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The compass that points toward food
The new breakfast of champions
We love a good ranking system here at LOTME world headquarters, especially the food-based ones. Luckily for us (and our readers), a new study published in Nature Food offers a food-based ranking system.
Sadly, unlike the last food-related ranking we covered, the Food Compass doesn’t tell you how much life you gain or lose from each food you eat down to the precise minute. Instead, it favors a more simple rating system from 1 to 100, with healthier foods scoring higher, and even incorporates mixed foods, not just single ingredients. This makes it better at assessing and comparing food combinations, rather than trying to mix and match the many ingredients that go into even relatively simple recipes.
The top and bottom of the rankings contain the usual suspects. Legumes and nuts, at 78.6, had the highest average score among the broad food groups, followed by fruits and then vegetables. Rounding out the bottom were sweets and savory snacks at 16.4. Among the individual foods, there were perfect scores in both directions: 100 for raw raspberries, while instant noodle soup and nonchocolate, ready-to-eat, nonfat pudding (very specific there) each earned a 1.
There are a few surprises in between. Nonfat cappuccino received a green light from the investigators, great news for the coffee drinkers out there. A serving of sweet potato chips scored better than a simple grilled chicken breast, and a slice of pizza, loaded up with extra meat and a thick crust, is still more nutritious than a bowl of corn flakes.
Neither is good for you, of course, but we’re still going to take this as a sign that pizza is the ideal breakfast food. Add that to your morning coffee, and you’re ready to start the day. Move over Wheaties, there’s a new breakfast of champions.
COVID-19 resisters, please step forward
Some people have all the luck with good genes, both inside and out.
Genetically speaking, humans are 99.9% the same, but that 0.1% is where things get interesting. Because of that 0.1% difference, some people are more likely to contract diseases such as HIV, while others might be more resistant. These small differences in genetic code could be the key to finding treatments for COVID-19.
“The introduction of SARS-CoV-2 to a naive population, on a global scale, has provided yet another demonstration of the remarkable clinical variability between individuals in the course of infection, ranging from asymptomatic infections to life-threatening disease,” the researchers said in Nature Immunology.
The investigators have been scouring the world to find people who might be resistant to SARS-CoV-2 and have enrolled over 400 individuals in a “dedicated resistance study cohort,” according to ScienceAlert.
The investigators are looking at households in which families were infected but one member did not show severe symptoms, or for individuals who have been around the virus multiple times and haven’t contracted it. They are also looking at blood types.
Enrollment is ongoing, so if you’ve been in contact with COVID-19 multiple times and have not gotten sick, scientists would like to hear from you.
Better living through parasitization
How would you like to triple your life span, while maintaining a youthful appearance and gaining special social standing and privileges?
Sounds pretty good, right, so what’s the catch? Well, you have to be infected with a tapeworm ... and you have to be an ant.
If you are an ant, here’s the deal: Workers of the species Temnothorax nylanderi that have tapeworms live much longer than uninfected workers, and while living out those longer lives they do less work and receive gifts of food.
In a study conducted at Johannes Gutenberg University in Mainz, Germany, infected ants’ metabolic rates and lipid levels were similar to those of younger ants, and they appeared to remain in a permanent juvenile stage as a result of the infection, the investigators reported.
They tracked Temnothorax colonies for 3 years, at which point 95% of the uninfected workers had died but over half of the infected ants were still alive. Pretty great, right? Wrong. There was no joy in antville, for the uninfected workers had struck out. “Strained by the additional burden of their wormed-up nestmates, they seemed to be shunting care away from their queen. They were dying sooner than they might have if the colonies had remained parasite-free,” according to an article in the Atlantic.
Does this situation seem just a wee bit familiar? A small group lives longer, healthier lives and enjoys special privileges while the majority of that society works harder to support them? We’ll put it into the form of a chicken-and-egg argument: Which came first, the tapeworms or the one-percenters?
Laughing the pandemic stress away
Doomscrolling on social media has become one of the world’s favorite pastimes during the pandemic, but research shows that those memes about COVID-19 might combat the doom and gloom of the outside world.
A study recently published in Psychology of Popular Media showed that viewing memes, specifically those that were COVID-19 related, actually lessened the stress of the pandemic.
The researchers conducted a survey of 748 people aged 18-88 years. Each participant viewed three memes with text or three memes with text but no images. All three memes had similar cuteness levels (baby or adult), subject (animal or human), and caption (COVID-19–related or not). The participants were then asked to report on their stress levels and feelings before and after the memes.
The people who looked at memes felt less stressed and a higher humor level, especially the participants who received the COVID-19 memes. Study Finds said that they had more “pandemic-coping confidence” than those who got regular memes.
“While the World Health Organization recommended that people avoid too much COVID-related media for the benefit of their mental health, our research reveals that memes about COVID-19 could help people feel more confident in their ability to deal with the pandemic,” lead author Jessica Gall Myrick, PhD, said in a written statement. “The positive emotions associated with this type of content may make people feel psychologically safer and therefore better able to pay attention to the underlying messages related to health threats.”
So if you think you’ve been wasting time looking at memes during this pandemic, think again. It actually might keep you sane. Keep on scrolling!
Giving the gift of stress reduction
It’s a big week here at LOTME. You’ve just read our 100th edition, and to help celebrate that milestone – along with Count Your Buttons Day, Celebration of the Mind Day, and the International Day of the Nacho – we’re presenting an extra-special bonus feature, courtesy of Sad and Useless: The most depressive humor site on the Internet.
We hope you’ll stop your doomscrolling long enough to enjoy this stress-reducing meme. Thanks for reading!
The new breakfast of champions
We love a good ranking system here at LOTME world headquarters, especially the food-based ones. Luckily for us (and our readers), a new study published in Nature Food offers a food-based ranking system.
Sadly, unlike the last food-related ranking we covered, the Food Compass doesn’t tell you how much life you gain or lose from each food you eat down to the precise minute. Instead, it favors a more simple rating system from 1 to 100, with healthier foods scoring higher, and even incorporates mixed foods, not just single ingredients. This makes it better at assessing and comparing food combinations, rather than trying to mix and match the many ingredients that go into even relatively simple recipes.
