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• W4328049014 abstract "To the editor, Following the coronavirus disease-2019 (COVID-19) outbreak, cutaneous manifestations associated with severe acute respiratory syndrome-coronavirus-2 (SARS-Cov-2) infection have been systematically reported and classified into five forms: erythema-edema, vesicular eruptions, urticarial lesions, maculopapules, and livedo/necrosis.1 Moreover, prolonged disability and/or recurrence after the acute phase of COVID-19 is also a unique characteristic of COVID-19 and is called long COVID.2 Several studies have suggested that the pathogenesis of long COVID is associated with persistent inflammation, which leads to disorders in various organs, including skin tissue.3 Here we report the patients with unusual severe adverse events immediately after laser hair removal, who had a recent experience of COVID-19 before the irradiation of Alexandrite 755 laser (GentleLASE Pro; Candela Corp., Wayland, MA, USA). Case 1.A 19-year-old Japanese female was diagnosed with COVID-19 having a high fever and arthralgia without skin abnormalities. Fifteen days after COVID-19, she received laser epilation for the first time in our clinic. Immediately after completing treatment on the left half of her back, deleterious skin features, which are fresh, itchy, edematous erythema, appeared in the entire irradiated area (Figure 1A). To exclude the possibility of photosensitivity, a provocation test was performed 9 months after the first laser irradiation. After this test, neither the right side nor the left side in the area of the previous irradiation showed abnormalities 20 min after irradiation, indicating that the patient had no sensitivity to the Alexandrite laser. Case 2.A 21-year-old Japanese female, she had received four times laser hair removal using Alexandrite laser so far, and there were no adverse events on her skin in the first three procedures. However, in the fourth-time irradiation, compound heterogeneous skin features, which mainly consists of urticaria and erythema, appeared in 50% of the treated area immediately after laser irradiation (Figure 1B). The clinical interview revealed that she had COVID-19 with a high fever, sore throat, and severe edematous erythema on her extremities after the third procedure, 3 months before the fourth procedure. All the COVID-19 symptoms resolved without any medications after several days, and she had no skin features until the fourth laser irradiation. From July 2021 to December 2022 in our clinic, we identified five patients who developed unusual severe skin features immediately after irradiation, using our clinical records (Table 1). Surprisingly, two of these five (40%) patients had a history of COVID-19. Considering the fact that a cumulative number of about 28 million cases,4 that is, at most 20% of the total population in Japan, had been infected with SARS-CoV-2, 40% of patients having a history of COVID-19 tends to be enriched in the group of severe adverse events. It is the limitation that only a small number of cases were presented in our report. In addition to the sample size limitation, various adverse events with a variability between patients could be developed after Alexandrite laser irradiation. However, the patients had no sensitivity against Alexandrite 755 laser. We thus considered that prolonged COVID-19-mediated immune system modification might, at least partially, affect the incidence of severe adverse events after Alexandrite laser hair removal. Further case reports and clinical studies would uncover the effects of COVID-19 in laser therapy. In the interview before the procedure, all our patients reported no complaints or relevant medical history, including photosensitivity. However, their recent COVID-19 experience was not revealed. Although laser epilation is a relatively safe modality, various adverse events have been reported with laser irradiation. Since the occurrence of adverse events depends on various factors,5 a complete medical history, including infectious disease such as COVID-19, is required before laser therapy to manage possible adverse events. SH and MK designed the provocation test and wrote the manuscript with support from AN and KK. We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript. The authors declare that they have no conflict of interest. This study adhered to the Declaration of Helsinki. Informed consent was obtained from patients." @default.
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• W4328049014 date "2023-03-21" @default.
• W4328049014 modified "2023-09-30" @default.
• W4328049014 title "Unusual severe skin features caused by Alexandrite laser irradiation after <scp>COVID</scp>‐19" @default.
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• W4328049014 doi "https://doi.org/10.1111/jocd.15733" @default.
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