Amylee Martin

The emergence of data from clinical trials of biologics, the approval of new biologics, and our improved understanding of psoriasis pathogenesis have increased the therapeutic possibilities for the treatment of moderate-to-severe psoriasis. Biologics currently approved for the treatment of psoriasis include tumor necrosis factor inhibitors, interleukin (IL)-17 inhibitors, ustekinumab (an IL-12/23 inhibitor), and IL-23 inhibitors. Data from clinical trials and studies of the safety and efficacy of biologics provide essential information for the personalization of patient care. We discuss the benefits and disadvantages of biologics as a first-line treatment choice, update treatment recommendations according to current evidence, and propose psoriasis treatment algorithms. Our discussion includes the following comorbid conditions: psoriatic arthritis, multiple sclerosis, congestive heart failure, inflammatory bowel disease, hepatitis B, nonmelanoma skin cancer, lymphoma, and latent tuberculosis. We make evidence-based treatment recommendations for special populations, including pediatric patients, patients with coronavirus 2019 (COVID-19), and pregnant and breastfeeding patients with psoriasis. Ultimately, individualized recommendations that consider patient preferences, disease severity, comorbid conditions, and additional risk factors should be offered to patients and updated as new trial data emerges.

To the Editor: The dermatology community remains concerned about the risk of COVID-19 in individuals with atopic dermatitis (AD). Using Symphony Health-derived data from the COVID-19 Research Database,1 we aimed to assess the risk of contracting COVID-19 in adults with AD while controlling for demographic factors and comorbidities known or speculated to be COVID-19 risk factors and assess the risk of contracting COVID-19 in adults with AD treated with dupilumab.

To the Editor: Recent studies have linked psoriasis with emerging comorbidities, thus requiring up-to-date prevalence of psoriasis to quantify a changing disease burden.1 As a representative database of health status among US adults, the National Health and Nutrition Examination Survey (NHANES) produces reliable estimates of psoriasis prevalence and comorbidities. This study aimed to update psoriasis prevalence rates among US adults in the most recent 2013-2014 NHANES cycle.

Due to the public health risk associated with SARS-CoV-2 (COVID-19) infection, universal use of face masks has been recommended to protect against viral spread. Adverse facial reactions from the utilization of masks in the general public are poorly characterized in literature.We aimed to provide a systematic review of studies reporting adverse facial reactions associated with use of face masks during the COVID-19 pandemic.PubMed and Cochrane databases were searched using the following search terms: "masks" AND "skin reactions, facial dermatosis, rash, acne, atopic dermatitis, rosacea, OR seborrheic dermatitis."A total of 954 cases of dermatological adverse effects were reported. Over 17 different adverse facial reactions were found, including the top 10 in order: itch (370, 38.8%), indentation/ear pain (102, 10.7%), discomfort (90, 9.4%), erythema (72, 7.5%), dryness (62, 6.5%), rash (60, 6.3%), scarring (42, 4.4%), desquamation (22, 2.3%), pain (19, 2.0%), burning (19, 2.0%), and wheals (7, 0.7%). Face masks can increase acne (n=44), rosacea (n=14), and seborrheic dermatitis (n=9).Publication bias of articles, with limited studies available regarding this topic.Wearing face masks to protect from COVID-19 can increase adverse facial dermatoses and exacerbate underlying dermatology conditions; however, several preventative measures may be taken.

To the Editor: Emerging evidence supports the association of psoriasis with several autoimmune diseases, including Graves' disease and Hashimoto thyroiditis.1 However, the association between psoriasis and thyroid disease remains inconclusive in the US population.2 This study sought to determine whether psoriasis is associated with an increased risk of thyroid disease in adults using the 2009-2014 National Health and Nutrition Examination Survey, a nationally representative database of health information of the general population in the United States.