The top and bottom of the rankings contain the usual suspects. Legumes and nuts, at 78.6, had the highest average score among the broad food groups, followed by fruits and then vegetables. Rounding out the bottom were sweets and savory snacks at 16.4. Among the individual foods, there were perfect scores in both directions: 100 for raw raspberries, while instant noodle soup and nonchocolate, ready-to-eat, nonfat pudding (very specific there) each earned a 1.
There are a few surprises in between. Nonfat cappuccino received a green light from the investigators, great news for the coffee drinkers out there. A serving of sweet potato chips scored better than a simple grilled chicken breast, and a slice of pizza, loaded up with extra meat and a thick crust, is still more nutritious than a bowl of corn flakes.
Neither is good for you, of course, but we’re still going to take this as a sign that pizza is the ideal breakfast food. Add that to your morning coffee, and you’re ready to start the day. Move over Wheaties, there’s a new breakfast of champions.
COVID-19 resisters, please step forward
Some people have all the luck with good genes, both inside and out.
Genetically speaking, humans are 99.9% the same, but that 0.1% is where things get interesting. Because of that 0.1% difference, some people are more likely to contract diseases such as HIV, while others might be more resistant. These small differences in genetic code could be the key to finding treatments for COVID-19.
“The introduction of SARS-CoV-2 to a naive population, on a global scale, has provided yet another demonstration of the remarkable clinical variability between individuals in the course of infection, ranging from asymptomatic infections to life-threatening disease,” the researchers said in Nature Immunology.
The investigators have been scouring the world to find people who might be resistant to SARS-CoV-2 and have enrolled over 400 individuals in a “dedicated resistance study cohort,” according to ScienceAlert.
The investigators are looking at households in which families were infected but one member did not show severe symptoms, or for individuals who have been around the virus multiple times and haven’t contracted it. They are also looking at blood types.
Enrollment is ongoing, so if you’ve been in contact with COVID-19 multiple times and have not gotten sick, scientists would like to hear from you.
Better living through parasitization
How would you like to triple your life span, while maintaining a youthful appearance and gaining special social standing and privileges?
Sounds pretty good, right, so what’s the catch? Well, you have to be infected with a tapeworm ... and you have to be an ant.
If you are an ant, here’s the deal: Workers of the species Temnothorax nylanderi that have tapeworms live much longer than uninfected workers, and while living out those longer lives they do less work and receive gifts of food.
In a study conducted at Johannes Gutenberg University in Mainz, Germany, infected ants’ metabolic rates and lipid levels were similar to those of younger ants, and they appeared to remain in a permanent juvenile stage as a result of the infection, the investigators reported.
They tracked Temnothorax colonies for 3 years, at which point 95% of the uninfected workers had died but over half of the infected ants were still alive. Pretty great, right? Wrong. There was no joy in antville, for the uninfected workers had struck out. “Strained by the additional burden of their wormed-up nestmates, they seemed to be shunting care away from their queen. They were dying sooner than they might have if the colonies had remained parasite-free,” according to an article in the Atlantic.
Does this situation seem just a wee bit familiar? A small group lives longer, healthier lives and enjoys special privileges while the majority of that society works harder to support them? We’ll put it into the form of a chicken-and-egg argument: Which came first, the tapeworms or the one-percenters?
Laughing the pandemic stress away
Doomscrolling on social media has become one of the world’s favorite pastimes during the pandemic, but research shows that those memes about COVID-19 might combat the doom and gloom of the outside world.
A study recently published in Psychology of Popular Media showed that viewing memes, specifically those that were COVID-19 related, actually lessened the stress of the pandemic.
The researchers conducted a survey of 748 people aged 18-88 years. Each participant viewed three memes with text or three memes with text but no images. All three memes had similar cuteness levels (baby or adult), subject (animal or human), and caption (COVID-19–related or not). The participants were then asked to report on their stress levels and feelings before and after the memes.
The people who looked at memes felt less stressed and a higher humor level, especially the participants who received the COVID-19 memes. Study Finds said that they had more “pandemic-coping confidence” than those who got regular memes.
“While the World Health Organization recommended that people avoid too much COVID-related media for the benefit of their mental health, our research reveals that memes about COVID-19 could help people feel more confident in their ability to deal with the pandemic,” lead author Jessica Gall Myrick, PhD, said in a written statement. “The positive emotions associated with this type of content may make people feel psychologically safer and therefore better able to pay attention to the underlying messages related to health threats.”
So if you think you’ve been wasting time looking at memes during this pandemic, think again. It actually might keep you sane. Keep on scrolling!
Giving the gift of stress reduction
It’s a big week here at LOTME. You’ve just read our 100th edition, and to help celebrate that milestone – along with Count Your Buttons Day, Celebration of the Mind Day, and the International Day of the Nacho – we’re presenting an extra-special bonus feature, courtesy of Sad and Useless: The most depressive humor site on the Internet.
We hope you’ll stop your doomscrolling long enough to enjoy this stress-reducing meme. Thanks for reading!
The new breakfast of champions
We love a good ranking system here at LOTME world headquarters, especially the food-based ones. Luckily for us (and our readers), a new study published in Nature Food offers a food-based ranking system.
Sadly, unlike the last food-related ranking we covered, the Food Compass doesn’t tell you how much life you gain or lose from each food you eat down to the precise minute. Instead, it favors a more simple rating system from 1 to 100, with healthier foods scoring higher, and even incorporates mixed foods, not just single ingredients. This makes it better at assessing and comparing food combinations, rather than trying to mix and match the many ingredients that go into even relatively simple recipes.
The top and bottom of the rankings contain the usual suspects. Legumes and nuts, at 78.6, had the highest average score among the broad food groups, followed by fruits and then vegetables. Rounding out the bottom were sweets and savory snacks at 16.4. Among the individual foods, there were perfect scores in both directions: 100 for raw raspberries, while instant noodle soup and nonchocolate, ready-to-eat, nonfat pudding (very specific there) each earned a 1.
There are a few surprises in between. Nonfat cappuccino received a green light from the investigators, great news for the coffee drinkers out there. A serving of sweet potato chips scored better than a simple grilled chicken breast, and a slice of pizza, loaded up with extra meat and a thick crust, is still more nutritious than a bowl of corn flakes.
Neither is good for you, of course, but we’re still going to take this as a sign that pizza is the ideal breakfast food. Add that to your morning coffee, and you’re ready to start the day. Move over Wheaties, there’s a new breakfast of champions.
