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Atopic dermatitis, covid 19, and hand dermatitis

Most Recent Atopic Dermatitis Updates

1. J Trop Pediatr. 2021 Jan 29;67(1):fmab011. doi: 10.1093/tropej/fmab011.


Fluctuating Palmar Erythema in a Toddler during COVID-19 Pandemic: Do You Know 

the Offender?


Panda PK, Sharawat IK.


Palmar erythema in children can be due to various reasons, such as chronic liver 

disease, rheumatological disorders, medications, irritant contact dermatitis and 

atopic dermatitis. Recently, there are few reports about contact dermatitis 

caused by frequent, daily use of hand sanitizers during this COVID-19 pandemic. 

A 3-year-old toddler brought with the concern of waxing-waning bilateral palmar 

erythema for the past 2 weeks. The parents revealed that the child liked the 

bright color of a recently bought hand sanitizer bottle so much he used to wash 

his hands every 20-30 min throughout the day. The atypical presentation of 

contact dermatitis might be because the child was using the sanitizer more 

frequently during the daytime. The dermatitis resolved with stopping excessive 

use of the hand sanitizer by the toddler. Clinicians should be aware of contact 

dermatitis during these pandemic times. Instead of investigating them 

extensively, careful history taking and merely advising them to judicially 

utilize the sanitizer can lead to complete reversal of symptoms.


© The Author(s) [2021]. Published by Oxford University Press. All rights 

reserved. For permissions, please email: journals.permissions@oup.com.


DOI: 10.1093/tropej/fmab011

PMID: 33620073



2. Dermatol Ther. 2021 Feb 22:e14911. doi: 10.1111/dth.14911. Online ahead of 

print.


DECISA Project (DErmatology Clinics in Italy: Survey on Alitretinoin): a 

real-life retrospective cohort multicentre study on 438 subjects with chronic 

hand eczema.


Ferrucci S(1), Persichini P(1), Gola M(2), Scandagli I(2), Pigatto P(3), Legori 

A(3), Musumeci ML(4), Micali G(4), D'Agata E(4), Schena D(5), Azzolini A(5), 

Gallo R(6), Trave I(6), Cristaudo A(7), Patruno C(8), Napolitano M(9), Zucca 

M(10), Piras V(11), Stingeni L(12), Bianchi L(12), Corazza M(13), Zedde P(13), 

Foti C(14), Romita P(14), Cannavò SP(15), Guarneri F(15).


Author information:

(1)U.O.C. Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore 

Policlinico Milano, Milan, Italy.

(2)SAS di Dermatologia Allergologica e Professionale - AUSL Toscana Centro e 

Università degli Studi di Firenze, Florence, Italy.

(3)UO Dermatologia IRCCS Ospedale Galeazzi & Università degli Studi di Milano, 

Milan, Italy.

(4)Dermatology Clinic, University of Catania, PO G. Rodolico, AOU 

Policlinico-Vittorio Emanuele, Catania, Italy.

(5)Section of Dermatology and Venereology, Department of Medicine, University of 

Verona, Verona, Italy.

(6)Clinica Dermatologica - DISSAL, Università di Genova e Ospedale Policlinico 

San Martino - IRCCS, Genoa, Italy.

(7)UOSD Dermatologia MST, Ambientale, Tropicale e Immigrazione Istituto 

Dermatologico San Gallicano (IRCCS), Rome, Italy.

(8)Unit of Dermatology, Department of Health Sciences, University Magna Graecia 

of Catanzaro, Catanzaro, Italy.

(9)Department of Health Sciences "Vincenzo Tiberio", University of Molise, 

Campobasso, Italy.

(10)Dermatologic Clinic, Hospital S.Giovanni di Dio, Cagliari, Italy.

(11)Department of Medical Sciences and Public Health, University of Cagliari, 

Cagliari, Italy.

(12)Dermatology Section, Department of Medicine, University of Perugia, Italy.

(13)Sezione di Dermatologia, Dipartimento di Scienze Mediche, Università di 

Ferrara, Ferrara, Italy.

(14)Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica 

Dermatologica, Policlinico di Bari, Bari, Italy.

(15)Dipartimento di Medicina Clinica e Sperimentale - Dermatologia, Università 

di Messina, Messina, Italy.


Alitretinoin is the only systemic agent approved to treat moderate-severe 

chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. No 

nationwide Italian data regarding real-life efficacy, safety, and tolerability 

of treatment are available. The DECISA project (DErmatology Clinics in Italy: 

Survey on Alitretinoin) retrospectively examined data from a registry including 

fifteen Dermatology Clinics authorized to prescription of alitretinoin for CHE 

patients. Disease severity was assessed at baseline, and after 3 and 6 months of 

treatment, using the 5-point Physician Global Assessment (PGA) and the modified 

Total Lesion-Symptoms-Severity (mTLSS) scores. Between November 2010 and July 

2018, data of 248 male and 190 female patients (mean age 49.71 ± 13.20 years) 

treated with alitretinoin were collected. Of them, 43.2% had irritant contact 

dermatitis, 22.2% allergic contact dermatitis, 18.0% atopic dermatitis, 16.7% 

mixed (irritant/allergic) type of eczema. At 3 months, the 420 re-evaluated 

patients showed significantly reduced mTLSS and PGA (P < 0.0000001 vs baseline 

for both); PGA was clear/almost clear in 35.6% of cases. At 6 months, the 341 

re-evaluated patients showed significant (P < 0.0000001) improvement of mTLSS 

and PGA vs baseline and 3 months (PGA clear/almost clear: 41.4%). Relapses 

occurred in 125 patients; 58 underwent an additional course of alitretinoin, 

with similarly good results. No relevant safety issues were reported; 86 

patients experienced adverse effects, which forced 40 to prematurely stop 

treatment. The DECISA project results confirm the real-life efficacy, safety and 

tolerability of alitretinoin in the treatment of moderate to severe CHE 

refractory to standard topical therapies. This article is protected by 

copyright. All rights reserved.


This article is protected by copyright. All rights reserved.


DOI: 10.1111/dth.14911

PMID: 33619833



3. Nat Med. 2021 Feb 22. doi: 10.1038/s41591-021-01256-2. Online ahead of print.


Development of a human skin commensal microbe for bacteriotherapy of atopic 

dermatitis and use in a phase 1 randomized clinical trial.


Nakatsuji T(1), Hata TR(1), Tong Y(1), Cheng JY(1), Shafiq F(1), Butcher AM(1), 

Salem SS(1), Brinton SL(1), Rudman Spergel AK(2), Johnson K(3), Jepson B(3), 

Calatroni A(3), David G(3), Ramirez-Gama M(4), Taylor P(4), Leung DYM(4), Gallo 

RL(5).


Author information:

(1)Department of Dermatology, University of California, San Diego, La Jolla, CA, 

USA.

