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Jak pandemia COVID-19 wpłynęła na choroby skóry?

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Około 7 proc. pacjentów z dodatnim wynikiem zakażenia SARS-CoV-2 doświadczyło zmian skórnych. Pojawiały się one w różnych stadiach zakażenia i towarzyszyły zarówno łagodnemu, jak i ciężkiemu przebiegowi COVID-19. Pandemia wpłynęła również na pogorszenie się stanu psychicznego pacjentów, co mogło prowadzić do zaostrzenia się istniejącej już choroby dermatologicznej. 

W kanadyjskim czasopiśmie naukowym „Canadian Family Physician” opublikowany został artykuł będący przeglądem najnowszego piśmiennictwa naukowego dotyczącego chorób skóry w czasie pandemii COVID-19. Autorzy przyjrzeli się zmianom dermatologicznym, na które wpływ bezpośrednio miało zakażenie SARS-CoV-2, a także pośrednio pandemia, np. poprzez używanie środków do dezynfekcji. Trzecim obszarem analiz był wpływ izolacji społecznej na zdrowie psychiczne i pogarszające się w konsekwencji istniejące wcześniej choroby skóry.

Jakie choroby skóry mogą pojawiać się przy zakażeniu COVID-19?

Hiszpańskie badanie z udziałem 375 pacjentów z COVID-19, u których zaobserwowano zmiany skórne, doprowadziło do wyłonienia 5 głównych problemów dermatologicznych towarzyszących infekcji: wysypka plamista, wysypka pęcherzykowa, pseudoodmrożenia, siność siatkowa, martwica i zmiany pokrzywkowe. Oprócz wymienionych reakcji skórnych, autorzy przeglądu wskazują, że klinicyści donosili również o występowaniu ropnych wysypek, koinfekcji COVID-19 z wirusem półpaśca (HZV) oraz wieloukładowego zespołu zapalnego u dzieci, podobnego do zespołu Kawasaki.

Inne badanie analizowane przez autorów raportu wykazało, że 7 proc. pacjentów z dodatnim wynikiem COVID-19 miało jeden lub więcej objawów skórnych. U prawie połowy pacjentów zdiagnozowano wysypkę plamisto-grudkową, która towarzyszyła umiarkowanemu przebiegowi COVID-19. Zmiany pojawiały się we wczesnym etapie choroby i przed wystąpieniem innych objawów zakażenia. Wysypka manifestowała się przezroczystymi lub krwawymi pęcherzami na całym tułowiu pacjentów.

Pacjenci z łagodnym przebiegiem COVID-19 doświadczali natomiast pseudoodmrożeń. Jak wyjaśniają naukowcy, objawy te spowodowane są oddziaływaniem SARS-CoV-2 na naczynia krwionośne. W niektórych przypadkach wirus doprowadza do niedokrwienia kończyn, powodując opuchliznę, zaczerwienienie i bolesność palców u rąk i nóg. Wśród uczestników badania zaobserwowano także siność siatkową, która również spowodowana jest wpływem SARS-CoV-2 na naczynia krwionośne. Zmiany miały charakter blednący i krótkotrwały bez towarzyszącego świądu. W przypadku ciężkiego przebiegu COVID-19 zmiany podatne były na martwicę.

Pokrzywka z kolei w wielu przypadkach poprzedzała lub towarzyszyła innym objawom COVID-19. Oznaczała również ciężki przebieg zakażenia. Zmiany ustępowały po podaniu doustnych leków przeciwhistaminowych.

Pośredni wpływ pandemii na choroby skóry

Pośrednie skutki pandemii COVID-19, jak wyjaśniają autorzy przeglądu, są związane ze zmianami behawioralnymi społeczeństwa – szczególnie w odniesieniu do stosowania środków ochrony osobistej i częstych dezynfekcji rąk.

W czasie pandemii duży odsetek osób, zarówno pracowników ochrony zdrowia, jak i ogółu populacji zgłaszał zapalenie skóry dłoni w efekcie częstego odkażania, a także zapalenie skóry twarzy poprzez noszenie gogli, maseczek i przyłbic. Ponadto personel medyczny zgłaszał suchość skóry (kserozę), a także urazy ciśnieniowe w miejscu noszenia masek i gogli.

Stan psychiczny a pogorszenie istniejącej choroby dermatologicznej

Pandemia COVID-19 w dużym stopniu przyczyniła się również do pogorszenia się zdrowia psychicznego społeczeństwa. Autorzy przeglądu podkreślają, że stan emocjonalny może mieć wpływ na zaostrzenie się istniejącej choroby dermatologicznej, np. egzemy, łuszczycy, łysienia, przewlekłej pokrzywki, atopowego zapalenia skóry. Naukowcy wskazują, że stresory psychospołeczne w czasie pandemii mogą być związane z reagującymi na stres chorobami skóry. Według badaczy konieczne są jednak dalsze badania w celu wyjaśnienia tego mechanizmu.

Źródło:

A. Zara, P. Fleming, K. Lee, C. Lynde, The COVID-19 pandemic and its skin effects, Canadian Family Physician, Vol 67: August 2021, str. 583-585

Przeczytaj także: Rzadkie przyczyny trudno gojących się ran: sporotrychoza

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