COVID-19 resisters, please step forward
Some people have all the luck with good genes, both inside and out.
Genetically speaking, humans are 99.9% the same, but that 0.1% is where things get interesting. Because of that 0.1% difference, some people are more likely to contract diseases such as HIV, while others might be more resistant. These small differences in genetic code could be the key to finding treatments for COVID-19.
“The introduction of SARS-CoV-2 to a naive population, on a global scale, has provided yet another demonstration of the remarkable clinical variability between individuals in the course of infection, ranging from asymptomatic infections to life-threatening disease,” the researchers said in Nature Immunology.
The investigators have been scouring the world to find people who might be resistant to SARS-CoV-2 and have enrolled over 400 individuals in a “dedicated resistance study cohort,” according to ScienceAlert.
The investigators are looking at households in which families were infected but one member did not show severe symptoms, or for individuals who have been around the virus multiple times and haven’t contracted it. They are also looking at blood types.
Enrollment is ongoing, so if you’ve been in contact with COVID-19 multiple times and have not gotten sick, scientists would like to hear from you.
Better living through parasitization
How would you like to triple your life span, while maintaining a youthful appearance and gaining special social standing and privileges?
Sounds pretty good, right, so what’s the catch? Well, you have to be infected with a tapeworm ... and you have to be an ant.
If you are an ant, here’s the deal: Workers of the species Temnothorax nylanderi that have tapeworms live much longer than uninfected workers, and while living out those longer lives they do less work and receive gifts of food.
In a study conducted at Johannes Gutenberg University in Mainz, Germany, infected ants’ metabolic rates and lipid levels were similar to those of younger ants, and they appeared to remain in a permanent juvenile stage as a result of the infection, the investigators reported.
They tracked Temnothorax colonies for 3 years, at which point 95% of the uninfected workers had died but over half of the infected ants were still alive. Pretty great, right? Wrong. There was no joy in antville, for the uninfected workers had struck out. “Strained by the additional burden of their wormed-up nestmates, they seemed to be shunting care away from their queen. They were dying sooner than they might have if the colonies had remained parasite-free,” according to an article in the Atlantic.
Does this situation seem just a wee bit familiar? A small group lives longer, healthier lives and enjoys special privileges while the majority of that society works harder to support them? We’ll put it into the form of a chicken-and-egg argument: Which came first, the tapeworms or the one-percenters?
Laughing the pandemic stress away
Doomscrolling on social media has become one of the world’s favorite pastimes during the pandemic, but research shows that those memes about COVID-19 might combat the doom and gloom of the outside world.
A study recently published in Psychology of Popular Media showed that viewing memes, specifically those that were COVID-19 related, actually lessened the stress of the pandemic.
The researchers conducted a survey of 748 people aged 18-88 years. Each participant viewed three memes with text or three memes with text but no images. All three memes had similar cuteness levels (baby or adult), subject (animal or human), and caption (COVID-19–related or not). The participants were then asked to report on their stress levels and feelings before and after the memes.
The people who looked at memes felt less stressed and a higher humor level, especially the participants who received the COVID-19 memes. Study Finds said that they had more “pandemic-coping confidence” than those who got regular memes.
“While the World Health Organization recommended that people avoid too much COVID-related media for the benefit of their mental health, our research reveals that memes about COVID-19 could help people feel more confident in their ability to deal with the pandemic,” lead author Jessica Gall Myrick, PhD, said in a written statement. “The positive emotions associated with this type of content may make people feel psychologically safer and therefore better able to pay attention to the underlying messages related to health threats.”
So if you think you’ve been wasting time looking at memes during this pandemic, think again. It actually might keep you sane. Keep on scrolling!
Giving the gift of stress reduction
It’s a big week here at LOTME. You’ve just read our 100th edition, and to help celebrate that milestone – along with Count Your Buttons Day, Celebration of the Mind Day, and the International Day of the Nacho – we’re presenting an extra-special bonus feature, courtesy of Sad and Useless: The most depressive humor site on the Internet.
We hope you’ll stop your doomscrolling long enough to enjoy this stress-reducing meme. Thanks for reading!
A 70-year-old man presents with firm papules on his hand and fingers
, although women are more often affected than men. GA most commonly appears in the first 3 decades of life. Although the etiology is not known, GA may represent a delayed hypersensitivity reaction. A link between GA and diabetes mellitus, autoimmune thyroiditis, dyslipidemia, and rarely, malignancy may exist.
GA is most commonly localized, presenting as an asymptomatic, erythematous, annular plaque with a firm border and central clearing localized to the wrists, ankles, and dorsal hands or feet. This form is the type most often seen in children. Generalized GA is far less common and presents later in life as multiple asymptomatic or pruritic papules and plaques on the trunk and extremities. Less common variants include subcutaneous GA, patch GA, atypical GA, and perforating GA. Perforating GA occurs on the dorsal hands and presents as (umbilicated) papules, and seems consistent with this patient’s clinical presentation. Histologically, transepidermal elimination of collagen is typically seen in perforating GA.1
Histology in this patient’s biopsy revealed a granulomatous dermatitis consistent with granuloma annulare. A palisaded arrangement of histiocytic cells surrounding altered collagen with increased dermal mucin was seen. There was associated perivascular mononuclear inflammatory infiltrates. The overlying epidermis was unremarkable.
Granuloma annulare often spontaneously resolves without sequelae. In some cases, atrophy may result. Lesions may also recur. Localized GA is often treated with high-potency topical corticosteroids or intralesional corticosteroids. For generalized GA, topical or intralesional corticosteroids may be used for select lesions. Topical calcineurin inhibitors, light therapy, cryotherapy, imiquimod, hydroxychloroquine, isotretinoin, and dapsone have also been reported in the literature as possible treatments.
This case and photo were provided by Dr. Berke, of Three Rivers Dermatology, Pittsburgh, and Dr. Bilu Martin.
Dr. Bilu Martin is a board-certified dermatologist in private practice at Premier Dermatology, MD, in Aventura, Fla. More diagnostic cases are available at mdedge.com/dermatology. To submit a case for possible publication, send an email to [email protected].