(2)Division of Allergy, Immunology and Transplantation, National Institute of 

Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 

USA.

(3)Rho Federal Systems Division, Inc., Durham, NC, USA.

(4)Division of Allergy and Immunology, Department of Pediatrics, National Jewish 

Health, Denver, CO, USA.

(5)Department of Dermatology, University of California, San Diego, La Jolla, CA, 

USA. rgallo@health.ucsd.edu.


Staphylococcus aureus colonizes patients with atopic dermatitis (AD) and 

exacerbates disease by promoting inflammation. The present study investigated 

the safety and mechanisms of action of Staphylococcus hominis A9 (ShA9), a 

bacterium isolated from healthy human skin, as a topical therapy for AD. ShA9 

killed S. aureus on the skin of mice and inhibited expression of a toxin from S. 

aureus (psmα) that promotes inflammation. A first-in-human, phase 1, 

double-blinded, randomized 1-week trial of topical ShA9 or vehicle on the 

forearm skin of 54 adults with S. aureus-positive AD (NCT03151148) met its 

primary endpoint of safety, and participants receiving ShA9 had fewer adverse 

events associated with AD. Eczema severity was not significantly different when 

evaluated in all participants treated with ShA9 but a significant decrease in S. 

aureus and increased ShA9 DNA were seen and met secondary endpoints. Some S. 

aureus strains on participants were not directly killed by ShA9, but expression 

of mRNA for psmα was inhibited in all strains. Improvement in local eczema 

severity was suggested by post-hoc analysis of participants with S. aureus 

directly killed by ShA9. These observations demonstrate the safety and potential 

benefits of bacteriotherapy for AD.


DOI: 10.1038/s41591-021-01256-2

PMID: 33619370



4. J Am Pharm Assoc (2003). 2021 Feb 19:S1544-3191(21)00002-9. doi: 

10.1016/j.japh.2021.01.001. Online ahead of print.


Analysis of prior authorization success and timeliness at a community-based 

specialty care pharmacy.


Hecht B, Frye C, Holland W, Holland CR, Rhodes LA, Marciniak MW.


BACKGROUND: Specialty medications may require a prior authorization (PA) before 

a patient can access the medication. Providers often identify PA approval as a 

burden for the practice. Pharmacists can facilitate the completion of the PA 

process.

OBJECTIVE: The primary objective was to evaluate the time to first PA decision 

(approval or denial) for dermatologic medications dispensed by a community-based 

specialty pharmacy. A secondary objective was to compare PA timeliness (time to 

PA approval and time to first medication fill) between a community-based 

specialty pharmacy and a dermatology provider office.

PRACTICE DESCRIPTION: Realo Specialty Care is a community-based independent 

specialty pharmacy that provides comprehensive care to patients with complex and 

chronic conditions such as plaque psoriasis, hidradenitis suppurativa, and 

atopic dermatitis. Pharmacy services include PA assistance, comprehensive 

medication management, patient education, and adherence monitoring.

PRACTICE INNOVATION: Pharmacy dispensing system data were used to conduct a 

retrospective analysis of the effectiveness at resolving PA requests. PAs are 

traditionally completed by a provider's practice, and data are documented within 

the pharmacy system as a PA task.

EVALUATION METHODS: Data included PA tasks for dermatology prescriptions for 

patients aged 18 years or older between January 1, 2017, and June 30, 2019. 

Initial receipt of the prescription, PA decision, and PA decision date were 

noted in the PA task and confirmed via fax documentation. The date of first fill 

was confirmed by prescription data.

RESULTS: The pharmacy completed 677 PA tasks with a mean time to PA decision of 

1.9 days, whereas the provider's office averaged 20.9 days (P < 0.001). The 

pharmacy demonstrated a mean time to first fill of 6.6 days, whereas the 

provider's office averaged 16.2 days (P < 0.001).

CONCLUSION: Pharmacies can effectively complete PAs to expedite the filling 

process for patients and increase medication access. Provider practices could 

benefit from delegating these tasks to a partnered pharmacy.


Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. 

All rights reserved.


DOI: 10.1016/j.japh.2021.01.001

PMID: 33618986




5. Dermatol Pract Concept. 2021 Jan 29;11(1):e2021132. doi: 10.5826/dpc.1101a132. 

eCollection 2021 Jan.


Diet and Skin Barrier: The Role of Dietary Interventions on Skin Barrier 

Function.


Parke MA(1), Perez-Sanchez A(2), Zamil DH(1), Katta R(3).


Author information:

(1)Baylor College of Medicine, Houston, TX, USA.

(2)Internal Medicine, University of Texas Health Science Center at San Antonio, 

TX, USA.

(3)Department of Dermatology, McGovern Medical School at UTHealth, Houston TX, 

USA.


Multiple research studies have examined the role of specific dietary 

interventions and their effects on skin barrier function. The skin barrier is 

one of the body's first lines of protection against environmental insults, and 

disruption of this natural line of defense can result in xerosis, irritation, 

chronic dermatitis, and other cutaneous effects. Multiple laboratory, animal, 

and human studies have demonstrated that certain dietary interventions have the 

potential to impact skin barrier function. Measurements of skin barrier function 

include stratum corneum hydration and transepidermal water loss. In this review, 

we examine this research and provide an overview of the effects of prebiotics, 

probiotics, fatty acids, and emerging research on other substances.


©2021 Parke et al.


DOI: 10.5826/dpc.1101a132

PMCID: PMC7875671

PMID: 33614213


Conflict of interest statement: Competing interests: Rajani Katta, MD, serves on 

an advisory board for Vichy Laboratories and is the author of a book on diet and 

dermatology for the general public. The other authors have no conflicts of 

interest to disclose.



6. Dermatol Pract Concept. 2021 Jan 29;11(1):e2021118. doi: 10.5826/dpc.1101a118. 

eCollection 2021 Jan.


General Practice Registrars' Management of and Specialist Referral Patterns for 

Atopic Dermatitis.


Willems A(1)(2), Tapley A(3)(4), Fielding A(3)(4), Tng V(5), Holliday EG(3), van 

Driel ML(6), Ball JI(7), Davey AR(3)(4), FitzGerald K(8)(9), Spike NA(1)(2), 

Magin PJ(3)(4).


Author information:

(1)Eastern Victoria GP Training, General Practice Training Organisation, 

Melbourne, VIC, Australia.

(2)The University of Melbourne, Department of General Practice, Melbourne, VIC, 

Australia.

(3)The University of Newcastle, School of Public Health and Medicine, Callaghan, 

NSW, Australia.

(4)GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation 

Unit, Newcastle, NSW, Australia.

(5)Department of Dermatology, John Hunter Hospital, Newcastle, NSW, Australia.

(6)The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, 

Brisbane, QLD, Australia.

(7)Hunter Medical Research Institute, Clinical Research Design, IT and 

Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia.

