come. As the co-founder of Apple Computer, Steve Wozniak has proclaimed, we should look ahead and Think different.
References
Schwartz RA, Kapila R: Pandemics over the Centuries. Clin Dermatol 2021; 39:5-8.
Almutairi N, Schwartz RA. COVID-19 with Dermatologic Manifestations and Implications: An Unfolding Conundrum. Dermatol Ther 2020 Sep;33(5):e13544. doi: 10.1111/dth.13544.
Schwartz RA, Kapila R: Cutaneous Manifestations of a 21st Century Worldwide Fungal Epidemic Possibly Complicating the COVID-19 Pandemic to Jointly Menace Mankind. Dermatol Ther 2020 Jul;33(4):e13481. doi: 10.1111/dth.13481. Epub 2020 May 27.
Mittal A, Elias ML, Schwartz RA, Kapila R. Recognition and treatment of devastating vasculopathic systemic disorders: Coronavirus disease 2019 and rickettsioses. Dermatol Ther. 2021 May 18:e14984. doi: 10.1111/dth.14984. Online ahead of print.
Adadas-Granado I, Palma Ruiz AM, Cerro PA, Gomez-Mateo G, Gilaberte Y, Schwartz RA: Generalized pustular figurate erythema. First report in two COVID-19 patients on hydroxychloroquine. J Eur Acad Dermatol 35(1): e5-e7, 2021.
Schwartz RA, Janniger CK: Generalized Pustular Figurate Erythema. A Newly Delineated Severe Cutaneous Drug Reaction Linked with Hydroxychloroquine. Dermatol Ther 2020; 33(3):e13380. doi: 10.1111/dth.13380.
Adadas-Granado I, Palma Ruiz AM, Cerro PA, Gomez-Mateo G, Gilaberte Y, Schwartz RA: Generalized pustular figurate erythema. First report in two COVID-19 patients on hydroxychloroquine. J Eur Acad Dermatol 35(1): e5-e7, 2021.
Schwartz RA, Kapila R. Pandemics throughout the centuries. Clin Dermatol 39:5-8, 2021.
Schwartz RA, Al-Qubati Y, Zieleniewski , Shah R, Kapila R. Onchocerciasis (river blindness): larva-induced eczema (onchodermatitis) from an important oculocutaneous tropical disease spilling over into North America and Europe. Int J Dermatol. 59:1065-1070, 2020.
Schwartz RA, Reynoso-Vasquez N, Kapila R. Chloronychia: The Goldman-Fox Syndrome – Implications for Patients and Healthcare Workers. Indian J Dermatol. 65:1-4, 2020.