References
1 Alves J, Barreiros H, Bartolo E. Healthcare (Basel). 2014 Sep 4;2(3):338-45.
2. Bolognia J et al. Dermatology (St. Louis: Mosby/Elsevier, 2008).
3. “Andrews’ Diseases of the Skin,” 13th ed. James W et al. Philadelphia: Saunders Elsevier, 2006.
, although women are more often affected than men. GA most commonly appears in the first 3 decades of life. Although the etiology is not known, GA may represent a delayed hypersensitivity reaction. A link between GA and diabetes mellitus, autoimmune thyroiditis, dyslipidemia, and rarely, malignancy may exist.
GA is most commonly localized, presenting as an asymptomatic, erythematous, annular plaque with a firm border and central clearing localized to the wrists, ankles, and dorsal hands or feet. This form is the type most often seen in children. Generalized GA is far less common and presents later in life as multiple asymptomatic or pruritic papules and plaques on the trunk and extremities. Less common variants include subcutaneous GA, patch GA, atypical GA, and perforating GA. Perforating GA occurs on the dorsal hands and presents as (umbilicated) papules, and seems consistent with this patient’s clinical presentation. Histologically, transepidermal elimination of collagen is typically seen in perforating GA.1
Histology in this patient’s biopsy revealed a granulomatous dermatitis consistent with granuloma annulare. A palisaded arrangement of histiocytic cells surrounding altered collagen with increased dermal mucin was seen. There was associated perivascular mononuclear inflammatory infiltrates. The overlying epidermis was unremarkable.
Granuloma annulare often spontaneously resolves without sequelae. In some cases, atrophy may result. Lesions may also recur. Localized GA is often treated with high-potency topical corticosteroids or intralesional corticosteroids. For generalized GA, topical or intralesional corticosteroids may be used for select lesions. Topical calcineurin inhibitors, light therapy, cryotherapy, imiquimod, hydroxychloroquine, isotretinoin, and dapsone have also been reported in the literature as possible treatments.
This case and photo were provided by Dr. Berke, of Three Rivers Dermatology, Pittsburgh, and Dr. Bilu Martin.
Dr. Bilu Martin is a board-certified dermatologist in private practice at Premier Dermatology, MD, in Aventura, Fla. More diagnostic cases are available at mdedge.com/dermatology. To submit a case for possible publication, send an email to [email protected].
References
1 Alves J, Barreiros H, Bartolo E. Healthcare (Basel). 2014 Sep 4;2(3):338-45.
2. Bolognia J et al. Dermatology (St. Louis: Mosby/Elsevier, 2008).
3. “Andrews’ Diseases of the Skin,” 13th ed. James W et al. Philadelphia: Saunders Elsevier, 2006.
, although women are more often affected than men. GA most commonly appears in the first 3 decades of life. Although the etiology is not known, GA may represent a delayed hypersensitivity reaction. A link between GA and diabetes mellitus, autoimmune thyroiditis, dyslipidemia, and rarely, malignancy may exist.
GA is most commonly localized, presenting as an asymptomatic, erythematous, annular plaque with a firm border and central clearing localized to the wrists, ankles, and dorsal hands or feet. This form is the type most often seen in children. Generalized GA is far less common and presents later in life as multiple asymptomatic or pruritic papules and plaques on the trunk and extremities. Less common variants include subcutaneous GA, patch GA, atypical GA, and perforating GA. Perforating GA occurs on the dorsal hands and presents as (umbilicated) papules, and seems consistent with this patient’s clinical presentation. Histologically, transepidermal elimination of collagen is typically seen in perforating GA.1
Histology in this patient’s biopsy revealed a granulomatous dermatitis consistent with granuloma annulare. A palisaded arrangement of histiocytic cells surrounding altered collagen with increased dermal mucin was seen. There was associated perivascular mononuclear inflammatory infiltrates. The overlying epidermis was unremarkable.
Granuloma annulare often spontaneously resolves without sequelae. In some cases, atrophy may result. Lesions may also recur. Localized GA is often treated with high-potency topical corticosteroids or intralesional corticosteroids. For generalized GA, topical or intralesional corticosteroids may be used for select lesions. Topical calcineurin inhibitors, light therapy, cryotherapy, imiquimod, hydroxychloroquine, isotretinoin, and dapsone have also been reported in the literature as possible treatments.
This case and photo were provided by Dr. Berke, of Three Rivers Dermatology, Pittsburgh, and Dr. Bilu Martin.
Dr. Bilu Martin is a board-certified dermatologist in private practice at Premier Dermatology, MD, in Aventura, Fla. More diagnostic cases are available at mdedge.com/dermatology. To submit a case for possible publication, send an email to [email protected].
References
1 Alves J, Barreiros H, Bartolo E. Healthcare (Basel). 2014 Sep 4;2(3):338-45.
2. Bolognia J et al. Dermatology (St. Louis: Mosby/Elsevier, 2008).
3. “Andrews’ Diseases of the Skin,” 13th ed. James W et al. Philadelphia: Saunders Elsevier, 2006.
FDA authorizes boosters for Moderna, J&J, allows mix-and-match
in people who are eligible to get them.
The move to amend the Emergency Use Authorization for these vaccines gives the vaccine experts on the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices latitude to recommend a mix-and-match strategy if they feel the science supports it.
The committee convenes Oct. 21 for a day-long meeting to make its recommendations for additional doses.
People who’ve previously received two doses of the Moderna mRNA vaccine, which is now called Spikevax, are eligible for a third dose of any COVID-19 vaccine if they are 6 months past their second dose and are:
- 65 years of age or older
- 18 to 64 years of age, but at high risk for severe COVID-19 because of an underlying health condition
- 18 to 64 years of age and at high risk for exposure to the SARS-CoV-2 virus because they live in a group setting, such as a prison or care home, or work in a risky occupation, such as healthcare
People who’ve previously received a dose of the Johnson & Johnson vaccine are eligible for a second dose of any COVID-19 vaccine if they are over the age of 18 and at least 2 months past their vaccination.
“Today’s actions demonstrate our commitment to public health in proactively fighting against the COVID-19 pandemic,” said Acting FDA Commissioner Janet Woodcock, MD, in a news release. “As the pandemic continues to impact the country, science has shown that vaccination continues to be the safest and most effective way to prevent COVID-19, including the most serious consequences of the disease, such as hospitalization and death.
