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COVID-19 Resources

The Relevance of Vitamin D Supplementation for People of Color in the Era of COVID-19

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Vitamin D

Source: JDD Online

The Journal of Drugs in Dermatology recently featured the article, The Relevance of Vitamin D Supplementation for People of Color in the Era of COVID-19, authored by Skin of Color Virtual Update faculty, Pearl E. Grimes MD, and Andrew F. Alexis MD MPH along with Nada Elbuluk MD MSU.

Introduction

African Americans (AA) and other people of color are dying at highly disproportionate rates from COVID-19. The statistics are staggering: in New York City alone, per 100,000 population, death rates in AA were 92.3, and in Hispanics 74.3, compared to 45.2 in Whites and 34.5 in Asians.1 Similar numbers have been reported in other cities and are presumed underestimations, given limited racial/ethnic reporting. In the states currently releasing the number of COVID-19 deaths by race and ethnicity, Blacks make up roughly 13 percent of the population, but 27 percent of the deaths. According to the American Public Media Research Lab, the rate of COVID-19 deaths nationally for Blacks has been reported as twice the rate of deaths of Asians and Latinos in the US and more than 2.5 times the rate for White residents.

Socio-economic reasons, pre-existing comorbidities, work circumstances, inconsistent healthcare access, stress, and decreased immunity, amongst other factors, have been posited as reasons for this shocking disparity. People of color, in particular AA and Hispanics, are more likely to be uninsured and to be frontline workers during the COVID-19 pandemic. This is compounded by the fact that comorbidities such as hypertension, diabetes, asthma, obesity, and cardiovascular disease are more common in AA and are also associated with higher COVID-19 mortality rates. Emerging evidence suggests that Vitamin D deficiency may represent another risk factor for poor outcomes from COVID-19.

Relevance of Vitamin D
Vitamin D is a secosteroid hormone synthesized in the skin following exposure to UVB ultraviolet radiation where it mediates the conversion of 7-dehydrocholesterol to pre-Vitamin D3. Following transport to the liver, it is hydroxylated to 25(OH)D, the primary circulating form typically used to measure serum Vitamin D levels. 25(OH)D is subsequently converted to the biologically active form 1,25, dihydroxy vitamin D in the kidneys by 1-alpha hydrolase. This active form binds to its nuclear Vitamin D receptor to induce the transcription of over 200 genes, affecting a wide range of physiologic functions.

Multiple studies have documented significant Vitamin D deficiency in people of color, especially in AA. Heavily melanized skin retards the synthesis of Vitamin D and necessitates longer periods of sun exposure for adequate synthesis of Vitamin D. Ginde et al. assessed demographic differences and trends of Vitamin D insufficiency in a US population.2Serum 25(OH)D levels were compared over two time periods (1988–1994 and 2001–2004) from the Third National Health and Nutrition Examination Survey (NHANES III) data base including two large populations (n=18,883 and n=13,369, respectively). Non-Hispanic Blacks had a significantly higher prevalence of Vitamin D deficiency, increasing in severity in the later data base. Recent NHANES data from 2011–2014 further documented the high risk of deficiency in non-Hispanic Blacks. In a recent prospective cohort study of 14,319 subjects, an estimated 65.4% of non-Hispanic Blacks were deficient in Vitamin D, compared to 29% of Hispanics and 14% of non-Hispanic Whites.3

Vitamin D deficiency has been shown to be a risk factor for many of the comorbidities that disproportionately plague AA including diabetes, hypertension, cardiovascular disease, autoimmune diseases such as lupus erythematosus, as well as aggressive forms of breast and prostate cancer.4 While the classic role of Vitamin D involves calcium and phosphorus homeostasis for healthy bone metabolism, it exerts a spectrum of pleotropic effects impacting cell growth, differentiation, inflammation, and immune regulation. Healthy levels of Vitamin D have been linked to significantly reduced mortality and improved health outcomes. Numerous investigations document the prolific role of Vitamin D in antimicrobial defense and modulation of the innate and adaptive immune responses. It mediates the induction of key antimicrobial peptides in the respiratory epithelium including cathelicidin (LL37) and beta defensins, which destroy invading organisms. In addition, Vitamin D inhibits the production of pro-inflammatory cytokines including IL-2, IFN-γ, TNF-α, and IL-6, while promoting Th2 responses by increasing IL-4, IL-5, and IL-10 production, hence skewing T cell responses to a down regulated, anti-inflammatory state.4

For the general population, the US Institutes of Medicine (IOM) recommends Vitamin D supplementation at doses that vary according to age and are based primarily on bone health. Current IOM supplementation recommendations are 400 IU (10ug) for infants, 600 IU/d (15ug) for children, adolescents, and adults, and 800 IU/d (20ug) for adults aged over 70 years to maintain a 25(OH)D concentration of 20ng/mL or higher. However, in individuals who are deficient in Vitamin D (25(OH)D level <20 ng/ mL), of which patients with skin of color are at a higher risk, supplementation is considerably higher. These recommendations are summarized summarized in Table 1.5