To the Editor: Research suggests an association between asthma and psoriasis.1Wang J. Ke R. Shi W. et al.Association between psoriasis and asthma risk: a meta-analysis.Allergy Asthma Proc. 2018; 39: 103-109Google Scholar However, this relationship is yet to be investigated within the United States (U.S.) population. Consequently, we aimed to assess the relationship between psoriasis and asthma in U.S. adults using the 2009-2014 National Health and Nutrition Examination Survey's data. The National Health and Nutrition Examination Survey is a nationally representative U.S. database, well described in the literature.2Liu J. Thatiparthi A. Martin A. Egeberg A. Wu J.J. Prevalence of psoriasis among adults in the U.S. 2009-2010 and 2013-2014 National Health and Nutrition Examination Surveys.J Am Acad Dermatol. 2021; 84: 767-769Google Scholar Medical conditions questionnaire responses were used to assess the psoriasis and asthma status (Table I). Data processing and analyses were performed using Stata/SE 16.1. Multivariable logistic models were constructed with asthma as the dependent variable and psoriasis as the explanatory variable. Age, sex, ethnicity, income, body mass index, tobacco use, and chronic obstructive pulmonary disease (COPD) were added as covariates to adjust the model.Table ISample characteristicsCharacteristicAsthma, n/N (weighted %)∗Weighted percentage using NHANES survey design parameters.†History of asthma assessed based on the question “Has a doctor or other health professional ever told you that you have asthma?”No asthma, n/N (weighted %)∗Weighted percentage using NHANES survey design parameters.P valueHistory of psoriasis‡History of psoriasis assessed based on the question “Have you ever been told by a doctor or other healthcare professional that you had psoriasis?” Yes118/2532 (5)383/14,986 (3)<.0001 No2414/2532 (95)14,603/14,986 (97)Sex Male1045/2532 (40)7442/14,986 (49)<.0001 Female1487/2532 (60)7544/14,986 (51)<.0001Mean age (y) ± SE45.3 ± 0.5147.6 ± 0.36<.0001Mean BMI (kg/m2) ± SE30.2 ± 0.2828.7 ± 0.09Ethnicity/race NHW1199/2532 (69)6278/14,986 (66)<.0001 Mexican American and other Hispanic453/2532 (11)3705/14,986 (15) NHB632/2532 (14)3118/14,986 (11) Other race/multiracial248/2532 (6)1885/14,986 (8)Annual household income <$20,000680/2424 (19)3107/14,203 (15)<.0001 ≥$20,0001744/2424 (81)11096/14,203 (85)History of tobacco use§History of tobacco use assessed by “Have you smoked at least 100 cigarettes in your entire life?”1289/2532 (50)6459/14,978 (43)<.0001History of COPDǁIndividuals determined to have a history of COPD if answered yes to “Has a doctor or other health professional ever told you that you had emphysema?” or “Has a doctor or other health professional ever told you that you had chronic bronchitis?”539/2522 (20)575/14,959 (4)<.0001Values that are statistically significant (2-sided P value ≤ .05) are bolded.BMI, Body mass index; COPD, chronic obstructive pulmonary disease; NHANES, National Health and Nutrition Examination Survey; NHB, Non-Hispanic Black; NHW, Non-Hispanic White; SE, standard error.∗ Weighted percentage using NHANES survey design parameters.† History of asthma assessed based on the question “Has a doctor or other health professional ever told you that you have asthma?”‡ History of psoriasis assessed based on the question “Have you ever been told by a doctor or other healthcare professional that you had psoriasis?”§ History of tobacco use assessed by “Have you smoked at least 100 cigarettes in your entire life?”ǁ Individuals determined to have a history of COPD if answered yes to “Has a doctor or other health professional ever told you that you had emphysema?” or “Has a doctor or other health professional ever told you that you had chronic bronchitis?” Open table in a new tab Values that are statistically significant (2-sided P value ≤ .05) are bolded. BMI, Body mass index; COPD, chronic obstructive pulmonary disease; NHANES, National Health and Nutrition Examination Survey; NHB, Non-Hispanic Black; NHW, Non-Hispanic White; SE, standard error. Of 17,547 adult participants (aged ≥20 years), 17,518 provided responses to both psoriasis and asthma questions and were included in the primary analyses. Multivariate analyses showed that the odds of having asthma were significantly increased in the adult psoriasis participants (adjusted odds ratio [aOR] 1.67, 95% confidence interval [CI] 1.26-2.21) (Table II).Table IIAssociation between asthma and psoriasis in U.S. adultsPsoriasis statusAsthma, n/N (weighted %)∗Weighted percentage using NHANES survey design parameters.Crude OR (95% CI)P valueAdjusted OR (95% CI)P valueAll participants aged 20 years or older No2414/17017 (14)1.00 (reference)<.00011.00 (reference).001 Yes118/501 (23)1.73 (1.37-2.18)1.67 (1.26-2.21)†Adjusted for sex, age, history of tobacco use, BMI, annual household income, ethnicity, and history of COPD.All nonobese participants aged 20 years or older (BMI < 30 kg/m2) No1258/10225 (13)1.00 (reference)<.00011.00 (reference).003 Yes57/271 (22)1.96 (1.41-2.72)1.82 (1.23-2.69)†Adjusted for sex, age, history of tobacco use, BMI, annual household income, ethnicity, and history of COPD.All obese participants aged 20 years or older (BMI ≥ 30 kg/m2) No1156/6792 (17)1.00 (reference).041.00 (reference).06 Yes61/230 (23)1.44 (1.01-2.04)1.45 (0.98-2.13)†Adjusted for sex, age, history of tobacco use, BMI, annual household income, ethnicity, and history of COPD.Sensitivity analyses excluding participants with a history of COPD No1907/15965 (12)1.00 (reference)<.00011.00 (reference)<.0001 Yes86/439 (19)1.65 (1.31-2.09)1.69 (1.30-2.18)‡Adjusted for sex, age, history of tobacco use, BMI, annual household income, and ethnicity.Sensitivity analyses excluding participants with eczema using the 2003-2006 data§Eczema and psoriasis data only available for the 2003-2006 NHANES cycles; Participants from the 2003-2004 cycles who responded yes to the question “During the past 12 months, that is since a year ago, have you had dermatitis, eczema, or any other type of red, inflamed skin rash?” were excluded from this analyses; Participants from the 2005-2006 cycles who responded yes to the question “Has a doctor or other health professional ever told you that you have eczema?” were excluded from the analyses. No738/5801 (13)1.00 (reference).031.00 (reference).05 Yes29/124 (21)1.73 (1.08-2.78)1.66 (1.00-2.75)†Adjusted for sex, age, history of tobacco use, BMI, annual household income, ethnicity, and history of COPD.Statistically significant values (2-sided P value ≤.05) are bolded.BMI, Body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; OR, odds ratio.∗ Weighted percentage using NHANES survey design parameters.† Adjusted for sex, age, history of tobacco use, BMI, annual household income, ethnicity, and history of COPD.‡ Adjusted for sex, age, history of tobacco use, BMI, annual household income, and ethnicity.§ Eczema and psoriasis data only available for the 2003-2006 NHANES cycles; Participants from the 2003-2004 cycles who responded yes to the question “During the past 12 months, that is since a year ago, have you had dermatitis, eczema, or any other type of red, inflamed skin rash?” were excluded from this analyses; Participants from the 2005-2006 cycles who responded yes to the question “Has a doctor or other health professional ever told you that you have eczema?” were excluded from the analyses. Open table in a new tab Statistically significant values (2-sided P value ≤.05) are bolded. BMI, Body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; OR, odds ratio. To account for residual confounding and the potential misdiagnosis of deconditioned obese individuals with asthma, we performed a subgroup analysis of nonobese adults (body mass index < 30 kg/m2). No significant changes in the odds ratio were observed compared with the odds ratio of our primary analyses (aOR 1.82, 95% CI 1.23-2.69). We also performed a sensitivity analysis excluding participants with COPD to account for diagnostic confusion between asthma and COPD. Compared with the odds ratio of our primary analyses, no significant changes in the odds ratio were found (aOR 1.69, 95% CI 1.30-2.18). To address the possible misdiagnosis of atopic dermatitis (eczema) as psoriasis, we conducted a sensitivity analysis excluding participants with eczema. We used the 2003-2006 data for this analysis because eczema was not surveyed in 2009-2014. There was no significant difference between the aORs upon excluding (aOR 1.66, 95% CI 1.00-2.75) and including (aOR 1.46, 95% CI 0.93-2.27) the participants with eczema. We found a higher odds ratio (aOR 1.67) compared with that in a 2018 meta-analysis (odds ratio 1.32).1Wang J. Ke R. Shi W. et al.Association between psoriasis and asthma risk: a meta-analysis.Allergy Asthma Proc. 2018; 39: 103-109Google Scholar Three factors may have accounted for this discrepancy. First, the meta-analysis examined Asian and European populations exclusively, whereas our study included multiple ethnic groups. Additionally, we used a nationally representative U.S. survey that is well suited to assess individuals with mild disease, whereas majority of the meta-analysis studies used insurance claims data. Lastly, none of the meta-analysis studies was conducted on the U.S. population, which has a unique genetic/environmental profile. Some researchers have suggested that interleukin-17 (IL-17) contributes to asthma in a limited subset of individuals.3Busse W.W. Asthma and psoriasis: what do they have in common? IL-17A!.J Allergy Clin Immunol. 2019; 144: 1169-1171Google Scholar,4Östling J. van Geest M. Schofield J.P. et al.IL-17–high asthma with features of a psoriasis immunophenotype.J Allergy Clin Immunol. 2019; 144: 1198-1213Google Scholar Moreover, a recent study showed that genes regulating epithelial barrier function and defense mechanisms are differentially expressed in both asthma patients with a high level of IL-17, as well as patients with psoriasis.4Östling J. van Geest M. Schofield J.P. et al.IL-17–high asthma with features of a psoriasis immunophenotype.J Allergy Clin Immunol. 2019; 144: 1198-1213Google Scholar Since IL-17 has been shown to correlate with psoriasis severity, future studies exploring the relationship among asthma, psoriasis severity, and IL-17 may be beneficial.5Fitz L. Zhang W. Soderstrom C. et al.Association between serum interleukin-17A and clinical response to tofacitinib and etanercept in moderate to severe psoriasis.Clin Exp Dermatol. 2018; 43: 790-797Google Scholar Our study was limited by the use of self-reported data, which was subject to a recall bias. Furthermore, one must consider the possible misdiagnosis of COPD as asthma. Likewise, diagnostic confusion may exist between psoriasis and other common dermatoses, including atopic/seborrheic/contact dermatitis and tinea infections. In conclusion, this study suggests an association between asthma and psoriasis in U.S. adults. Dr Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Dr Reddy's Laboratories, Eli Lilly, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Regeneron, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, Valeant Pharmaceuticals North America LLC, and Zerigo Health. Dr Egeberg has received research funding from Pfizer , Eli Lilly , Novartis , Bristol-Myers Squibb , AbbVie , Janssen Pharmaceuticals , the Danish National Psoriasis Foundation , the Simon Spies Foundation , and the Kgl Hofbundtmager Aage Bang Foundation and has received honoraria as a consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd, Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals. Dr Ge and Authors Martin, Thatiparthi, and Liu have no conflicts of interest to declare. Correspondence to “Association between psoriasis and asthma among United States adults in the 2009-2014 national health and nutrition examination survey”Journal of the American Academy of DermatologyVol. 86Issue 3PreviewTo the Editor: We read with immense interest the article by Martin et al and believe a few matters could be addressed. First, models in this study were adjusted by age, sex, ethnicity, income, body mass index, tobacco use, and chronic obstructive pulmonary disease. We suggest adding confounders, such as air pollution, atopy, asthma family history and steroid use, as these were found to be strong confounders in our previous study.1 Vitamin D3 levels have been significantly linked to psoriasis2 and asthma. Full-Text PDF