“The available data suggest waning immunity in some populations who are fully vaccinated. The availability of these authorized boosters is important for continued protection against COVID-19 disease.”
A version of this article was first published on Medscape.com.
in people who are eligible to get them.
The move to amend the Emergency Use Authorization for these vaccines gives the vaccine experts on the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices latitude to recommend a mix-and-match strategy if they feel the science supports it.
The committee convenes Oct. 21 for a day-long meeting to make its recommendations for additional doses.
People who’ve previously received two doses of the Moderna mRNA vaccine, which is now called Spikevax, are eligible for a third dose of any COVID-19 vaccine if they are 6 months past their second dose and are:
- 65 years of age or older
- 18 to 64 years of age, but at high risk for severe COVID-19 because of an underlying health condition
- 18 to 64 years of age and at high risk for exposure to the SARS-CoV-2 virus because they live in a group setting, such as a prison or care home, or work in a risky occupation, such as healthcare
People who’ve previously received a dose of the Johnson & Johnson vaccine are eligible for a second dose of any COVID-19 vaccine if they are over the age of 18 and at least 2 months past their vaccination.
“Today’s actions demonstrate our commitment to public health in proactively fighting against the COVID-19 pandemic,” said Acting FDA Commissioner Janet Woodcock, MD, in a news release. “As the pandemic continues to impact the country, science has shown that vaccination continues to be the safest and most effective way to prevent COVID-19, including the most serious consequences of the disease, such as hospitalization and death.
“The available data suggest waning immunity in some populations who are fully vaccinated. The availability of these authorized boosters is important for continued protection against COVID-19 disease.”
A version of this article was first published on Medscape.com.
in people who are eligible to get them.
The move to amend the Emergency Use Authorization for these vaccines gives the vaccine experts on the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices latitude to recommend a mix-and-match strategy if they feel the science supports it.
The committee convenes Oct. 21 for a day-long meeting to make its recommendations for additional doses.
People who’ve previously received two doses of the Moderna mRNA vaccine, which is now called Spikevax, are eligible for a third dose of any COVID-19 vaccine if they are 6 months past their second dose and are:
- 65 years of age or older
- 18 to 64 years of age, but at high risk for severe COVID-19 because of an underlying health condition
- 18 to 64 years of age and at high risk for exposure to the SARS-CoV-2 virus because they live in a group setting, such as a prison or care home, or work in a risky occupation, such as healthcare
People who’ve previously received a dose of the Johnson & Johnson vaccine are eligible for a second dose of any COVID-19 vaccine if they are over the age of 18 and at least 2 months past their vaccination.
“Today’s actions demonstrate our commitment to public health in proactively fighting against the COVID-19 pandemic,” said Acting FDA Commissioner Janet Woodcock, MD, in a news release. “As the pandemic continues to impact the country, science has shown that vaccination continues to be the safest and most effective way to prevent COVID-19, including the most serious consequences of the disease, such as hospitalization and death.
“The available data suggest waning immunity in some populations who are fully vaccinated. The availability of these authorized boosters is important for continued protection against COVID-19 disease.”
A version of this article was first published on Medscape.com.
How is psoriasis related to coronary inflammation and atherosclerotic burden?
Key clinical point: Patients with psoriasis showed lower coronary inflammation and higher atherosclerotic burden than matched control participants.
Major finding: Compared with cardiovascular disease (CVD) risk factor-matched control participants, patients with psoriasis showed a lower perivascular fat attenuation index (−80.19 ± 7.48 vs −78.14 ± 7.81 Hounsfield unit; P less than .001), indicating lower coronary inflammation and a higher overall computed tomography-adapted Leaman score (5.86 vs 4.69; P = .030).
Study details: This was a retrospective, single-center study including 98 patients with psoriasis and 196 CVD risk factor-matched control participants.
Disclosures: No specific funding for the study was disclosed. Z Xu declared being an employee of Siemens Healthineers CT Collaboration. No other potential conflict of interests was declared.
Source: Bao W et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518771.
Key clinical point: Patients with psoriasis showed lower coronary inflammation and higher atherosclerotic burden than matched control participants.
Major finding: Compared with cardiovascular disease (CVD) risk factor-matched control participants, patients with psoriasis showed a lower perivascular fat attenuation index (−80.19 ± 7.48 vs −78.14 ± 7.81 Hounsfield unit; P less than .001), indicating lower coronary inflammation and a higher overall computed tomography-adapted Leaman score (5.86 vs 4.69; P = .030).
Study details: This was a retrospective, single-center study including 98 patients with psoriasis and 196 CVD risk factor-matched control participants.
Disclosures: No specific funding for the study was disclosed. Z Xu declared being an employee of Siemens Healthineers CT Collaboration. No other potential conflict of interests was declared.
Source: Bao W et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518771.
Key clinical point: Patients with psoriasis showed lower coronary inflammation and higher atherosclerotic burden than matched control participants.
Major finding: Compared with cardiovascular disease (CVD) risk factor-matched control participants, patients with psoriasis showed a lower perivascular fat attenuation index (−80.19 ± 7.48 vs −78.14 ± 7.81 Hounsfield unit; P less than .001), indicating lower coronary inflammation and a higher overall computed tomography-adapted Leaman score (5.86 vs 4.69; P = .030).
Study details: This was a retrospective, single-center study including 98 patients with psoriasis and 196 CVD risk factor-matched control participants.
Disclosures: No specific funding for the study was disclosed. Z Xu declared being an employee of Siemens Healthineers CT Collaboration. No other potential conflict of interests was declared.
Source: Bao W et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518771.
Delineating factors behind frequent biologic switching in psoriasis
Key clinical point: Switching biologics in patients with psoriasis was mostly impelled by secondary lack of efficacy for skin symptoms with young age and the presence of psoriatic arthritis (PsA) linked to a higher frequency of switching in the long-term.
Major finding: Switching of first- and second-line biologics was likely attributed to a secondary lack of efficacy for skin disease. Each unit increase in age decreased the likelihood of switching twice or more by 4% (odds ratio [OR], 0.964; P = .038), whereas the existence of PsA increased the likelihood by 2.69-fold (OR, 2.69; P = .026).
Study details: This was a retrospective study including 115 adult patients with psoriasis who had been receiving biologics for 12 consecutive months or more and underwent at least a single biologic switch.
