A message from Cynthia F. Griffith, MPAS, PA-C, JDPA Editor-in-Chief
As the seasons change and we head into spring, I begin to think of birth and the growth of new beginnings. It is often a time of hope and optimism. I sincerely hope that as the COVID-19 case numbers continue to decrease, the stressors of the pandemic will also do the same.
However, we continue to uncover evidence that social stressors and economic factors are drastically affecting patient health outcomes and quality of healthcare delivery overall. I wanted to share with you a few articles that illustrate the impact of stress, particularly on new infants and mothers.
In January 2022, Fitzpatrick et al1 described the results of their retrospective cohort analysis comparing risk of adverse pregnancy and maternal outcomes among women with and without hidradenitis suppurativa (HS). The authors concluded that HS appears to be an independent risk factor for adverse pregnancy and maternal outcomes and that this risk is influenced by comorbidities, like smoking and obesity, that may be modifiable with early identification and management.
As I read the article, I thought about my patients with HS and wondered whether some of the adverse outcomes, such as spontaneous abortion, preterm birth, gestational diabetes mellitus, gestational hypertension, and preeclampsia, might be related to social determinants of health. Could these mothers have lacked obstetric care during the prenatal period? Could an increase in inflammation seen in patients with HS affect in utero development?
Another recent article reported results from a small study of mothers in New York City conducted to answer one key question—Is maternal SARS-CoV-2 infection during pregnancy associated with infant neurobehavioral development at age 6 months?2 Interestingly, they found that birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2 infection, was associated with differences in neurodevelopment at age 6 months. Infants born during the pandemic, regardless of maternal SARS-CoV-2 status, scored significantly lower on the gross motor, fine motor, and personal-social subdomains compared with a historical cohort of infants born at the same institution.
The authors stated these results suggest COVID-19-related stress should be considered as a potential underlying mechanism, presenting another example and opportunity to further study how maternal stressors might significantly impact fetal development.
As we continue to observe the impact of stress, we uncover more evidence that social stressors and economic factors affect not only our patients’ health but also the way in which we deliver care. We are living in a time of great stress and as we know many dermatological conditions are worsened by stress. As healthcare providers, we are often the people that our patients are most likely to confide in about life’s various challenges. However, we are not immune to experiencing our own stressors. Empathy can be the first thing to wane as we battle burnout. Knowing this gives me more motivation to prioritize caring for myself so I can show up to clinic with the awareness, knowledge, and tools to help alleviate my patients’ pain and suffering in a meaningful way.
Turning the pages of this issue you will find valuable contributions from dermatology PA authors. I’m especially excited to see a case report of guttate psoriasis following COVID-19 infection by Kathryn Harrison, MMS, PA-C. This is a novel and timely case illustration of a post-COVID complication. In this issue’s Continuing Medical Education offering, Susan K. Smith, DMSc, PA-C, discusses the complexity of managing HS. She reviews physical and psychological comorbidities of HS, both of which impact patients’ quality of life, and concludes that comorbidity screening by dermatology providers is essential.
Mandy Frith, DMSc, MPAS, PA-C, presents a review of Merkel cell carcinoma (MCC), a rare, aggressive cutaneous neuroendocrine neoplasm that can be difficult to diagnose. We also have a review of cutaneous sarcoidosis by Parth S. Patel, DMSc, MPAS, PA-C, that includes a case description and table of treatment options broken down by condition severity.
JDPA Editorial Board Member and seasoned derm PA author Sara Wilchowski, MS, PA-C, provides a brief overview of utilizing Omega 3 Fatty Acids in clinic. Finally, we are pleased to debut a new journal section dedicated to highlighting clinical trials relevant to dermatology.
I hope you enjoy reading this issue and gain knowledge from the efforts of the fellow dermatology PA authors who contributed their time to write as well as the peer reviewers working behind the scenes.
I hope to see many of you at the SDPA Annual Summer Dermatology Conference, taking place June 16-19, 2022, in Austin, Texas!
1. Fitzpatrick L, Hsiao J, Tannenbaum R, Strunk A, Garg A. Adverse pregnancy and maternal outcomes in women with hidradenitis suppurativa. J Am Acad Dermatol. 2022;86(1):46-54. doi:10.1016/j.jaad.2021.06.023
2. Shuffrey LC, Firestein MR, Kyle MH, et al. Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection. JAMA Pediatr. Published online January 04, 2022. doi:10.1001/jamapediatrics.2021.5563