Phototherapy is a standard treatment for moderate-to-severe psoriasis. However, concern remains regarding the associated cutaneous carcinogenic risk. Our objective is to conduct a systematic review of skin cancer risk for psoriasis patients treated with phototherapy. To achieve our goal, we searched Cochrane, PubMed, and Embase databases. We aimed to evaluate existing literature (from July 1, 2010, to December 31, 2020) on phototherapy for all Fitzpatrick skin phototypes (FSP) which includes 71 articles, and eight articles being categorized in this review. Five studies did not report an increased skin cancer risk with narrowband-ultraviolet blue (UVB) and unspecified UVB for FSP II through VI, with one study not reporting FSP. Three studies did report an increased risk of skin cancer with narrowband-UVB and broadband-UVB for FSP I-VI, with one study also not specifying skin phototypes or UVB phototherapy type. Additionally, a study with psoralen and ultraviolet A with and without narrowband-UVB demonstrated an increased risk of skin cancer in phototypes III and IV. The most commonly reported secondary outcomes with phototherapy were actinic keratosis (123) and solar lentigines (10). Numerous patients were also on additional therapies including methotrexate, acitretin, and biologics. Study limitations include publication bias due to limited number of studies published on this topic in the last ten years along with heterogeneity in reporting. The relationship between phototherapy, psoriasis, and cutaneous oncogenic risk remains contradictory. While phototherapy for psoriasis is an efficacious therapy, further studies are needed to understand the cutaneous oncogenic risk based on FSP to help clinicals tailor treatment recommendations based on skin phototypes.

To the Editor: Due to the SARS-CoV-2 (COVID-19) pandemic, the dermatology residency application cycle was altered to mitigate adverse outcomes. The resulting actions necessitate governance processes to monitor outcomes and effects.

To the Editor: Despite a lower risk of skin cancer compared with non-Hispanic whites (NHWs), individuals of color have a greater propensity to present with skin cancer at an advanced stage.1 In 2011, Summers et al2 found that non-Hispanic blacks (NHBs) who reported severe sunburns were 7 times less likely to wear sunscreen compared with NHWs who reported severe sunburns.2 Through a comprehensive review on skin cancer in people of color, the American Academy of Dermatology recommended educational campaigns targeting communities of color in 2014.

To the Editor: A prior study by our group revealed that Asian Americans are significantly less likely to use sunscreen consistently compared to non-Hispanic Whites (NHW); however, other photoprotective behaviors were not evaluated.1 Therefore, this study examined shade-seeking and long-sleeved shirt use in these same groups using the 2011-2018 National Health and Nutrition Examination Survey (NHANES) data.