Disclosures: No specific funding for the study was disclosed. The authors declared no potential conflict of interests.
Source: Akdogan N et al. Expert Rev Clin Pharmacol. 2021 Sep 23. doi: 10.1080/17512433.2021.1979394.
Key clinical point: Switching biologics in patients with psoriasis was mostly impelled by secondary lack of efficacy for skin symptoms with young age and the presence of psoriatic arthritis (PsA) linked to a higher frequency of switching in the long-term.
Major finding: Switching of first- and second-line biologics was likely attributed to a secondary lack of efficacy for skin disease. Each unit increase in age decreased the likelihood of switching twice or more by 4% (odds ratio [OR], 0.964; P = .038), whereas the existence of PsA increased the likelihood by 2.69-fold (OR, 2.69; P = .026).
Study details: This was a retrospective study including 115 adult patients with psoriasis who had been receiving biologics for 12 consecutive months or more and underwent at least a single biologic switch.
Disclosures: No specific funding for the study was disclosed. The authors declared no potential conflict of interests.
Source: Akdogan N et al. Expert Rev Clin Pharmacol. 2021 Sep 23. doi: 10.1080/17512433.2021.1979394.
Key clinical point: Switching biologics in patients with psoriasis was mostly impelled by secondary lack of efficacy for skin symptoms with young age and the presence of psoriatic arthritis (PsA) linked to a higher frequency of switching in the long-term.
Major finding: Switching of first- and second-line biologics was likely attributed to a secondary lack of efficacy for skin disease. Each unit increase in age decreased the likelihood of switching twice or more by 4% (odds ratio [OR], 0.964; P = .038), whereas the existence of PsA increased the likelihood by 2.69-fold (OR, 2.69; P = .026).
Study details: This was a retrospective study including 115 adult patients with psoriasis who had been receiving biologics for 12 consecutive months or more and underwent at least a single biologic switch.
Disclosures: No specific funding for the study was disclosed. The authors declared no potential conflict of interests.
Source: Akdogan N et al. Expert Rev Clin Pharmacol. 2021 Sep 23. doi: 10.1080/17512433.2021.1979394.
High body weight and previous biologic use counter real-life guselkumab efficacy against plaque psoriasis
Key clinical point: This real-life study showed reduced efficacy of guselkumab for over 36 weeks in patients with moderate-to-severe chronic plaque psoriasis than previously reported, with body weight and exposure to biologics being the major predictors of response.
Major finding: At week 36, 67% of patients achieved Psoriasis Area Severity Index (PASI) 75 with heavier vs. low‐weight patients showing a decreased likelihood of achieving PASI 75 until week 4 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.88-0.99). Even at week 36, PASI 75 response rates were lower for patients exposed to 1 (OR, 0.07; 95% CI, 0.00-0.68) or more than 1 (OR, 0.00; 95% CI, 0.00-0.044) biologics than for biologic-naïve patients.
Study details: Findings are from a multicenter retrospective cohort study including 135 adult patients with moderate-to-severe chronic plaque psoriasis.
Disclosures: The study was supported by the Chang Gung Memorial Hospital and National Taiwan University Hospital, Hsin-Chu branch. Some of the authors declared serving as clinical trial participant or receiving speaker/consultancy honoraria from various sources.
Source: Hung YT et al. Ther Adv Chronic Dis. 2021 Sep 29. doi: 10.1177/20406223211046685.
Key clinical point: This real-life study showed reduced efficacy of guselkumab for over 36 weeks in patients with moderate-to-severe chronic plaque psoriasis than previously reported, with body weight and exposure to biologics being the major predictors of response.
Major finding: At week 36, 67% of patients achieved Psoriasis Area Severity Index (PASI) 75 with heavier vs. low‐weight patients showing a decreased likelihood of achieving PASI 75 until week 4 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.88-0.99). Even at week 36, PASI 75 response rates were lower for patients exposed to 1 (OR, 0.07; 95% CI, 0.00-0.68) or more than 1 (OR, 0.00; 95% CI, 0.00-0.044) biologics than for biologic-naïve patients.
Study details: Findings are from a multicenter retrospective cohort study including 135 adult patients with moderate-to-severe chronic plaque psoriasis.
Disclosures: The study was supported by the Chang Gung Memorial Hospital and National Taiwan University Hospital, Hsin-Chu branch. Some of the authors declared serving as clinical trial participant or receiving speaker/consultancy honoraria from various sources.
Source: Hung YT et al. Ther Adv Chronic Dis. 2021 Sep 29. doi: 10.1177/20406223211046685.
Key clinical point: This real-life study showed reduced efficacy of guselkumab for over 36 weeks in patients with moderate-to-severe chronic plaque psoriasis than previously reported, with body weight and exposure to biologics being the major predictors of response.
Major finding: At week 36, 67% of patients achieved Psoriasis Area Severity Index (PASI) 75 with heavier vs. low‐weight patients showing a decreased likelihood of achieving PASI 75 until week 4 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.88-0.99). Even at week 36, PASI 75 response rates were lower for patients exposed to 1 (OR, 0.07; 95% CI, 0.00-0.68) or more than 1 (OR, 0.00; 95% CI, 0.00-0.044) biologics than for biologic-naïve patients.
Study details: Findings are from a multicenter retrospective cohort study including 135 adult patients with moderate-to-severe chronic plaque psoriasis.
Disclosures: The study was supported by the Chang Gung Memorial Hospital and National Taiwan University Hospital, Hsin-Chu branch. Some of the authors declared serving as clinical trial participant or receiving speaker/consultancy honoraria from various sources.
Source: Hung YT et al. Ther Adv Chronic Dis. 2021 Sep 29. doi: 10.1177/20406223211046685.
Occult blood in feces tied to increased risk for psoriasis
Key clinical point: Patients with positive fecal immunochemistry test (FIT) results showed a significantly higher risk for psoriasis than those who were FIT-negative.
Major finding: During a 6.68-year median follow-up, the incidence rate of psoriasis per 1000 person-years was higher for the FIT-positive vs the FIT-negative group (4.14 vs 3.76). After multivariable adjustment, the adjusted hazard ratios for psoriasis were 1.029 (95% confidence interval [CI], 0.997-1.061), 1.118 (95% CI, 1.04-1.201), and 1.342 (95% CI, 1.157-1.557) for 1, 2, and 3 positive FIT results, respectively, vs negative FIT results.