(8)University of Tasmania, School of Medicine, Hobart, TAS, Australia.

(9)General Practice Training Tasmania (GPTT), Regional Training Organisation, 

Hobart, TAS, Australia.


BACKGROUND: Atopic dermatitis (AD) is a common presentation in the general 

practice (GP) setting. Implementation of appropriate referral pathways is 

instrumental for best patient care and is an essential skill for Australian GP 

registrars.

OBJECTIVES: We aimed to explore the prevalence and associations of GP registrar 

referrals to specialists for AD management.

METHODS: A cross-sectional analysis utilizing data from the Registrar Clinical 

Encounters in Training (ReCEnT) project, an ongoing cohort study that documents 

in-consultation clinical and educational experience of Australian GP registrars. 

Registrar, patient, and consultation factors associated with referrals for AD 

were established using logistic regression.

RESULTS: A total of 2,783 registrars (96% response rate) provided data from 

381,180 consultations from 2010 to 2019. A total of 3,285 (0.55%) of 595,412 

diagnoses managed were AD, of which 222 (6.8%) resulted in referral. Of these 

referrals, 70% were to dermatologists, 17% to allergists/immunologists, and 10% 

to pediatricians. Associations of referral included registrar female gender, 

patient age, longer consultation duration; an established (rather than new) AD 

diagnosis; supervisor advice being sought; and learning goals being generated.

CONCLUSIONS: Both registrar and patient factors influence AD referral patterns. 

Registrars referred established rather than newly diagnosed AD, suggesting a 

level of comfort in initial management. Referral was associated with longer 

consultations, seeking supervisor advice, and generation of learning 

goals-suggesting these are more complex presentations and, possibly, registrar 

learning opportunities. A significant proportion of referrals were to 

non-dermatologist specialists. The implication of this for optimal patient care 

is a subject for further study.


©2021 Willems et al.


DOI: 10.5826/dpc.1101a118

PMCID: PMC7875659

PMID: 33614210


Conflict of interest statement: Competing interests: The authors have no 

conflicts of interest to disclose.



7. Oxf Med Case Reports. 2021 Feb 15;2021(2):omaa143. doi: 10.1093/omcr/omaa143. 

eCollection 2021 Feb.


Rickets and gross motor delay in a child with atopic dermatitis.


Salloum S(1), Hatcher V(2).


Author information:

(1)Department of Pediatric Hospital Medicine, Dayton Children's Hospital, 

Dayton, OH, USA.

(2)PGY-3, Dayton Children's Hospital, Dayton, OH, USA.


We report a case of a 14-month-old boy with atopic dermatitis (AD) who presented 

to our hospital with hypocalcemic tetany and gross motor delay. Further 

laboratory and imaging confirmed the diagnosis of vitamin D deficiency and 

rickets. He was breastfeeding and on a restricted diet due to presumed multiple 

food allergies. He received calcium and vitamin D supplementation which 

corrected his hypocalcemia. The patient developed Staphylococcus aureus 

bacteremia and superficial septic thrombophlebitis for which he was treated with 

antibiotics and anticoagulation. An elimination diet should be avoided in AD 

patients as true food-induced AD is rare and management should focus on optimal 

skincare. AD patients have a higher rate of S. aureus skin colonization, which 

increases their risk for infectious complications. This case also highlights the 

importance of maintaining a high index of suspicion for rickets in children with 

isolated gross motor delay, especially in those with risk factors.


© The Author(s) 2021. Published by Oxford University Press. All rights reserved. 

For Permissions, please email: journals.permissions@oup.com.


DOI: 10.1093/omcr/omaa143

PMCID: PMC7885143

PMID: 33614053



8. Front Immunol. 2021 Feb 3;11:603059. doi: 10.3389/fimmu.2020.603059. eCollection 

2020.


Regulatory T Cells Developing Peri-Weaning Are Continually Required to Restrain 

Th2 Systemic Responses Later in Life.


Knoop KA(1)(2), McDonald KG(1), Hsieh CS(1), Tarr PI(1)(3), Newberry RD(1).


Author information:

(1)Department of Internal Medicine, Washington University School of Medicine, 

St. Louis, MO, United States.

(2)Department of Immunology, Mayo Clinic, Rochester, MN, United States.

(3)Department of Pediatrics and Molecular Medicine, Washington University School 

of Medicine, St. Louis, MO, United States.


Atopic disorders including allergic rhinitis, asthma, food allergy, and 

dermatitis, are increasingly prevalent in Western societies. These disorders are 

largely characterized by T helper type 2 (Th2) immune responses to environmental 

triggers, particularly inhaled and dietary allergens. Exposure to such stimuli 

during early childhood reduces the frequency of allergies in at-risk children. 

These allergic responses can be restrained by regulatory T cells (Tregs), 

particularly Tregs arising in the gut. The unique attributes of how early life 

exposure to diet and microbes shape the intestinal Treg population is a topic of 

significant interest. While imprinting during early life promotes the 

development of a balanced immune system and protects against immunopathology, it 

remains unclear if Tregs that develop in early life continue to restrain 

systemic inflammatory responses throughout adulthood. Here, an inducible 

deletion strategy was used to label Tregs at specified time points with a 

targeted mechanism to be deleted later. Deletion of the Tregs labeled 

peri-weaning at day of life 24, but not before weaning at day of life 14, 

resulted in increased circulating IgE and IL-13, and abrogated induction of 

tolerance towards new antigens. Thus, Tregs developing peri-weaning, but not 

before day of life 14 are continually required to restrain allergic responses 

into adulthood.


Copyright © 2021 Knoop, McDonald, Hsieh, Tarr and Newberry.


DOI: 10.3389/fimmu.2020.603059

PMCID: PMC7891039

PMID: 33613522


Conflict of interest statement: RN, KK, and KM are inventors on U.S. 

Nonprovisional Application Serial No. 15/880,658 Compositions and Methods for 

Modulation of Dietary and Microbial Exposure. PT discloses a financial conflict 

of interest with MediBeacon Inc (member of their Scientific Advisory Board, 

consultant, and equity holder), is a consultant to Kallyope Inc., and is a 

potential recipient of royalties from a patent to test human gut permeability 

noninvasively. The remaining author declares that the research was conducted in 

the absence of any commercial or financial relationships that could be construed 

as a potential conflict of interest.

Atopic Dermatitis

1. Vet Dermatol. 2020 Aug 13. doi: 10.1111/vde.12873. Online ahead of print.


Measurement of serum Interleukin 34 (IL-34) and correlation with severity and 

pruritus scores in client-owned dogs with atopic dermatitis.


Gow DJ(1), Jackson H(2), Forsythe P(2), Nuttall T(1), Gow AG(1), Mellanby RJ(1), 

Hume DA(1).


Author information:

(1)R(D)SVS and The Roslin Institute, Hospital for Small Animals, The University 

of Edinburgh, Edinburgh, EH25 9RG, Scotland, UK.