The path to becoming a physician is challenging, with various barriers influencing medical student and resident physician residency and fellowship training career decisions. Studies comparing perceived obstacles at disparate training levels are limited and given these obstacles are dynamic, studies are frequently needed to evaluate perceived barriers to pursuing residency specialty or fellowship of interest for physician trainees.To evaluate and compare perceived barriers to obtaining residency specialty or fellowship of choice for medical students and resident physicians, respectively.A Likert scale survey assessing perceived barriers was administered via the listservs of medical schools and organizations in 2021. Differences in the Likert scale score mean between medical students and resident physicians were measured with student t-tests (2-sided).A total of 404 medical trainees participated (301 medical students and 103 resident physicians). Medical students indicated lack of opportunity to obtain alpha omega alpha membership as the most crucial perceived barrier (mean Likert scale score &plusmn; standard deviation, 4.01&plusmn;1.97), followed by USMLE Step 1 score (3.92&plusmn;1.89) and lack of home program in specialty/fellowship of interest (3.62&plusmn;1.85). Similarly, resident physicians implicated the lack of a home program in a specialty/fellowship of interest as the most prominent barrier (3.48&plusmn;1.78), followed by lack of connections/networking (3.17&plusmn;1.50) and probability of matching (3.14&plusmn;1.44).The lack of a home program was an important barrier to pursuing a specialty or fellowship of choice for both medical students and resident physicians, respectively, and may have been heightened during the COVID-19 pandemic. J Drugs Dermatol. 2023;22(11):e17-e20&nbsp; &nbsp; doi:10.36849/JDD.7005e.

The study aimed to compare barriers perceived by medical students and resident physicians identifying as of underrepresented groups in medicine (UIM) and/or as sexual and gender minorities (SGM) to individuals not identifying with these groups, especially for trainees with an interest in dermatology.Cross-sectional survey of medical students and resident physicians based in the United States from February 2021 to July 2021, with subgroup analysis of trainees with interest in dermatology.Among trainees interested in dermatology, the most notable barriers for the UIM group were 1) lack of home program in specialty/fellowship of interest (4.71&plusmn;1.73); 2) lack of connections/networking opportunities (4.14&plusmn;1.29); 3) lack of opportunity to obtain AOA membership (4.00&plusmn;1.96); 4) obtaining mentorship (4.00&plusmn;1.47); and lack of diversity in specialty/fellowship of interest (3.93&plusmn;1.14).Increasing focused mentorship programs and fostering environments that embrace diversity are key to reducing perceived barriers for minority candidates. J Drugs Dermatol. 2023;22(12):1210-1215. doi:10.36849/JDD.7528R1.

To the Editor: We read with great interest Male Balding is a Major Risk Factor for Severe COVID-19 by Lee et al1 regarding androgenic alopecia as a risk factor for COVID-19 severe symptomatology. A recent study by Wambier et al2 observed similar findings regarding androgenic alopecia and COVID-19. Yet, the relationship between scalp health, androgenic alopecia, and COVID-19 has not been explored. We examined the current, yet limited, literature regarding the role of the scalp in preventing transmission of COVID-19.

Journal of the European Academy of Dermatology and VenereologyVolume 35, Issue 6 p. e375-e377 Letter to the Editor Association between atopic dermatitis and osteoarthritis among US adults in the 1999–2006 NHANES J. Liu, J. Liu orcid.org/0000-0003-3106-785X Keck School of Medicine, University of Southern California, Los Angeles, CA, USASearch for more papers by this authorA. Martin, A. Martin School of Medicine, University of California Riverside, Riverside, CA, USASearch for more papers by this authorA. Thatiparthi, A. Thatiparthi orcid.org/0000-0001-8344-9011 Western University of Health Sciences, Pomona, CA, USASearch for more papers by this authorJ.J. Wu, Corresponding Author J.J. Wu jashinwu@gmail.com orcid.org/0000-0002-1722-1892 Dermatology Research and Education Foundation, Irvine, CA, USA Correspondence: J.J. Wu. E-mail: jashinwu@gmail.comSearch for more papers by this author J. Liu, J. Liu orcid.org/0000-0003-3106-785X Keck School of Medicine, University of Southern California, Los Angeles, CA, USASearch for more papers by this authorA. Martin, A. Martin School of Medicine, University of California Riverside, Riverside, CA, USASearch for more papers by this authorA. Thatiparthi, A. Thatiparthi orcid.org/0000-0001-8344-9011 Western University of Health Sciences, Pomona, CA, USASearch for more papers by this authorJ.J. Wu, Corresponding Author J.J. Wu jashinwu@gmail.com orcid.org/0000-0002-1722-1892 Dermatology Research and Education Foundation, Irvine, CA, USA Correspondence: J.J. Wu. E-mail: jashinwu@gmail.comSearch for more papers by this author First published: 04 February 2021 https://doi.org/10.1111/jdv.17147Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume35, Issue6June 2021Pages e375-e377 RelatedInformation

Trends in phototherapy utilization including its main clinical indications were last characterized by Luersen et al. for the time period of 1997-2010. In this study, we update data on the use of phototherapy in the United States from 2015 to 2018.We queried the National Ambulatory Medical Care Survey (NAMCS) data on the number of phototherapy visits as well as demographics and associated dermatoses.There were approximately 1.31 million outpatient phototherapy visits during the study period with a decreasing trend over time. Leading indications for phototherapy were dermatitis not otherwise specified (NOS), (25.7%) followed by atopic dermatitis (AD) (11.7%), and pruritus (9.7%).There is a downtrend in the use of phototherapy from 2015 to 2018. Psoriasis is no longer the main indication for phototherapy, which may be due to the advent of highly effective novel biologics.