Conclusions

Vitamin D deficiency has been well documented in people of color, in particular AA. The aforementioned data suggest a relationship between low Vitamin D status and COVID-19 mortality rates. While myriad socioeconomic and health care disparities may be contributing factors, we must indeed consider key biological variables, including Vitamin D status, that may impact these observations. Future prospective studies are necessary to confirm these findings. As there is currently no readily available treatment or vaccine for COVID-19, treating physicians should be cognizant of the higher prevalence of Vitamin D deficiency in skin of color populations and its emerging potential role in COVID-19 outcomes. Given the devastating statistics of COVID-19 among minority communities and the multifaceted role of Vitamin D in skin and systemic health, dermatologists are essential partners in decreasing health care disparities by initiating the vitamin D dialogue. As such, we can play an invaluable role in improving the health outcomes of our patients, particularly people of color, during and beyond the COVID-19 pandemic.

Read Full Article….

Recommendations for Managing Lichen Planopilaris With Hydroxychloroquine During the COVID-19 Pandemic

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Recommendations Chart

Source: Journal of Drugs in Dermatology

The recommendations are noted in the article, Considerations of Managing Lichen Planopilaris With Hydroxychloroquine During the COVID-19 Pandemic, will be available in the June print issue of the Journal of Drugs in Dermatology.

Chloroquine (CQ) and hydroxychloroquine (HCQ), two well-known drugs among dermatologists, have shown their efficacy in the inhibition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication.1,2 HCQ is found to possess a better clinical safety profile, more potency, and fewer drug–drug interactions compared to chloroquine.3 HCQ has been reported to exert efficacy in the inhibition of SARS-CoV-2 in vitro replication through diverse mechanisms. First, it interferes with the glycosylation of angiotensin-converting enzyme 2 (ACE2), resulting in a subsequent reduction in the binding efficacy between ACE2 on host cells and the SARS-CoV-2 spike protein. Second, it blocks the fusion of the virus to the host cell. Finally, it suppresses the “cytokine storm” accountable for the disease progression to acute respiratory distress syndrome (ARDS). Although studies are underway to confirm the in vivo effectiveness of HCQ in the SARS-CoV-2 infection, promising primary results have led to a shortage of the drug for dermatologic purposes, which is a real concern in the current pandemic.1

While we are amid a pandemic with the possible shortage of HCQ, dermatologists should be reminded that:

  • The anti-inflammatory effect of HCQ may improve the clinical signs of LPP; however, administration of this drug is insufficient to prevent the subclinical disease progression.9 Dermatologists may discontinue the use of HCQ in responders after 1 year with monitoring the patients for recurrence or relapse.5
  • Topical and intralesional super potent corticosteroids are recommended as the first-line treatment in localized LPP.4
  • Oral cyclosporine followed by systemic corticosteroid may be the most effective medications in LPP; however, disease relapse may be detected.10 Mycophenolate mofetil has a more favorable safety profile compared to cyclosporine11 but the immunosuppressive nature of these medications necessitates extreme caution toward their administration during COVID-19 pandemic.12
  • Acitretin (25 mg/day) may be an appropriate alternative since it has shown improvement in 66% of patients.7
  • Pioglitazone (hypoglycemic drug, 15–30 mg/day) has shown some efficacy in the treatment of LPP and can be considered as an alternative to HCQ.4
  • Tetracyclines antibiotics can also be considered as an alternative due to favorable outcomes in previous studies.13

Read Full Article….

On-Demand Recording: COVID-19: Special Considerations for the Skin of Color Patient – A Conversation with the Experts

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SOC COVID 19 Webinar

This webinar was previously recorded on April 27th, 2020 and is now available on demand. Almirall has graciously supported the on-demand broadcast of this webinar.

Skin of Color Update (SOCU) and JDD invite you to attend “COVID-19: Special Considerations for the Skin of Color Patient – A Conversation with the Experts”. During this 90-minute webinar, Dr. Andrew Alexis will be joined by skin of color key opinion leaders to discuss special considerations and practical approaches to managing dermatologic disorders in skin of color during the COVID-19 pandemic.

 

Topics to be addressed include the following:

  • Hair Disorders
  • Pigmentary Disorders
  • Aesthetic Concerns
  • Inflammatory Disorders (including acne, atopic dermatitis, psoriasis, and others)
  • How to stay connected with your skin of color patients on social media
  • Vitamin D deficiency among people of color and its potential relevance to COVID-19 in patients of color
  • COVID-19 related shifts in common dermatologic concerns in skin of color
  • Impact on the practice of aesthetic dermatology for skin of color

MODERATOR:

Andrew Alexis, MD, MPH (Chair, Department of Dermatology, Mount Sinai West and Mount Sinai Morningside and Professor, Icahn School of Medicine at Mount Sinai)

 

PANELISTS:

Eliot F. Battle, Jr., MD (CEO and Co-Founder of Cultura Dermatology & Plastic Surgery)

Amy McMichael, MD (Professor and Chair of Dermatology, Wake Forest Baptist Medical Center)

Heather Woolery-Lloyd, MD (Director, Skin of Color Division, University of Miami School of Medicine)

Pearl Grimes, MD (Founder and Director, Vitiligo and Pigmentation Institute of Southern California)

Supported by:

Almirall Logo

Webinar Series Held to Assist Dermatology Practitioners During COVID-19

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3,644 registrants and 1,644 participants in COVID19 webinar

On April, 1, 2020, the Journal of Drugs in Dermatology (JDD) and SanovaWorks brands, including Skin of Color Update, launched Part I of the webinar series: COVID-19: Urgent Dermatology and Aesthetic Issues for Dermatology.