(2)The Dermatology Referral Service, 528 Paisley Road West, Glasgow, G51 1RN, 

UK.


BACKGROUND: Atopic dermatitis (AD) is a common inflammatory skin disease of 

dogs. Interleukin (IL)-34 is a monocyte/macrophage growth factor, produced 

mainly by keratinocytes, that has been implicated in several human inflammatory 

conditions including human AD.

HYPOTHESIS: Canine serum IL-34 concentrations are increased in dogs with AD and 

correlate with clinical lesion and pruritus scores.

ANIMALS: Forty seven client-owned dogs diagnosed with AD and 25 healthy, 

unaffected control dogs.

METHODS AND MATERIALS: A commercially available IL-34 ELISA was optimized for 

the measurement of IL-34 in canine serum samples. Information regarding 

treatment, clinical lesion scores [Canine Atopic Dermatitis Extent and Severity 

Index, 4th iteration (CADESI-04)] and pruritus Visual Analog Score (pVAS) were 

recorded for each dog at the time of serum collection.

RESULTS: Dogs with AD had significantly increased serum IL-34 concentrations 

compared to controls. There was a significant positive correlation between IL-34 

concentrations and CADESI-04 and pVAS scores. Concentrations of IL-34 remained 

increased in dogs with AD receiving steroids or the JAK1 inhibitor, oclacitinib, 

compared to unaffected control dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE: Serum IL-34 concentrations are increased in 

dogs with AD and are correlated with clinical severity and pruritus. IL-34 may 

be a suitable candidate therapeutic target for canine AD.


Publisher: CONTEXTE: La dermatite atopique (AD) est une dermatose inflammatoire 

fréquente chez le chien. L’interleukine (IL)-34 est un facteur de croissance des 

monocytes/macrophages principalement produit par les kératinocytes, et est 

impliqué dans plusieurs maladies inflammatoires de l’homme dont la dermatite 

atopique. HYPOTHÈSES: Les concentrations sériques d’IL-34 canin sont augmentées 

chez le chien atopique et corrèlent avec les scores de lésions cliniques et de 

prurit.

SUJETS: Quarante sept chiens de propriétaires avec diagnostic d’AD et 25 chiens 

sains contrôles. MATÉRIELS ET MÉTHODES: Un test ELISA IL-34 disponible dans le 

commerce a été optimisé pour la mesure d’IL-34 des échantillons de serum de 

chien. Les données concernant le traitement, les scores clinique [Canine Atopic 

Dermatitis Extent and Severity Index, 4th iteration (CADESI-04)] et de prurit 

pVAS (pruritus Visual Analog Score) ont été enregistrés pour chaque chien au 

moment du prélèvement de serum. RÉSULTATS: Les chiens avec AD avaient des 

concentrations sériques d’IL-34 significativement plus élevées comparé aux 

contrôles. Il y avait une corrélation positive significative entre les 

concentrations d’IL-34 et les scores de CADESI-04 et pVAS. Les concentrations 

d’IL-34 restaient élevées chez les chiens atopiques recevant des corticoïdes ou 

l’inhibiteur de JAK1, l’oclacitinib, comparé aux chiens non atteints.

CONCLUSIONS ET IMPORTANCE CLINIQUE: Les concentrations sériques d’IL-34 sont 

augmentées chez les chiens atopiques et sont corrélés avec la sévérité du prurit 

et la clinique. L’IL-34 pourrait être une cible thérapeutique adaptée pour l’AD 

canine.


Publisher: INTRODUCCIÓN: la dermatitis atópica (AD) es una enfermedad cutánea 

inflamatoria común en los perros. La interlequina (IL)-34 es un factor de 

crecimiento de monocitos/macrófagos, producido principalmente por 

queratinocitos, que se ha implicado en varias afecciones inflamatorias humanas, 

incluida la AD humana. HIPÓTESIS: las concentraciones de IL-34 en suero canino 

están aumentadas en perros con AD y se correlacionan con las lesiones clínicas y 

los valores de prurito. ANIMALES: cuarenta y siete perros propiedad de clientes 

diagnosticados con AD y 25 perros de control sanos y no afectados. MÉTODOS Y 

MATERIALES: se optimizó un ELISA IL-34 disponible comercialmente para la 

medición de IL-34 en muestras de suero canino. La información sobre el 

tratamiento, los valores de lesiones clínicas (Índice de extensión y severidad 

de la dermatitis atópica canina, 4ta reevaluación (CADESI-04)) y el valor visual 

análogo del prurito (pVAS) se registraron para cada perro en el momento de la 

recolección de suero. RESULTADOS: los perros con AD presentaron un incremento 

significativo en las concentraciones séricas de IL-34 en comparación con los 

controles. Hubo una correlación positiva significativa entre las concentraciones 

de IL-34 y los valores de CADESI-04 y pVAS. Las concentraciones de IL-34 

permanecieron aumentadas en perros con AD que recibieron esteroides o el 

inhibidor de JAK1, oclacitinib, en comparación con los perros de control no 

afectados. CONCLUSIONES E IMPORTANCIA CLÍNICA: las concentraciones séricas de 

IL-34 aumentan en perros con AD y se correlacionan con la gravedad clínica y el 

prurito. IL-34 puede ser un candidato adecuado a objetivo terapéutico para la AD 

canina.


Publisher: HINTERGRUND: Die atopische Dermatitis (AD) ist eine häufige 

entzündliche Hauterkrankung bei Hunden. Interleukin (IL)-34 ist ein 

Monozyten/Makrophagen Wachstumsfaktor, der hauptsächlich von Keratinozyten 

produziert wird und bei mehreren entzündlichen Erkrankungen des Menschen wie 

auch der humanen AD eine Rolle spielt.

HYPOTHESE: Die caninen IL-34 Serumkonzentrationen sind bei Hunden mit AD erhöht 

und korrelieren mit klinischen Veränderungen und den Pruritus Werten.

TIERE: Siebenundvierzig Hunde in Privatbesitz, die mit AD diagnostiziert worden 

waren sowie 25 gesunde, nicht betroffene Kontrollhunde nahmen an der Studie 

teil.

METHODEN UND MATERIALIEN: Ein kommerziell erhältlicher IL-34 ELISA wurde für die 

IL-34 Messung in caninen Serumproben optimiert. Es wurden die Informationen in 

Bezug auf die Behandlung, die klinischen Veränderungswerte [Canine Atopic 

Dermatitis Extent and Severity Index, 4te Ausgabe (CADESI-04)] und die Pruritus 

Visual Analog Score (pVAS) für jeden Hund zum Zeitpunkt der Serumgewinnung 

festgehalten.