To the Editor: Rheumatoid arthritis (RA) and psoriasis are chronic immune-mediated diseases, with resulting cutaneous and joint manifestations.1Coates L.C. FitzGerald O. Helliwell P.S. Paul C. Psoriasis, psoriatic arthritis, and rheumatoid arthritis: is all inflammation the same?.Semin Arthritis Rheum. 2016; 46: 291-304Crossref PubMed Scopus (119) Google Scholar These diseases have similar comorbidity profiles, with overlapping therapeutic options.1Coates L.C. FitzGerald O. Helliwell P.S. Paul C. Psoriasis, psoriatic arthritis, and rheumatoid arthritis: is all inflammation the same?.Semin Arthritis Rheum. 2016; 46: 291-304Crossref PubMed Scopus (119) Google Scholar In 2012, a retrospective cohort study of 25,341 patients with psoriasis reported a strong association between psoriasis and RA (odds ratio 3.6).2Wu J.J. Nguyen T.U. Poon K.Y.T. Herrinton L.J. The association of psoriasis with autoimmune diseases.J Am Acad Dermatol. 2012; 67: 924-930Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar More recently, analyses of the Korean National Health Insurance claims database demonstrated an increase of 1.95 in the odds of RA in individuals with psoriasis.3Ju H.J. Kim K.J. Kim D.S. et al.Increased risks of autoimmune rheumatic diseases in patients with psoriasis: a nationwide population-based study.J Am Acad Dermatol. 2018; 79: 778-781Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar However, this relationship is yet to be explored in a nationally representative population in the United States. Therefore, we aimed to investigate the association between RA and psoriasis using the 2009-2014 National Health and Nutrition Examination Survey, which employs a complex multistage sampling design to obtain estimates representative of the population in the United States. The National Health and Nutrition Examination Survey is administered by trained interviewers using a computer-assisted personal interview system. The psoriasis status was ascertained by asking the following question: “Have you ever been told by a doctor or other healthcare professional that you had psoriasis?” Participants with RA were identified based on their responses to the following questions: “Has a doctor or other healthcare professional ever told you that you had arthritis?” and “Which type of arthritis was it?” Of 17,547 participants aged ≥20 years, data on the RA and psoriasis status were available in 16,066, who were then included in the analyses. Since data on the psoriasis or RA status were missing in <10% of adults, according to the National Health and Nutrition Examination Survey analytic guidelines, no adjustments for the missing data were required. A multivariable logistic regression model was constructed with RA as a dependent variable and psoriasis as an independent variable. Sex, age, ethnicity or race, body mass index, tobacco use, and income were added to adjust the model. Approximately 8.1% of subjects with psoriasis reported a history of RA compared with 4.0% of subjects without psoriasis (Table I). Multivariate analyses revealed that adults with psoriasis are more likely to have RA than adults without psoriasis (adjusted odds ratio 1.94, 95% CI 1.27-2.97, P = .003). In age subgroup analyses, the point estimate was higher for participants aged 20-49 years (adjusted odds ratio 2.82, 95% CI 1.23-6.44) than for those aged ≥50 years (adjusted odds ratio 1.64, 95% CI 0.99-2.74); however, the 95% CIs were overlapping (Table II).Table ICharacteristics of US adults (aged ≥ 20 years) in the 2009-2014 NHANESCharacteristic∗1481/17,547 (8.4%) subjects aged ≥20 years with missing psoriasis and/or RA data were excluded from the analysis.Psoriasis-yes, n/N (weighted percentage)†Weighted percentage was calculated using NHANES survey design parameters.Psoriasis-no, n/N (weighted percentage)†Weighted percentage was calculated using NHANES survey design parameters.P valueHistory of RA Yes47/438 (8.1)772/15,628 (4.0).0002 No391/438 (91.9)14,856/15,628 (96.0)Sex Male210/438 (47.9)7653/15,628 (48.5).8356 Female228/438 (52.1)7975/15,628 (51.5)Mean age ± SD, y49.87 ± 13.4446.31 ± 14.63.0010Mean BMI ± SD, kg/m2‡Missing for 713 subjects.29.51 ± 5.8128.73 ± 5.91.0760Ethnicity or race NHW258/438 (79.7)6587/15,628 (66.2)<.0001 Mexican American/other Hispanic79/438 (8.8)3752/15,628 (14.6) NHB47/438 (5.1)3298/15,628 (11.3) Other race or multiracial54/438 (6.4)1991/15,628 (7.9)Annual household income§Missing for 800 subjects. <$20,000100/419 (16.0)3234/14,847 (15.0).5227 ≥$20,000319/419 (84.0)11613/14,847 (85.0)History of tobacco use‖History of tobacco use assessed by the question “Have you smoked at least 100 cigarettes in your entire life?”,¶Missing for 7 subjects. Yes237/438 (55.8)6727/15,621 (43.0).0001 No201/438 (44.2)8894/15,621 (57.0)Values that are statistically significant (2-sided P value ≤ .05) are bolded.BMI, Body mass index; NHANES, National Health and Nutrition Examination Survey; NHB, non-Hispanic Black; NHW, non-Hispanic White; RA, rheumatoid arthritis; SD, standard deviation; US, United States.∗ 1481/17,547 (8.4%) subjects aged ≥20 years with missing psoriasis and/or RA data were excluded from the analysis.† Weighted percentage was calculated using NHANES survey design parameters.‡ Missing for 713 subjects.§ Missing for 800 subjects.‖ History of tobacco use assessed by the question “Have you smoked at least 100 cigarettes in your entire life?”¶ Missing for 7 subjects. Open table in a new tab Table IIAssociation between psoriasis and RA in US adults (aged ≥ 20 years) from the 2009-2014 NHANESPsoriasis statusRA, n/N (weighted percentage)∗Weighted percentage was calculated using NHANES survey design parameters.Crude OR (95% CI)P valueAdjusted OR (95% CI)†Adjusted for sex, age, history of tobacco use, BMI, annual household income, and ethnicity or race.P valueParticipants aged ≥20 y No772/15,628 (4.0)1.00 (reference)<.00011.00 (reference).003 Yes47/438 (8.1)2.13 (1.44-3.16)1.94 (1.27-2.97)Subgroup analysis of participants aged 20-49 y No153/8566 (1.9)1.00 (reference).0031.00 (reference).015 Yes14/199 (5.8)3.28 (1.53-7.04)2.82 (1.23-6.44)Subgroup analysis of participants aged ≥50 y No619/7062 (6.9)1.00 (reference).0861.00 (reference).057 Yes33/239 (10.1)1.52 (0.94-2.47)1.64 (0.99-2.74)Values that are statistically significant (2-sided P value ≤ .05) are bolded.BMI, Body mass index; NHANES, National Health and Nutrition Examination Survey; OR, odds ratio; RA, rheumatoid arthritis; US, United States.∗ Weighted percentage was calculated using NHANES survey design parameters.† Adjusted for sex, age, history of tobacco use, BMI, annual household income, and ethnicity or race. Open table in a new tab Values that are statistically significant (2-sided P value ≤ .05) are bolded. BMI, Body mass index; NHANES, National Health and Nutrition Examination Survey; NHB, non-Hispanic Black; NHW, non-Hispanic White; RA, rheumatoid arthritis; SD, standard deviation; US, United States. Values that are statistically significant (2-sided P value ≤ .05) are bolded. BMI, Body mass index; NHANES, National Health and Nutrition Examination Survey; OR, odds ratio; RA, rheumatoid arthritis; US, United States. Because of the self-reported nature of the data, the potential for patient misreporting of psoriatic arthritis as RA deserves mention; however, the survey items were carefully worded to minimize bias. Our results support the findings by Wu et al2Wu J.J. Nguyen T.U. Poon K.Y.T. Herrinton L.J. The association of psoriasis with autoimmune diseases.J Am Acad Dermatol. 2012; 67: 924-930Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar and Ju et al3Ju H.J. Kim K.J. Kim D.S. et al.Increased risks of autoimmune rheumatic diseases in patients with psoriasis: a nationwide population-based study.J Am Acad Dermatol. 2018; 79: 778-781Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar suggesting an association between psoriasis and RA in adults in the United States. This association may be attributed to a similar pathophysiology, with tumor necrosis factor-alpha and interleukin 17 implicated in both the disorders.1Coates L.C. FitzGerald O. Helliwell P.S. Paul C. Psoriasis, psoriatic arthritis, and rheumatoid arthritis: is all inflammation the same?.Semin Arthritis Rheum. 2016; 46: 291-304Crossref PubMed Scopus (119) Google Scholar,4Gaffen S.L. The role of interleukin-17 in the pathogenesis of rheumatoid arthritis.Curr Rheumatol Rep. 2009; 11: 365-370Crossref PubMed Scopus (162) Google Scholar Interestingly, tumor necrosis factor-alpha inhibitors have been reported to paradoxically induce and/or worsen psoriasis, most commonly, in individuals with RA or Crohn disease.5Brown G. Wang E. Leon A. et al.Tumor necrosis factor-α inhibitor-induced psoriasis: systematic review of clinical features, histopathological findings, and management experience.J Am Acad Dermatol. 2017; 76: 334-341Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar The detrimental consequences of both the diseases, including physical disability, psychologic distress, and the risk of major adverse cardiovascular events, may be higher for individuals with both the diseases than for those with either of the diseases alone.1Coates L.C. FitzGerald O. Helliwell P.S. Paul C. Psoriasis, psoriatic arthritis, and rheumatoid arthritis: is all inflammation the same?.Semin Arthritis Rheum. 2016; 46: 291-304Crossref PubMed Scopus (119) Google Scholar Consequently, the prompt and effective treatment of both the diseases is critical for patients with concomitant psoriasis and RA. Prospective studies are needed to determine if psoriasis and/or RA disease course differs in individuals with both the diseases and to identify the optimal treatment choices for these patients. Dr Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Dr. Reddy's Laboratories, Eli Lilly, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Regeneron, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, Valeant Pharmaceuticals North America LLC, and Zerigo Health. Authors Martin, Thatiparthi, and Liu have no conflicts of interest to declare.