Over the course of the 2 hours, Joel L. Cohen, MD and 6 different thought leaders joined the COVID-19 conversation, discussing the pressing questions that are on the minds of many dermatologists and providers in the country. The initial broadcast attracted 1,900 registrants and nearly 800 attendees comprised of physicians, residents, fellows, nurse practitioners and physician assistants.  Attendees were interested and engaged throughout the entire 2 hours with a 76% average attentiveness and 72% average interest rating.

The on-demand broadcast has attracted over 500 registrants as of April 9th and is available on JDDonline.com.

On April 7, 2020, Part II of the webinar series was broadcasted: COVID-19: Your Questions Answered. Dermatology experts and thought leaders examined the legal and financial concerns of dermatology providers during the global coronavirus pandemic. Experts discussed furlough vs. layoffs; mortgage and rent relief programs; the CARES Act; the pros and cons of leveraging NPs or PAs for teledermatology and more. Then, hear questions answered by our panel of experts; discussed practical tips you can use in your practice right now; and how to move forward with patient care. Part II attracted 1,300 registrants with nearly 700 attendees. Attendees were engaged and interested throughout with an 82% attentiveness average and 75+% interest rating.

The on-demand broadcast of Part II will be available on April 11, 2020 on JDDonline.com.

Join Dermatology Leadership Discussion of COVID-19

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Join Dermatology Leadership Discussion of COVID-19

Skin of Color Update and JDD invite you to attend a webinar panel to provide discussion, guidance, and leadership for dermatologists and dermatology practices during the global coronavirus pandemic.

Over the course of the 2 hours, 8 different thought leaders will join the conversation, discussing questions that are on the mind of many dermatologists in the country. Click here to register.

MODERATOR
Joel L. Cohen, MD (Director, About Skin Dermatology & Associate Clinical Professor, University of California at Irvine)

AGENDA
6:00-7:00PM
Neal Bhatia, MD (Vice President-elect of the AAD & Director of Clinical Dermatology, Therapeutics Clinical Research)
Adam Friedman, MD (Professor and Interim Chair of Dermatology, GW School of Medicine & Health Sciences)
William D. Humphries (President, Ortho Dermatologics)
Mark Kaufman, MD (Associate Clinical Professor, Icahn School of Medicine at Mount Sinai)

7:00-8:00PM
Sue Ellen Cox, MD (Founder, Aesthetic Solutions)
Kavita Mariwalla, MD (Founder, Mariwalla Dermatology)
Carrie Strom (Senior Vice President, US Medical Aesthetics at Allergan)

ARCHIVED RECORDING
This webinar will be archived for on demand viewing on JDDonline.com by end of day Friday April 3rd.

STATEMENT ABOUT COVID-19, CORONAVIRUS ACTION

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NEW YORK (Mar. 13, 2020) – A Note from Shelley Tanner, SanovaWorks CEO/President

First and foremost, in light of the rapidly evolving global COVID-19 situation, we hope that you and your family are safe and healthy. We send companywide thoughts and prayers to the individuals, families, and other groups who have been impacted by this situation, and hope that things will improve very soon.

While many things are uncertain surrounding this virus, as an organization, SanovaWorks believes in taking action early. We are dedicated to providing the best care and support we can to all our employees and business partners.

We have the extremely good fortune to be functioning already as a virtual company and because of this we hope to be able to provide support and resources to our entire network who might not have the experience we have. Please check our blog for our tips and recommendations for transitioning to and being successful in a remote work environment:https://sanovaworks.com/2020/03/11/top-immediate-needs-of-remote-employees/

In addition to this, in order to protect our teams and others, until further notice, we have issued a complete restriction on all business-related travel. While the CDC has not placed restrictions on domestic travel, they have recently posted travel warnings on their website: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-in-the-us.html?mod=article_inline

The CDC also provide general recommendations that we should all be following to prevent the spread of this disease:https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html

We will be working diligently as teams to connect with many of you so that we can share some very interesting ways to accomplish our results in this new, virtual environment. We have many years of experience transitioning traditional programs to digital programs, and launching successful virtual programs. Because we are already positioned as a remote company that produces virtual programs, we hope that we are able to support your own initiatives and bridge the gap this global situation has caused.

And last but not least, with a shout out to Jim Collins who introduced me to the Stockdale Paradox in his book Good To Great, we all need to look squarely at the facts, but have confidence that together we will prevail, as we balance realism with optimism.

 

Together.

Shelley and the entire SanovaWorks Team