Study details: Findings are from a retrospective nationwide population-based study of 1,395,147 participants aged 50 years or above who underwent screening for colorectal cancer.
Disclosures: The study was supported by the New Faculty Startup Fund from Seoul National University. The authors declared no potential conflict of interests.
Source: Lee HJ et al. Dermatology. 2021 Sep 16. doi: 10.1159/000518625.
Key clinical point: Patients with positive fecal immunochemistry test (FIT) results showed a significantly higher risk for psoriasis than those who were FIT-negative.
Major finding: During a 6.68-year median follow-up, the incidence rate of psoriasis per 1000 person-years was higher for the FIT-positive vs the FIT-negative group (4.14 vs 3.76). After multivariable adjustment, the adjusted hazard ratios for psoriasis were 1.029 (95% confidence interval [CI], 0.997-1.061), 1.118 (95% CI, 1.04-1.201), and 1.342 (95% CI, 1.157-1.557) for 1, 2, and 3 positive FIT results, respectively, vs negative FIT results.
Study details: Findings are from a retrospective nationwide population-based study of 1,395,147 participants aged 50 years or above who underwent screening for colorectal cancer.
Disclosures: The study was supported by the New Faculty Startup Fund from Seoul National University. The authors declared no potential conflict of interests.
Source: Lee HJ et al. Dermatology. 2021 Sep 16. doi: 10.1159/000518625.
Key clinical point: Patients with positive fecal immunochemistry test (FIT) results showed a significantly higher risk for psoriasis than those who were FIT-negative.
Major finding: During a 6.68-year median follow-up, the incidence rate of psoriasis per 1000 person-years was higher for the FIT-positive vs the FIT-negative group (4.14 vs 3.76). After multivariable adjustment, the adjusted hazard ratios for psoriasis were 1.029 (95% confidence interval [CI], 0.997-1.061), 1.118 (95% CI, 1.04-1.201), and 1.342 (95% CI, 1.157-1.557) for 1, 2, and 3 positive FIT results, respectively, vs negative FIT results.
Study details: Findings are from a retrospective nationwide population-based study of 1,395,147 participants aged 50 years or above who underwent screening for colorectal cancer.
Disclosures: The study was supported by the New Faculty Startup Fund from Seoul National University. The authors declared no potential conflict of interests.
Source: Lee HJ et al. Dermatology. 2021 Sep 16. doi: 10.1159/000518625.
Guselkumab: A promising treatment option for moderate-to-severe plaque psoriasis
Key clinical point: Guselkumab positively affected both clinician- and patient-reported outcomes in patients with moderate-to-severe plaque psoriasis, irrespective of their history of psoriasis therapies.
Major finding: After 28 weeks, 56.8% of patients attained a Dermatology Life Quality Index (DLQI) score of 1 or less, with the mean DLQI score decreasing from 13.7 at baseline to 2.8 (95% confidence interval [CI], 2.3-3.2), and mean Psoriasis Area Severity Index (PASI) decreasing from 16.4 at baseline to 3.0 (95% CI, 2.3-3.6), with a 55.3% PASI 90 response rate. Most adverse events were mild or moderate.
Study details: The data come from PERSIST, an ongoing, prospective, real-life study that enrolled 303 patients aged 18 years or above with moderate-to-severe plaque psoriasis for 2 years or more who were prescribed guselkumab.
Disclosures: This study was supported by Janssen-Cilag GmbH (Germany). S Wegner, Y Personke, and M Gomez reported being employees of Janssen-Cilag, whereas the other authors declared serving as an advisor, speaker, or clinical trial participant or receiving grants from various companies including Janssen-Cilag.
Source: Gerdes S et al. J Dermatol. 2021 Sep 12. doi: 10.1111/1346-8138.16128.
Key clinical point: Guselkumab positively affected both clinician- and patient-reported outcomes in patients with moderate-to-severe plaque psoriasis, irrespective of their history of psoriasis therapies.
Major finding: After 28 weeks, 56.8% of patients attained a Dermatology Life Quality Index (DLQI) score of 1 or less, with the mean DLQI score decreasing from 13.7 at baseline to 2.8 (95% confidence interval [CI], 2.3-3.2), and mean Psoriasis Area Severity Index (PASI) decreasing from 16.4 at baseline to 3.0 (95% CI, 2.3-3.6), with a 55.3% PASI 90 response rate. Most adverse events were mild or moderate.
Study details: The data come from PERSIST, an ongoing, prospective, real-life study that enrolled 303 patients aged 18 years or above with moderate-to-severe plaque psoriasis for 2 years or more who were prescribed guselkumab.
Disclosures: This study was supported by Janssen-Cilag GmbH (Germany). S Wegner, Y Personke, and M Gomez reported being employees of Janssen-Cilag, whereas the other authors declared serving as an advisor, speaker, or clinical trial participant or receiving grants from various companies including Janssen-Cilag.
Source: Gerdes S et al. J Dermatol. 2021 Sep 12. doi: 10.1111/1346-8138.16128.
Key clinical point: Guselkumab positively affected both clinician- and patient-reported outcomes in patients with moderate-to-severe plaque psoriasis, irrespective of their history of psoriasis therapies.
Major finding: After 28 weeks, 56.8% of patients attained a Dermatology Life Quality Index (DLQI) score of 1 or less, with the mean DLQI score decreasing from 13.7 at baseline to 2.8 (95% confidence interval [CI], 2.3-3.2), and mean Psoriasis Area Severity Index (PASI) decreasing from 16.4 at baseline to 3.0 (95% CI, 2.3-3.6), with a 55.3% PASI 90 response rate. Most adverse events were mild or moderate.
Study details: The data come from PERSIST, an ongoing, prospective, real-life study that enrolled 303 patients aged 18 years or above with moderate-to-severe plaque psoriasis for 2 years or more who were prescribed guselkumab.
Disclosures: This study was supported by Janssen-Cilag GmbH (Germany). S Wegner, Y Personke, and M Gomez reported being employees of Janssen-Cilag, whereas the other authors declared serving as an advisor, speaker, or clinical trial participant or receiving grants from various companies including Janssen-Cilag.