ERGEBNISSE: Hunde mit AD zeigten im Vergleich zu den Kontrollen signifikant 

erhöhte IL-34 Konzentrationen. Es bestand eine signifikant positive Korrelation 

zwischen den IL-34 Konzentrationen und dem CADESI-04 und den pVAS Werten. Die 

Konzentrationen von IL-34 blieben bei Hunden mit AD während der Verabreichung 

von Steroiden oder dem JAK1 Inhibitor, Oclacitinib, im Vergleich zu nicht 

betroffenen Kontrollhunden erhöht.

SCHLUSSFOLGERUNGEN UND KLINISCHE BEDEUTUNG: Die Serum IL-34 Konzentrationen sind 

bei Hunden mit AD erhöht und mit dem klinischen Schweregrad und dem Juckreiz 

korreliert. IL-34 könnte ein passender Kandidat als therapeutisches Ziel für die 

AD des Hundes sein.


Publisher: 背景: 异位性皮炎 (AD) 是犬常见的炎性皮肤病。白细胞介素 

(IL)-34是一种单核/巨噬细胞生长因子,主要由角质细胞产生,角质细胞也参与包括人AD在内的多种人类炎症。 假设: 

AD患犬的血清IL-34浓度升高,并且与临床病变和瘙痒评分相关。 动物: 诊断为AD的47只私家犬和25只健康、无症状的对照犬。 方法和材料: 

对测定犬血清IL-34的市售IL-34ELISA进行优化。采集血清时,记录每只犬的治疗信息、临床病变评分 [犬异位性皮炎程度和严重性指数,第4版 

(CADESI-04)] 和瘙痒评分 (pVAS)。 结果: 与对照组相比, 

AD患犬的血清IL-34浓度显著升高。IL-34浓度与CADESI-04、pVAS评分呈显著正相关。与无症状对照犬相比,接受类固醇或JAK1抑制剂-奥拉替尼的AD患犬,其IL-34浓度保持升高。 

结论和临床重要性: AD患犬血清IL-34浓度升高,并且与临床严重性和瘙痒相关。IL-34可能是犬AD治疗的合适备选靶点。.


Publisher: 背景: 

アトピー性皮膚炎(AD)は、犬の一般的な炎症性皮膚疾患である。インターロイキン(IL)-34は、主にケラチノサイトによって産生される単球/マクロファージ増殖因子であり、人ADを含むいくつかの人の炎症疾患に関与しているとされている。 

仮説: イヌの血清IL-34濃度は、AD犬で増加し、臨床病変および掻痒スコアと相関する。 被験動物: 

ADと診断されたクライアント所有犬47頭および健常で弛緩していない対照犬25頭。 材料と方法: 商業的に利用可能なIL-34 

ELISAが、犬血清サンプル中のIL-34の測定用に最適化された。治療に関する情報、臨床病変スコア[犬のアトピー性皮膚炎の程度と重症度指数(CADESI-04)]および掻痒性視覚アナログスコア(pVAS)は、血清採取時に各犬について記録された。 

結果: AD犬は、対照群と比較して血清IL-34濃度が大幅に増加した。 IL-34濃度とCADESI-04およびpVASスコアの間に有意な正の相関があった。 

IL-34の濃度は、罹患していない対照犬と比較して、ステロイドまたはJAK1阻害剤であるオクラシチニブを投与されているAD犬で増加したままであった。 

結論と臨床的重要性: AD犬では血清IL-34濃度が増加し、臨床的重症度と掻痒と相関している。 IL-34は犬ADの適切な候補治療標的であり得る。.


Publisher: CONTEXTO: A dermatite atópica (DA) é uma dermatopatia inflamatória 

comum de cães. A interleucina (IL) -34 é um fator de crescimento de monócitos / 

macrófagos, produzido principalmente por queratinócitos, que tem sido implicado 

em várias condições inflamatórias humanas, incluindo a DA. HIPÓTESE: As 

concentrações séricas de IL-34 canina aumentam em cães com DA e se correlacionam 

com os escores clínicos de lesões e prurido.

ANIMAIS: Quarenta e sete cães diagnosticados com DA pertencentes a clientes e 25 

cães saudáveis ​​e não afetados. MÉTODOS E MATERIAIS: Um kit de ELISA para IL-34 

disponível comercialmente foi otimizado para a mensuração de IL-34 em amostras 

de soro canino. Informações sobre o tratamento, escores de lesões [Índice de 

severidade e extensão da dermatite atópica canina, 4ª iteração (CADESI-04)] e a 

escala analógica visual de prurido (pVAS) foram registrados para cada cão no 

momento da coleta de soro.

RESULTADOS: Cães com DA apresentaram aumento significativo das concentrações 

séricas de IL-34 em comparação aos controles. Houve uma correlação positiva 

significativa entre as concentrações de IL-34 e os escores CADESI-04 e pVAS. As 

concentrações de IL-34 permaneceram aumentadas em cães com DA recebendo 

esteroides ou o inibidor de JAK1, oclacitinib, em comparação com cães controle 

não afetados. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: As concentrações séricas de 

IL-34 estão aumentadas em cães com DA e estão correlacionadas com a gravidade 

clínica e o prurido. A IL-34 pode ser uma candidata adequada a alvo terapêutico 

para a DA canina.


© 2020 ESVD and ACVD, throughout article.


DOI: 10.1111/vde.12873

PMID: 32794277



2. Allergy. 2020 Aug 13. doi: 10.1111/all.14557. Online ahead of print.


Predicting persistence of atopic dermatitis in children using clinical 

attributes and serum proteins.


Lauffer F(1), Baghin V(1), Standl M(2), Stark SP(3), Jargosch M(1), Wehrle 

J(4)(5)(6), Thomas J(3), Schmidt-Weber C(3)(7), Biedermann T(1), Eyerich S(3), 

Eyerich K(1)(8), Garzorz-Stark N(1)(8).


Author information:

(1)Technical University of Munich, Department of Dermatology and Allergy, 

Munich, Germany.

(2)Institute of Epidemiology, Helmholtz Zentrum München - German Research Center 

for Environmental Health, Neuherberg, Germany.

(3)Center of Allergy and Environment (ZAUM), Technical University of Munich and 

Helmholtz Zentrum Munich, Munich and Neuherberg, Germany.

(4)Department of Medicine I, Medical Center - University of Freiburg, Freiburg, 

Germany.

(5)German Cancer Consortium (DKTK), Freiburg, Germany.

(6)German Cancer Research Center (DKFZ), Heidelberg, Germany.

(7)Member of the German Center of Lung Research (DZL), Germany.

(8)Division of Dermatology and Venereology, Department of Medicine Solna, and 

Center for molecular medicine, Karolinska Institutet, Stockholm, Sweden.


BACKGROUND: Atopic dermatitis (AD) is the most common inflammatory skin disease 

in children, with 30% of all those diagnosed developing chronic or relapsing 

disease by adolescence. Such disease persistence cannot yet be predicted. The 

aim of the present study was to predict the natural course of AD using clinical 

parameters and serum proteins.