Martin, Amylee BS; Nguyen, Cristina MD, MSBS, MHA; Sung, Calvin T. MD, MBA; Mesinkovska, Natasha Atanaskova MD, PhD Author Information

We sought to determine the risk of contracting coronavirus disease (COVID-19) in individuals with alopecia areata (AA) compared to individuals without AA.We queried the Symphony Health-derived data from the COVID-19 Research Database, and individuals with a diagnosis of AA from 2019 to 2020 were included in the AA cohort. Subjects with no record of AA diagnosis from 2019 to 2020 were randomly placed in the control group in a 4:1 size ratio compared with the AA group. Laboratory-confirmed cases of COVID-19 between January 1, 2020, and September 1, 2021, were identified.The AA and non-AA cohorts included 73,784 and 280,991 subjects, respectively. The COVID-19 incidence rate ratio (IRR) for adults with AA was 0.72 (95% CI 0.68, 0.76) compared with adults without AA (p<0.001). Within the AA cohort, moderate-severe AA showed a similar decreased risk in COVID-19 infection compared to mild AA.This study is limited by its retrospective nature and the use of ICD-10 codes for the identification of individuals with AA and COVID-19, which may underestimate the true burden of disease.Individuals with AA have a slightly decreased risk of contracting COVID-19. Notably, it has been demonstrated that interferon-gamma (IFN- γ) leads to the downregulation of the angiotensin-converting enzyme 2 (ACE2), the SARS-CoV receptor.1 Thus, it is possible that increased levels of IFN- γ seen in individuals with AA confer some protection against this viral infection.

