News in brief: Dermatologist referrals for AD; Livedoid vasculopathy; COVID-19 chilblains seen in 2019

24 Feb 2021

GP registrars bypass dermatologists for referrals

GP registrars are generally confident in managing atopic dermatitis, referring 7% of patients for specialist management and with a preference for referring those with an established diagnosis, a new study shows. However the finding that 17% of referrals were to an allergy specialist and only 70% to a dermatologist suggested that GP registrars may be over-emphasising the role of food allergies in atopic dermatitis, said the Melbourne University researchers in Dermatology Practical and Conceptual journal.

Livedoid vasculopathy responds to plant based diet

A whole foods, plant-based diet may ease the painful skin blistering and scarring of livedoid vasculopathy, according to doctors in New Zealand. Writing in BMJ Case Reports they describe the relief obtained of the condition by a woman in her early 60s. She had regular outbreaks of painful ulcers that became infected for eight years until she switched to a diet based on vegetables, fruits, legumes, grains, herbs and spices, and which avoided high-fat foods, meat, dairy, eggs, fried foods and heavily processed foods. The condition resolved within months after she adopted the diet but relapsed when she resumed eating things such as fish and chips. The authors said a possible explanation might be that foods high in fat, salt, and sugar may damage endothelial cells) while a vegetarian diet may improve arterial function.

COVID-19 chilblain case in 2019 may be patient zero

A chilblain-like dermatosis diagnosed in an Italian patient weeks before the Wuhan outbreak could be a clue to Europe’s patient zero for coronavirus, dermatologists in Milan believe. Based on hindsight knowledge of the skin manifestations of COVID-19 disease, clinicians in Milan retrospectively investigated a skin biopsy tissue sample of a 25 year old woman who presented with unexplained urticarial plaque‐like dermatosis on her arms, as well as sore throat in November 2019. Immunohistochemical investigations revealed signs of  SARS‐CoV‐2 antigens, which the researchers say add to  other evidence from wastewater and cancer screening samples that COVID-19 may have been circulating in Italy prior to January 2020. The findings are reported in the British Journal of Dermatology.

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