METHODS: Sera of 144 children with AD (age 0-3 years) were analyzed for IgE and 

33 cytokines, chemokines, and growth factors. Patient disease course until the 

age of 7 years was assessed retrospectively. Unsupervised k-means clustering was 

performed to define disease endotypes. Identified factors associated with AD 

persistence at the age of 7 years were validated in children with AD in an 

independent cohort (LISA Munich; n=168). Logistic regression and XGBoosting 

methods followed by cross-validation were applied to predict individual disease 

outcomes.

RESULTS: Three distinct endotypes were found in infancy, characterized by a 

unique inflammatory signature. Factors associated with disease persistence were 

disease score (SCORAD), involvement of the limbs, flexural lesion distribution 

at the age of 3 years, allergic comorbidities and disease exacerbation by the 

trigger factors stress, pollen exposure, and change in weather. Persistence was 

predicted with a sensitivity of 81.8% and a specificity of 82.4%. Factors with a 

high impact on the prediction of persistence were SCORAD at the age of 3 years, 

trigger factors, and low VEGF serum levels.

CONCLUSIONS: AD in infancy comprises three immunological endotypes. Disease 

persistence can be predicted using serum cytokines and clinical variables.


This article is protected by copyright. All rights reserved.


DOI: 10.1111/all.14557

PMID: 32794228



3. Am J Ophthalmol Case Rep. 2020 Aug 5;19:100848. doi: 10.1016/j.ajoc.2020.100848. 

eCollection 2020 Sep.


Corneal ulceration associated with dupilumab use in a patient with atopic 

dermatitis.


Li G(1), Berkenstock M(1), Soiberman U(1).


Author information:

(1)The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 

600 North Wolfe St, Baltimore, MD, 21237, USA.


PURPOSE: To describe a case of corneal ulceration associated with dupilumab use 

for atopic dermatitis.

OBSERVATIONS: A patient developed an inflammatory corneal ulcer 3 weeks after 

starting bi-weekly intravenous dupilumab therapy. Symptoms resolved with topical 

prednisolone and discontinuation of the systemic therapy with dupilumab.

CONCLUSION AND IMPORTANCE: Dupilumab is known to cause ocular surface 

inflammation, but we report a novel association between dupilumab use and 

potentially sight-threatening corneal ulceration.


© 2020 The Authors.


DOI: 10.1016/j.ajoc.2020.100848

PMCID: PMC7415768

PMID: 32793843


Conflict of interest statement: No conflicting relationship exists for any 

author.



4. Postepy Dermatol Alergol. 2020 Jun;37(3):390-395. doi: 10.5114/ada.2020.96112. 

Epub 2020 Jul 16.


Evaluation of contact sensitivity to food additives in children with atopic 

dermatitis.


Anıl H(1), Harmancı K(1).


Author information:

(1)Department of Paediatric Allergy and Immunology, Faculty of Medicine, 

Osmangazi University, Eskisehir, Turkey.


INTRODUCTION: Atopic dermatitis (AD) is a chronic inflammatory disease caused by 

the complex interaction of genetic, immune and environmental factors such as 

food and airborne allergens. The atopy patch test (APT) is a useful way to 

determine delayed-type hypersensitivity reactions to food and aeroallergens. 

Many studies have also suggested that food additives are associated with 

dermatologic adverse reactions and the aggravation of pre-existing atopic 

dermatitis symptoms.

AIM: To elucidate the contact sensitivity to food additives in children 

suffering from AD by using standardized atopy patch testing.

MATERIAL AND METHODS: A total of 45 children with AD and 20 healthy children 

have been enrolled. All the children have regularly consumed food containing 

additives, and were subjected to atopy patch tests.

RESULTS: In total, 28 (62%) children with AD and 4 (20%) healthy children have 

had positive patch test reactions to ≥ 1 allergens. There has been a significant 

difference (p = 0.04) between the groups in terms of the positivity rate in the 

patch test and the most common allergen that elicited positive patch test 

results in the AD group was azorubine (n = 11, 24.4%, p = 0.014).

CONCLUSIONS: In our study, contact sensitivity was detected more frequently in 

AD patients. Food additives may play a role in the development and exacerbation 

of AD. Atopy patch testing with food additives can be useful in the treatment 

and follow-up of children with AD.


Copyright: © 2020 Termedia Sp. z o. o.


DOI: 10.5114/ada.2020.96112

PMCID: PMC7394164

PMID: 32792881


Conflict of interest statement: The authors declare no conflict of interest.



5. Postepy Dermatol Alergol. 2020 Jun;37(3):319-325. doi: 10.5114/ada.2020.96260. 

Epub 2020 Jul 16.


The ambiguous pruritogenic role of interleukin-31 in cutaneous T-cell lymphomas 

in comparison to atopic dermatitis: a review.


Olszewska B(1), Sokołowska-Wojdyło M(1), Lakomy J(2), Nowicki RJ(1).


Author information:

(1)Department of Dermatology, Venereology and Allergology, Medical University of 

Gdansk, Gdansk, Poland.

(2)Department of Pathology, Medical University of Gdansk, Gdansk, Poland.


Cutaneous T-cell lymphomas (CTCLs) comprise a group of chronic heterogeneous 

diseases of unknown pathogenesis, characterized by non-specific skin lesions 

such as patches, plaques and tumours. CTCL is accompanied by persistent pruritus 

poorly responding to antihistamines and therefore significantly reducing quality 

of life in patients with lymphomas. According to research data, interleukin-31 

(IL-31) contributes to initiation and maintenance of the inflammatory process of 

the skin and pruritus in inflammatory dermatoses such as atopic dermatitis (AD), 

which is well established. The studies of a similar role of IL-31 in CTCLs are 

less homogenous. Due to contradictory reports concerning IL-31 and CTCL we have 

analysed available literature to summarize its role, focusing on CTCL and AD.


Copyright: © 2020 Termedia Sp. z o. o.


DOI: 10.5114/ada.2020.96260

PMCID: PMC7394154

PMID: 32792870


Conflict of interest statement: The authors declare no conflict of interest.



6. Cell Death Dis. 2020 Aug 13;11(8):617. doi: 10.1038/s41419-020-02845-8.


Costello syndrome model mice with a Hras(G12S/+) mutation are susceptible to 

develop house dust mite-induced atopic dermatitis.


Katata Y(1)(2), Inoue SI(1), Asao A(3), Kobayashi S(3)(4), Terui H(5), 

Inoue-Shibui A(1), Abe T(1), Niihori T(1), Aiba S(5), Ishii N(3), Kure S(2), 

Aoki Y(6).


Author information:

(1)Department of Medical Genetics, Tohoku University Graduate School of 

Medicine, Sendai, Japan.

(2)Department of Pediatrics, Tohoku University Graduate School of Medicine, 

Sendai, Japan.