Source: Gerdes S et al. J Dermatol. 2021 Sep 12. doi: 10.1111/1346-8138.16128.
Smokers with periodontitis are at soaring risk for psoriasis
Key clinical point: Periodontitis serves as an independent risk factor for psoriasis and in combination with smoking synergistically contributes to psoriasis development.
Major finding: The risk for psoriasis was higher in patients with vs. without periodontitis (adjusted hazard ratio [aHR], 1.116; 95% confidence interval [CI], 1.101-1.13). Compared with nonsmokers without periodontitis, the risk for psoriasis in nonsmokers with periodontitis and smokers with periodontitis increased by 11% (aHR, 1.11; 95% CI, 1.094-1.127) and 26.5% (aHR, 1.265; 95% CI, 1.234-1.296), respectively.
Study details: The data come from a 9-year follow-up, nationwide, population-based cohort study that included 1,063,004 and 8,655,587 patients with and without periodontitis, respectively, and not pre-diagnosed with psoriasis.
Disclosures: The study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declared no potential conflict of interests.
Source: Han JH et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518296.
Key clinical point: Periodontitis serves as an independent risk factor for psoriasis and in combination with smoking synergistically contributes to psoriasis development.
Major finding: The risk for psoriasis was higher in patients with vs. without periodontitis (adjusted hazard ratio [aHR], 1.116; 95% confidence interval [CI], 1.101-1.13). Compared with nonsmokers without periodontitis, the risk for psoriasis in nonsmokers with periodontitis and smokers with periodontitis increased by 11% (aHR, 1.11; 95% CI, 1.094-1.127) and 26.5% (aHR, 1.265; 95% CI, 1.234-1.296), respectively.
Study details: The data come from a 9-year follow-up, nationwide, population-based cohort study that included 1,063,004 and 8,655,587 patients with and without periodontitis, respectively, and not pre-diagnosed with psoriasis.
Disclosures: The study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declared no potential conflict of interests.
Source: Han JH et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518296.
Key clinical point: Periodontitis serves as an independent risk factor for psoriasis and in combination with smoking synergistically contributes to psoriasis development.
Major finding: The risk for psoriasis was higher in patients with vs. without periodontitis (adjusted hazard ratio [aHR], 1.116; 95% confidence interval [CI], 1.101-1.13). Compared with nonsmokers without periodontitis, the risk for psoriasis in nonsmokers with periodontitis and smokers with periodontitis increased by 11% (aHR, 1.11; 95% CI, 1.094-1.127) and 26.5% (aHR, 1.265; 95% CI, 1.234-1.296), respectively.
Study details: The data come from a 9-year follow-up, nationwide, population-based cohort study that included 1,063,004 and 8,655,587 patients with and without periodontitis, respectively, and not pre-diagnosed with psoriasis.
Disclosures: The study was supported by a National Research Foundation of Korea grant funded by the Korean government. The authors declared no potential conflict of interests.
Source: Han JH et al. Dermatology. 2021 Sep 15. doi: 10.1159/000518296.
Cal/BD foam gains ground among patients with plaque psoriasis
Key clinical point: Proactive management with calcipotriene 50 μg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam vs. reactive management with vehicle foam decreased the severity of patient-reported symptoms in patients with plaque psoriasis.
Major finding: Proactive vs. reactive management during 52-week maintenance showed greater improvement in Psoriasis Symptom Inventory (difference, −0.75; P = .0128) and Dermatology Life Quality Index (difference −0.45; P = .007) and nonsignificantly higher EuroQol-5D for psoriasis (0.89 vs 0.88; P = .0842) scores.
Study details: Findings are from a post hoc analysis of phase 3 PSO-LONG trial including 521 patients with plaque psoriasis randomly assigned to proactive management (Cal/BD foam twice weekly) or reactive management (vehicle foam twice weekly) arms.
Disclosures: The study was sponsored by Leo Pharma. The authors declared serving as consultants, advisory board members, and clinical trial investigators or receiving grants/speaker honoraria from various sources, including LEO Pharma.
Source: Jalili A et al. J Eur Acad Dermatol Venereol. 2021 Sep 20. doi: 10.1111/jdv.17673.
Key clinical point: Proactive management with calcipotriene 50 μg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam vs. reactive management with vehicle foam decreased the severity of patient-reported symptoms in patients with plaque psoriasis.
Major finding: Proactive vs. reactive management during 52-week maintenance showed greater improvement in Psoriasis Symptom Inventory (difference, −0.75; P = .0128) and Dermatology Life Quality Index (difference −0.45; P = .007) and nonsignificantly higher EuroQol-5D for psoriasis (0.89 vs 0.88; P = .0842) scores.
Study details: Findings are from a post hoc analysis of phase 3 PSO-LONG trial including 521 patients with plaque psoriasis randomly assigned to proactive management (Cal/BD foam twice weekly) or reactive management (vehicle foam twice weekly) arms.
Disclosures: The study was sponsored by Leo Pharma. The authors declared serving as consultants, advisory board members, and clinical trial investigators or receiving grants/speaker honoraria from various sources, including LEO Pharma.
Source: Jalili A et al. J Eur Acad Dermatol Venereol. 2021 Sep 20. doi: 10.1111/jdv.17673.
Key clinical point: Proactive management with calcipotriene 50 μg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam vs. reactive management with vehicle foam decreased the severity of patient-reported symptoms in patients with plaque psoriasis.
Major finding: Proactive vs. reactive management during 52-week maintenance showed greater improvement in Psoriasis Symptom Inventory (difference, −0.75; P = .0128) and Dermatology Life Quality Index (difference −0.45; P = .007) and nonsignificantly higher EuroQol-5D for psoriasis (0.89 vs 0.88; P = .0842) scores.
Study details: Findings are from a post hoc analysis of phase 3 PSO-LONG trial including 521 patients with plaque psoriasis randomly assigned to proactive management (Cal/BD foam twice weekly) or reactive management (vehicle foam twice weekly) arms.
Disclosures: The study was sponsored by Leo Pharma. The authors declared serving as consultants, advisory board members, and clinical trial investigators or receiving grants/speaker honoraria from various sources, including LEO Pharma.
Source: Jalili A et al. J Eur Acad Dermatol Venereol. 2021 Sep 20. doi: 10.1111/jdv.17673.