Delayed cutaneous reactions seen with COVID-19 vaccine

Doctors in the US have warned that clinicians may not be prepared to address delayed local cutaneous reactions occurring a median of eight days after receipt of the mRNA COVID-19 vaccine.

Reporting on a series of 12 patients who experienced large local reactions anywhere from four to 11 days after receiving their first dose, doctors from four US sites said delayed cutaneous reactions from the vaccine have not been consistently recognised, guidance regarding the second dose of vaccine has varied, and many patients have unnecessarily received antibiotic agents.

Detailing their observations in a letter to the editor published in NEJM Dr Kimberly Blumenthal and colleagues said delayed reactions had a variable appearance though all appeared near the injection site.

Five of the reactions were grade 3 plaques (≥10 cm in diameter). Some patients had concurrent systemic adverse effects, commonly headache, fatigue, or myalgia and among these patients, two had reported additional rash.

Most patients received treatment for their symptoms with ice and antihistamines. Some patients received glucocorticoids (topical, oral, or both), and one patient received antibiotic therapy for presumptive cellulitis. The symptoms resolved a median of 6 days after onset

Dr Blumenthal and colleagues say additional reporting and widespread communication of the causes and implications of these delayed reactions might allay patient concerns, encourage completion of vaccination and reduce the use of unnecessary use of antibiotics.

Researchers identify melanoma genetic changes that leads to lethal metastatic disease 

A large collaboration of researchers, involving many from Australian institutions, has identified the genetic changes that drive the evolution of melanoma from early disease through treatment to lethal end-stage disease.

Investigators from more than 25 institutions analysed 88 tumour samples from 13 patients taken at multiple sites and times. Whole exome and genome sequencing of the samples reveals that melanoma progression is dominated by whole genome doubling and large-scale aneuploidy.

The mutation pattern leads to widespread loss of heterozygosity,  which ‘sculpts the burden of point mutations, neoantigens and structural variants’ even in treatment-naïve and primary skin melanomas in some patients.

Writing in  Nature Communications investigators say the results suggest that dysregualtion of genomic integrity is a key driver for the selective advantage of mutated cells during melanoma progression.

“The finding highlights the importance of defective DNA repair as a mechanism that permits cancer cell adaptation in the face of selective pressures such as anti-cancer therapy, and is consistent with known mechanisms of acquired resistance in melanoma to targeted therapy and immunotherapy,” they add.

Read more.

Females first but not top when it comes to dermatology publishing

Female dermatology researchers have achieved parity with males when it comes to first authorship in leading dermatology journals, but they still lag on being senior authorship.

A review of article authorship in the Journal of Investigative Dermatology (JID), the Journal of the American Academy of Dermatology (JAAD) and JAMA Dermatology for the past ten years found that female first authorship rates had been equivalent to those of their male counterparts at around 50% each. But female senior authorship (FSA) had remained consistently below that of their male colleagues with average percentages of female last authors being 38.6% (JID), 38.6% (JAAD) and 37.5% (JAMA Dermatology) respectively. The gender disparity likely reflected the fact that associate and full dermatology professorships in university hospitals were disproportionately held by male physicians, according to the study authors writing in JAAD.