(3)Department of Microbiology and Immunology, Tohoku University Graduate School 

of Medicine, Sendai, Japan.

(4)Department of Organ Anatomy, Tohoku University Graduate School of Medicine, 

Sendai, Japan.

(5)Department of Dermatology, Tohoku University Graduate School of Medicine, 

Sendai, Japan.

(6)Department of Medical Genetics, Tohoku University Graduate School of 

Medicine, Sendai, Japan. aokiy@med.tohoku.ac.jp.


Costello syndrome is an autosomal dominant disorder that is caused by germline 

HRAS mutations. Patients with Costello syndrome present craniofacial 

abnormalities, cardiac defects, and cancer predisposition, as well as skin 

abnormalities, including papillomas, keratosis pilaris, and eczematous 

dermatitis. However, the mechanisms underlying the dermatological abnormalities 

remain unclear. Here, we demonstrated that knock-in mice expressing an Hras G12S 

mutation (HrasG12S/+ mice) are susceptible to develop atopic dermatitis 

(AD)-like skin lesions, including eczema, pruritus, elevated serum IgE levels, 

acanthosis, and the infiltration of mast cells, basophils, and type-2 innate 

lymphoid cells in the dermis, after stimulation with house dust mite allergens 

(Dermatophagoides farinae, Dfb). Reduced skin barrier function, increased 

proliferation of phosphorylated ERK (p-ERK)-positive epidermal cells, and 

increased Th2-type cytokines as well as epithelial cell-derived cytokines, 

including IL-33, were observed in the skin tissue of HrasG12S/+ mice compared 

with Hras+/+ mice. Cultured HrasG12S/+ keratinocytes exhibited increased IL-33 

expression after Dfb stimulation. PD0325901, an MEK inhibitor, ameliorated 

AD-like symptoms in HrasG12S/+ mice, showing decreased proliferation of 

p-ERK-positive epidermal cells and decreased expression of IL-33. Our findings 

indicate that the epidermis of HrasG12S/+ mice stimulated by Dfb strongly 

induced IL-33 expression and type-2 innate lymphoid cells, resulting in AD-like 

skin lesions. These results suggest that the epidermis of HrasG12S/+ mice are 

prone to development of eczematous dermatitis stimulated with house dust mite 

allergens.


DOI: 10.1038/s41419-020-02845-8

PMID: 32792500



7. Medicine (Baltimore). 2020 Jul 24;99(30):e21255. doi: 

10.1097/MD.0000000000021255.


Atopic dermatitis in Taiwanese children: The laboratory values that correlate 

best to the SCORAD index are total IgE and positive Cheddar cheese IgE.


Kuo HC(1), Chu CH, Su YJ, Lee CH.


Author information:

(1)aDepartment of Pediatrics and Kawasaki Disease Center, Kaohsiung Chang Gung 

Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 

bClinical Trial Center cDepartment of Internal Medicine dDepartment of 

Dermatology, Kaohsiung Chang Gung Memorial Hospital, 83301, Taiwan.


Atopic dermatitis (AD) is a common chronic relapsing inflammatory skin disease 

associated with a personal or family history of atopic diseases. Determining the 

objective severity scoring of AD index (SCORAD) and total immunoglobulin E (IgE) 

to help to stage the severity (lesions extent and intensity of the lesions and 

then the itch and sleep disturbance they may cause) of AD in children.In this 

study, we adopted the SCORAD index, which consists of severity, area, and sleep 

disturbance, to evaluate the AD status of children up to 18 years old. We 

examined the blood levels of total serum IgE, white blood cell 

count/differential count (WBC/DC), eosinophil counts (EC), eosinophil cationic 

protein (ECP) and specific IgE.A total of 208 children with AD were enrolled in 

this study. Serum IgE values and a number of specific IgE that are positive 

significantly different SCORAD index through simple linear regression; however, 

after multiple linear regression, only IgE values (95% CI: 0.001-0.004, 

P < .001), total WBC count (95% CI: 0.112-1.736, P = .026), EC (95% CI: 

0.045-6.706, P = .047), and specific IgE to Cheddar cheese (95% CI: 

1.814-16.731, P = .015) remain different. After applying the Phi coefficient, we 

found that specific IgE to tuna (r = 0.632), codfish (r = 0.613), and clam 

(r = 0.613) each had a moderate correlation with specific IgE to Cheddar cheese. 

The 6 most common allergens were found to be mite (D. Farinae: 65.9%), mite (D. 

Pterony: 64.9%), house dust (47.6%), cockroach mix (37.0%), shrimp (30.8%), and 

crab (22.6%). Covariates of SCORAD index, severity, area, and sleep disturbance 

differed.In this study, we found that total IgE values, specific IgE values, 

WBC, EC, and specific IgE to Cheddar cheese have significant correlations with 

SCORAD index in AD of Taiwanese children.


DOI: 10.1097/MD.0000000000021255

PMID: 32791702



8. Environ Anal Health Toxicol. 2020 Sep;35(3):e2020012-0. doi: 

10.5620/eaht.2020012. Epub 2020 Jul 16.


Age-period-cohort analysis of asthma, allergic rhinitis, and atopic dermatitis 

prevalence in Japan.


Okui T(1).


Author information:

(1)Medical Information Center, Kyusyu University Hospital, Fukuoka city, Japan.


This study aims to analyze the trends in the Japanese prevalence of asthma, 

allergic rhinitis, and atopic dermatitis by using age-period-cohort (APC) 

analysis. Data regarding the prevalence of diseases from 1999 to 2017 were 

collected from Patient Survey in Japan. The data were divided according to age 

groups ranging from 0-4 years old up to 65-69 years old in 5-year increments. A 

cohort was defined for each age group of each year with a one-year shift, and 

cohorts born from 1930-1934 up to 2013-2017 were examined. We used Bayesian APC 

analysis to decompose the changes in prevalence into age, period, and cohort 

effects. Results show that the period effect for asthma began to increase in 

2008, and those of allergic rhinitis and atopic dermatitis began to increase in 

1999. The cohort effects for asthma and atopic dermatitis increased rapidly in 

cohorts born from approximately 1950 to 1980 and then decreased thereafter. 

Furthermore, the cohort effect for allergic rhinitis increased from cohorts born 

in approximately the late 1970s for men and in 1990 for women. The time points 

with increasing cohort effects for asthma and atopic dermatitis are consistent 

with the history of air pollution accompanied by rapid economic growth in Japan. 

The onset of the increased cohort effect for allergic rhinitis was also 

relatively consistent with the time point at which the mass scattering of pollen 

began.


DOI: 10.5620/eaht.2020012

PMID: 32791576



9. J Allergy Clin Immunol Pract. 2020 Aug 10:S2213-2198(20)30810-2. doi: 

10.1016/j.jaip.2020.07.051. Online ahead of print.


The use of probiotics and bacteria-derived preparations in topical treatment of 

atopic dermatitis - a systematic review.


