Heba Sati

To evaluate the efficacy of ablative laser therapy, compared to sham laser or topical corticosteroids, or an alternative laser treatment protocol for improving symptom burden and disease severity in women with vulvar lichen sclerosus (VLS). Systematic review and meta-analysis of RCTs. PubMed, Embase, Cochrane Library, Scopus, and Web of Science were searched for RCTs evaluating fractional ablative lasers in adult women with confirmed VLS. Primary outcomes were change in patient-reported symptom burden (visual analog scale [VAS]) and objective disease severity (LS Score, Clinical Scoring System, vulvar-appearance VAS). Mean differences and standardized mean differences were pooled using a random-effects model with restricted maximum-likelihood (REML) estimation of between-study variance and Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment of confidence intervals; heterogeneity was assessed with I²; risk of bias was assessed with Cochrane RoB 2.0. Three RCTs (151 patients) evaluating fractional CO2 laser versus sham laser, topical clobetasol propionate 0.05%, or low-dose CO2 laser were included, with follow-up of 18 to 32 weeks. Laser therapy produced a non-significant reduction in VAS total (mean difference, 1.04; 95% CI, -4.71 to 6.79; P =0.52; I²=58%) and LS severity scores (standardized mean difference, -0.27; 95% CI, -1.47 to 0.94; P =0.44; I²=65%). No adverse events were reported. Current evidence from three small, short-duration RCTs does not demonstrate a statistically significant benefit of fractional ablative laser therapy for vulvar lichen sclerosus. Larger, adequately powered trials with standardized outcomes are needed before laser therapy can be recommended as primary or adjunct treatment. PROSPERO CRD420261385742. Not applicable.

Morgellons disease is characterized by the persistent delusion of skin infestation, ultimately inflicting wounds and impairing quality of life. There is insufficient and conflicting research pertaining to this condition, imposing challenges on clinicians in understanding, diagnosing, and treating it. In this review, we summarize the available literature on Morgellons disease including its historical evolution, epidemiology, proposed pathophysiology, underlying structural and functional brain pathologies, typical and atypical clinical presentations, diagnosis, and treatment. A comprehensive review of the literature was conducted on PubMed, Embase, and Scopus using specified keywords. Selected articles were screened by two independent reviewers based on set inclusion and exclusion criteria. Conflicts were resolved by a third reviewer as needed. No limit to the date of selected articles was set due to the scarce literature available on the subject. Morgellons disease is an underdiagnosed entity, owing mostly to the lack of an established pathophysiology and treatment guidelines. While many authors classify it as a type of delusional infestation (DI), others correlate MD with an underlying spirochetal infection, namely Lyme disease. Neuroimaging studies have revealed abnormalities in the “fronto-striato-thalamo-parietal network”, a finding common to patients with DI, in addition to alterations in structures related to the “Itch Processing Pathway”. Patients tend to extract fibers from their skin lesions and place them in a match box hence the term “match box sign”. The diagnosis is that of exclusion, requiring extensive work up to rule out secondary causes and differential diagnoses. Treatment is largely based on the use of antipsychotics, with or without cognitive behavioral therapy. Despite being a diagnosis of exclusion, clinicians must be aware of this entity and have a profound understanding of the pathogenesis underlying it. Upon clinical suspicion, secondary Morgellons should always be ruled out through a thorough history taking, physical examination, and laboratory exams. Despite the challenges brought by the heterogeneous presentation of the condition and the paucity of research revolving around it, the great impact that Morgellons disease has on patients’ quality of life forms a pressing need for its adequate detection, diagnosis, and treatment.

This review aims to highlight the diverse skin manifestations in children and adolescents with COVID induced multisystem inflammatory syndrome in children (MIS‐C). The symptoms of COVID‐19 can vary greatly in severity between different age groups. Although most children infected with SARS‐CoV‐2 experience either no symptoms or only mild symptoms, some reported cases of severely affected children with a clinical presentation similar to incomplete Kawasaki disease have led to the definition of a new condition called MIS‐C. MIS‐C can involve multiple organs, including the skin, and may pose a life‐threatening risk to affected children. Such cases highlight the need for continuous research into the possible skin manifestations associated with COVID‐19 in pediatric populations to aid in early diagnosis and prompt treatment. We conducted a search of PubMed, Scopus, and ScienceDirect databases for studies published up until October 1, 2022. Three reviewers independently examined each study, and a fourth reviewer resolved any disagreements. A narrative review of all relevant papers was conducted. We present an overview of the clinical presentation, pathophysiology, diagnosis, and treatment of the various skin manifestations in children and adolescents with COVID‐19 or MIS‐C. The skin manifestations of COVID‐19 and MIS‐C can be diverse and are frequently overlooked. It is important to conduct further research to better understand the impact of this disease on children to provide appropriate care for these at‐risk populations.

Food security is a major element for the sustainability, stability and development of a country. However, despite fundamental efforts in fighting poverty, Afghanistan continues to struggle with food insecurity with a large proportion of its population living below the poverty line. With extreme climates, protracted conflict, and now COVID-19, food insecurity has become rampant and is on the rise in the country. Efforts have been reinforced to mitigate this issue, but a spate of obstacles which seems not to come to an end, has contributed to the deterioration of the situation. With the collaboration and efforts of international organizations, there remains a glimmer of hope to potentially reduce the gravity of the food insecurity in the country. This paper aims to highlight the efforts of Afghanistan in alleviating food insecurity with a focus on the impact of COVID-19 on this issue. It also presents recommendations that may help ameliorate the country’s food security status during and after the pandemic.