Adverse Skin Reactions to Personal Protective Equipment Among Health-Care Workers During COVID-19 Pandemic: A Multicenter Cross-sectional Study in Indonesia

Objective:Health-care workers(HCWs)in Indonesia have been participating in the war against the coronavirus disease-2019 since March 2020.Ever since HCWs were exposed to the regular use of personal protective equipment(PPE)with varying levels and maintain hand hygiene more as recommended by the World Health Organization.Adverse skin reactions to PPE in Indonesia has yet to be acknowledged.This study aimed to study the prevalence and characteristics-,possible risk factors-,and suggest possible solutions towards adverse skin reactions to PPE among HCWs in a multi-center setting of Indonesia.Methods:A cross-sectional survey was conducted online among HCWs in the Siloam Hospitals Group of Banten province.HCWs of Banten Province were surveyed from June 1 to August 31,2020.The data was obtained using avalidated online survey questionnaire including(1)demographic characteristics;(2)occupational-related characteristics;(3)adverse skin reactions.Results:A response rate of 40.2%was obtained and 200 valid respondents were yielded.The mean age of respondents was(26.94±7.23)years old.Adverse skin reactions(66.5%)were reported primarily in female(73.7%)working as doctors(82.7%)of a non-referral center for coronavirus disease-2019(60.2%)wearing level 2 and 3 PPE(43.6% and 37.6%,respectively).The cheeks and chin was the most common site involved(69.9%)with dryness/tightness(63.9%)and acne(77.4%)as the highest symptoms and signs reported.Sex,age group classification,level of PPE worn,hand hygiene frequency,and duration of PPE worn daily were factors considerably associated with adverse skin reactions to PPE(P<0.05).Conclusions:Adverse skin reactions to PPE are common among HCWs in Indonesia.Comprehensive strengthening of the skin condition and awareness on adverse skin reactions should be advocated.

Rare bullous pemphigoid during PD-1 inhibitor therapy:a case report

Immunotherapy is an important treatment modality in cancer,but it can also cause adverse reactions,with skin toxicity being the most common.The increasing number of immune checkpoint inhibitors being used in the clinic will inevitably cause an increase in the rate of adverse skin reactions that markedly affect the patient's quality of life.A 58-year-old patient with intrahepatic cholangiocareinoma developed bullous pemphigoid(BP)nearly a year after using immune checkpoint inhibitors,which is different from what has been reported inthe literature within two weeks of treatment.Pathologically,the skin biopsy diagnosis was epidermal hyperplasia and focal sub-epidermal pustule formation,consistent with drug-induced dermatitis.The patient was treated with methylprednisolone,minocyeline,colchicine,nicotinamide,triamcinolone,and traditional Chinese medicine decoction.No new blisters developed after 1 week of treatment.The medication was gradually discontinued,and BP did not recur.Clinicians should carefully consider the risk-benefit ratio when using PD-1 inhibitors,particularly concerning rash severity.Further studies are needed to investigate the relationship between adverse skin reactions and drug efficacy.