To the Editor: We appreciate the interest of Ya et al1Ya Y.C. Chen S.P. Wei J.C.C. Correspondence to “Association between psoriasis and asthma among United States adults in the 2009-2014 national health and nutrition examination survey”.J Am Acad Dermatol. 2022; 86: e117https://doi.org/10.1016/j.jaad.2021.06.899Google Scholar regarding our article “Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.”2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar The authors highlight potential covariates to add to our multivariable logistic regression models. Additionally, they recommend further discussion of the subgroup analyses of obese and nonobese participants. Lastly, they address asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS) and discuss dysregulation of the interleukin (IL) 23/Th17 axis in both asthma and psoriasis.2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar We agree that adding air pollution, family history of asthma, and history of atopy as covariates to the models would further strengthen our study and we thank the authors for their recommendations. However, these variables are not available in the 2009-2014 National Health and Nutrition Examination Survey data. Notably, participants were asked “During the past 12 months, have you had an episode of hay fever?” in these cycles. However, this question does not specifically ask if hay fever was diagnosed by a health care professional and only questions participants about hay fever symptoms within the last year. As such, we do not believe data from this question are reliable enough to properly assess atopic history. Although oral corticosteroids are not generally recommended for treatment of psoriasis due to the risk of flaring with reduction or withdrawal, there is no strong evidence to suggest systemic steroid exposure poses risk of new-onset psoriasis.3Mrowietz U. Domm S. Systemic steroids in the treatment of psoriasis: what is fact, what is fiction?.J Eur Acad Dermatol Venereol. 2013; 27: 1022-1025https://doi.org/10.1111/J.1468-3083.2012.04656.XGoogle Scholar Thus, oral corticosteroids are unlikely to account for a higher prevalence of asthma in adults with psoriasis compared to adults without psoriasis. After adding 25-hydroxyvitamin D levels to the model, the adjusted odds ratio from the primary analyses remained unchanged, indicating this vitamin level is not an important covariate when evaluating the association between asthma and psoriasis. Although subgroup analysis of nonobese participants yielded a higher adjusted odds ratio point estimate compared to subgroup analysis of obese participants, results from an adjusted Wald test (P = .40) suggest the adjusted odds ratio are not significantly different between the 2 groups. Subgroup analysis and full sample analysis are expected to have consistent inferences. Therefore, it is encouraged to use full-sample–based inferences over subgroup-based inferences, which are of lower power and require testing to determine if mean trends are significantly different. We concur that it may be difficult to differentiate isolated asthma from ACOS in certain clinical scenarios. Furthermore, ACOS is a poorly defined entity with evolving diagnostic criteria, making ACOS challenging to assess in epidemiology studies.4Cosío B.G. Dacal D. de Llano L.P. Asthma–COPD overlap: identification and optimal treatment.Ther Adv Respir Dis. 2018; 12 (1753466618805662)https://doi.org/10.1177/1753466618805662Google Scholar Ya et al2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar correctly highlight that our study was limited by the use of questionnaire data. However, the National Health and Nutrition Examination Survey specifically asks subjects if chronic bronchitis and emphysema were diagnosed by a health care professional, who are likely utilizing spirometry to diagnose these diseases, as it is a cornerstone of chronic obstructive pulmonary disease evaluation. Besides promoting Th17 cells, which drive neutrophil recruitment frequently seen in lungs of patients with severe asthma, IL 23 has been shown to mediate Th2 cytokines production and eosinophil infiltration, independent of IL-17.5Li Y. Hua S. Mechanisms of pathogenesis in allergic asthma: role of interleukin-23.Respirology. 2014; 19: 663-669https://doi.org/10.1111/RESP.12299Google Scholar Consequently, as Ya et al2Martin A. Thatiparthi A. Liu J. Ge S. Egeberg A. Wu J.J. Association between psoriasis and asthma among United States adults in the 2009-2014 National Health and Nutrition Examination Survey.J Am Acad Dermatol. 2021; 18https://doi.org/10.1016/j.jaad.2021.04.027Google Scholar suggested, IL-17 and IL-23 warrant further attention as a potential link between asthma and psoriasis. Dr Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Dr. Reddy's Laboratories, Eli Lilly, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Regeneron, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, Valeant Pharmaceuticals North America LLC, and Zerigo Health. Dr Egeberg has received research funding from Pfizer , Eli Lilly , Novartis , Bristol-Myers Squibb , AbbVie , Janssen Pharmaceuticals , the Danish National Psoriasis Foundation , the Simon Spies Foundation , and the Kgl Hofbundtmager Aage Bang Foundation , and honoraria as consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals. Authors Martin, Thatiparthi, and Liu, and Dr Ge have no conflicts of interest to declare. Correspondence to “Association between psoriasis and asthma among United States adults in the 2009-2014 national health and nutrition examination survey”Journal of the American Academy of DermatologyVol. 86Issue 3PreviewTo the Editor: We read with immense interest the article by Martin et al and believe a few matters could be addressed. First, models in this study were adjusted by age, sex, ethnicity, income, body mass index, tobacco use, and chronic obstructive pulmonary disease. We suggest adding confounders, such as air pollution, atopy, asthma family history and steroid use, as these were found to be strong confounders in our previous study.1 Vitamin D3 levels have been significantly linked to psoriasis2 and asthma. Full-Text PDF

Since the advent of biologic treatments for psoriasis in the early 2000s, this class of medicines has proven to be a safe and effective therapeutic option in the treatment of moderate-to-severe psoriasis. Numerous biologic treatment options have been developed in the past 20 years, allowing for tailored treatment regimens for psoriasis in special populations, which will be the focus of this chapter. Specifically, this section will focus on treatment algorithms in the following groups: pregnant and breastfeeding patients, human immunodeficiency virus-positive patients, patients with a history of nonmelanoma skin cancer and lymphoma, patients undergoing surgery, and geriatric patients. Additionally, an upcoming precision medicine tool meant to guide clinicians in selecting biologics for psoriasis treatment will be discussed.

Although biologics are highly effective in the treatment of psoriasis, some patients consistently fail monotherapy. For these patients, combination therapy is commonly employed. However, evidence-based recommendations for combination therapy in the treatment of psoriasis with interleukin-17 (IL-17) inhibitors are currently lacking. Therefore, we aimed to conduct a systematic review of existing literature discussing the efficacy and safety of IL-17 inhibitors in combination with other therapeutic modalities in the treatment of psoriasis.By way of a search of PubMed, Cochrane, and Web of Science databases in March 2021, we identified peer-reviewed articles with data on the safety and/or efficacy of IL-17 inhibitor combination therapies in adults with psoriasis and/or psoriatic arthritis (PsA). A modified version of the 2011 Oxford Centre for Evidence-Based Medicine Scheme was utilized for assessing study quality.Twenty-four articles with a total of 3,154 patients met inclusion/exclusion criteria. These articles comprised six post-hoc/subgroup analyses of randomized controlled trials (RCTs), four uncontrolled clinical trials, three case series, and 11 case reports that provided data on IL-17 inhibitor therapy in combination with conventional disease-modifying antirheumatic drugs (cDMARDs), apremilast, acitretin, topical therapy, phototherapy, and/or medications for comorbid diseases.Our results are limited by the lack of data from RCTs.Although cDMARDs are often used in psoriasis combination therapies, the current literature suggests concomitant cDMARDs with IL-17 inhibitor therapy provides no added benefit compared to IL-17 inhibitor monotherapy. However, IL-17 inhibitor in combination with apremilast or acitretin shows efficacy and safety in case series/reports and may allow for a reduction in medication dosing and/or frequency, thereby minimizing costs and adverse events. Future RCTs investigating IL-17 inhibitor therapy in combination with acitretin or apremilast are warranted.

Data from the program director survey of the National Resident Matching Program offer key insights into the 2021 dermatology application process. 1,2Examination of data from the 2020 (N=12) and 2021 (N=17) program director survey regarding interviewing applicants revealed that specialty-specific letters of recommendation (LORs), personal prior knowledge of an applicant, and personal statement increased in importance by 17%, 7.4%, and 17%, respectively, whereas away rotations within the department decreased in importance by 44.9% (Table ). 1,2terestingly, for ranking applicants, programs decreased their emphasis on specialty-specific LORs by 25.8% and away rotations within the department by 22.7% and increased emphasis on personal statements by 14.7% and personal prior knowledge of an applicant by 0.8% from 2020 to 2021 (Table ). 1,2These findings align with the prior recommendation to limit away rotations; data are contradictory-when comparing factors for interviewing as compared to ranking applicantsfor specialty-specific LORs.We further compared data from the otolaryngology cycle, which implemented preference signaling by which an applicant can signal their interest in a particular residency program in the 2021 Match, to data from dermatology with no preference signaling.A 90% probability of matching is estimated to require approximately 8 or 9 interviews for dermatology or 12 interviews for otolaryngology for MD senior students in 2020. 4In prior dermatology application cycles, the most highly qualified candidates constituted 7% to 21% of all applicants but were estimated to receive half of all interviews, causing a maldistribution of interviews. 5,6or the 2021 otolaryngology match, the Society of University Otolaryngologists implemented a novel preference signaling system that allowed candidates to show interest in programs by sending 5 preferences, or tokens. 7

Free open access data sources are a valuable tool for dermatology researchers and may uncover crucial information about dermatological diseases and delivery of dermatological care. This short review discusses six open access data sources including: National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), National Survey of Children's Health (NSCH), National Ambulatory Medical Care Survey (NAMCS)/National Hospital Ambulatory Medical Care Survey (NHAMCS), Centers for Medicare and Medicaid Services (CMS), and Gene Expression Omnibus (GEO). We explain the role of each data source in dermatology and provide examples of past studies, which have used these data repositories.

Nkomiso Tsalwa leri I ndzavisiso wa mavonelo, vutivi, matitwelo na ku pfumela ka vantshwa eka ku pfariwa ka tiko hi kwalaho ka xitsongwa-tsongwana xa Covid-19. Xikongomelo xa ndzavisiso lowu iku hoxa xandla—ku suka eka tlhelo ra tidyondzo ta ximunhu na ku hlanganela ka vanhu—kuya eka ku humelela loku anameke ka ku lwisana na Covid-19. Maendleno ya hina iku hlamusela mahungu ya Covid-19 ku suka eka lava vulavuleke timhaka ta vona, tlhandla ka mbirhi, ku veka erivaleni hiku katsakanya kumbe ha rinwe-ha-rinwe ra mahungu ya vanhu lava va nga va xiphemu xa ndzavisiso lowu. Mavekelo lawa ya le rivaleni ya ta katsa tinxaka to hundza rinwe ta mitirho, xikombiso, ta miehleketo, ta ku hlanganela ka vanhu na ta maehleketelelo. Tsalwa leri ari humesi njheka-njhekisano. Kambe I inhlamuselo ya mahungu yo huma eka leswi swi vuriweke. Ndzavisiso, ngopfu-ngopfu wa tidyondzo ta ximunhu no hlanganela ka vanhu awu boheka kuva wunga vi lowu tolovelekeke hikwalaho ko pfariwa ka tiko. Swipimelo swo pfariwa ka tiko hi swona swinga endla leswaku ku langutiwa eka vantshwa va vantima lava humaka eka ndhawu leyi hi kuya hi matimu yinga ya vanhu va ntima ntsena. Hikwalaho ka xivangelo lexi, ndzavisiso lowu wu ve lowunga anamangiku. Nakambe, tsalwa leri ari na xikongomelo xo engetela mavoleno, vutivi na matitwelo lama kumekeke kuva ya ri ya “vantshwa va vantima hinkwavo.” Ntsena, I ku hoxa xandla eka ku hlayiseka ka ntirho lowu tiyisisiweke eka ku humelela ka xiyimo xa xisayense lexi tshembisaka. Abstract This essay is an inquiry into the perceptions, knowledge, attitudes and beliefs of Young Black Adults towards Covid-19 and the lockdown. The motive for the inquiry is to make a contribution—from the perspective of the humanities and the social sciences—towards the success of the broad-based fight against Covid-19. Our approach is to present the narratives on Covid-19 by those who told their stories and then to present a commentary either per narrative or cumulatively. The commentary will be multidisciplinary; covering, for example, psychology, sociology and philosophy. This essay does not, therefore, present an argument. Instead, it is an interpretative commentary on the narratives. Research, especially in the humanities and the social sciences, was bound to be unusual as well as abnormal because of the lockdown restrictions. The restrictions account for the fact that only Young Black Adults in a specific historical Black township in South Africa were the point of focus. For this reason, the focus is severely limited. Accordingly, the essay bears no intention to extend the perceptions, knowledge beliefs and attitudes found in the area to all Young Black Adults. It is a contribution to the conservation of empirical material for use in propitious scientific conditions.