Ambrożej D(1), Kunkiel K(1), Dumycz K(1), Feleszko W(2).


Author information:

(1)Department of Pediatric Respiratory Diseases and Allergy,The Medical 

University of Warsaw, Warsaw, Poland.

(2)Department of Pediatric Respiratory Diseases and Allergy,The Medical 

University of Warsaw, Warsaw, Poland. Electronic address: 

wojciech.feleszko@wum.edu.pl.


DOI: 10.1016/j.jaip.2020.07.051

PMID: 32791245



10. Brain Behav Immun. 2020 Aug 10:S0889-1591(20)30486-4. doi: 

10.1016/j.bbi.2020.08.003. Online ahead of print.


Depressive and anxiety symptomatology among people with asthma or atopic 

dermatitis: a population-based investigation using the UK Biobank data.


Hussain S(1), Ronaldson A(2), Arias de la Torre J(3), Sima R(4), Hatch S(2), 

Hotopf M(5), Dregan A(6).


Author information:

(1)Department of Psychological Medicine, Institute of Psychiatry, Psychology, 

and Neuroscience, King's College London, London, United Kingdom; School of 

Psychology, Victoria University of Wellington, Wellington, New Zealand.

(2)Department of Psychological Medicine, Institute of Psychiatry, Psychology, 

and Neuroscience, King's College London, London, United Kingdom.

(3)Department of Psychological Medicine, Institute of Psychiatry, Psychology, 

and Neuroscience, King's College London, London, United Kingdom; CIBER 

Epidemiology and Public Health (CIBERESP), Madrid, Spain.

(4)USAMV, Cluj-Napoca, Romania.

(5)Department of Psychological Medicine, Institute of Psychiatry, Psychology, 

and Neuroscience, King's College London, London, United Kingdom; South London 

and Maudsley NHS Foundation Trust, London, United Kingdom.

(6)Department of Psychological Medicine, Institute of Psychiatry, Psychology, 

and Neuroscience, King's College London, London, United Kingdom. Electronic 

address: alexandru.dregan@kcl.ac.uk.


The present study investigated the association of depression and anxiety 

symptomatology (DAS) with asthma and atopic dermatitis (AD) diagnosis during 

mid-adult years. The study employed data from 502,641 participants in the UK 

Biobank. Neutrophils to Lymphocytes Ratios (NLRs) of patients with asthma and AD 

were calculated and evaluated in relation to DAS, measured via the Patient 

Health Questionnaire-4 (PHQ-4). Age of asthma or AD onset association with DAS 

were also estimated. Multivariable regression analyses were implemented among 

participants with asthma or AD, compared to those without these disorders. Out 

of 58,833 participants with asthma and 13,462 with AD, the prevalence of DAS was 

11.7% and 2.7%, respectively. DAS increased among participants with either 

asthma or AD, being highest within patients having both (β= 0.41, 95% confidence 

interval (95%CI), 0.34,0.49). NLR showed a linear increase with PHQ scores in 

asthma patients, (tertile 1, β= 0.30, 95% CI, 0.27,0.34; tertile 2, β= 0.36, 

95%CI, 0.32,0.39, and tertile 3, β= 0.43, 95%CI, 0.39,0.46). An inverted 

U-shaped association was seen between age of asthma onset and PHQ, with the 

40-59 age group (β= 0.54, 95%CI, 0.48,0.59) showing the highest risk followed by 

the 60+ (β= 0.43, 95%CI, 0.34,0.51 and 20-39 groups (β= 0.32, 95%CI, 0.27,0.38). 

Similar patterns emerged within AD. Asthma and AD were associated with increased 

DAS during mid-adult years, being strongest among participants reporting both 

disorders. A dose-response relationship between NLR and DAS was observed. Asthma 

or AD onset during mid-adult years (40-59) were associated with the highest 

increment in DAS.


Copyright © 2020. Published by Elsevier Inc.


DOI: 10.1016/j.bbi.2020.08.003

PMID: 32791209

Atopic Dermatitis and Its Associations

1. Dermatol Ther. 2020 May 27:e13687. doi: 10.1111/dth.13687. Online ahead of 

print.

Considerations for safety in the use of systemic medications for psoriasis and 

atopic dermatitis during the COVID-19 pandemic.

Ricardo JW(1), Lipner SR(1).

Author information:

(1)Department of Dermatology, Weill Cornell Medicine, New York, New York, USA.

Coronavirus disease 2019 (COVID-19) is responsible for at least 2 546 527 cases 

and 175 812 deaths as of April 21, 2020. Psoriasis and atopic dermatitis (AD) 

are common, chronic, inflammatory skin conditions, with immune dysregulation as 

a shared mechanism; therefore, mainstays of treatment include systemic 

immunomodulating therapies. It is unknown whether these therapies are associated 

with increased COVID-19 susceptibility or worse outcomes in infected patients. 

In this review, we discuss overall infection risks of nonbiologic and biologic 

systemic medications for psoriasis and AD and provide therapeutic 

recommendations. In summary, in patients with active infection, systemic 

conventional medications, the Janus kinase inhibitor tofacitinib, and biologics 

for psoriasis should be temporarily held until there is more data; in uninfected 

patients switching to safer alternatives should be considered. Interleukin 

(IL)-17, IL-12/23, and IL-23 inhibitors are associated with low infection risk, 

with IL-17 and IL-23 favored over IL-12/23 inhibitors. Pivotal trials and 

postmarketing data also suggest that IL-17 and IL-23 blockers are safer than 

tumor necrosis factor alpha blockers. Apremilast, acitretin, and dupilumab have 

favorable safety data and may be safely initiated and continued in uninfected 

patients. Without definitive COVID-19 data, these recommendations may be useful 

in guiding treatment of psoriasis and AD patients during the COVID-19 pandemic.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/dth.13687

PMCID: PMC7283778

PMID: 32458536

2. Br J Dermatol. 2020 Apr 29:10.1111/bjd.19161. doi: 10.1111/bjd.19161. Online 

ahead of print.

Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an 

opportunity to inform care during a pandemic.

Mahil SK(1), Yiu ZZN(2), Mason KJ(2), Dand N(3), Coker B(4), Wall D(5)(6), 

Fletcher G(6), Bosma A(7), Capon F(3), Iversen L(8), Langan SM(1)(9), Di Meglio 

P(3), Musters AH(7), Prieto-Merino D(9), Tsakok T(1), Warren RB(2), Flohr C(1), 

Spuls PI(7), Griffiths CEM(2), Barker J(1), Irvine AD(10), Smith CH(1); 

Secure-AD and PsoProtect study groups.

Author information:

(1)St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust 

and King's College London, London, UK.

(2)Dermatology Centre, Salford Royal NHS Foundation Trust, The University of 

Manchester, Manchester Academic Health Science Centre, NIHR Manchester 

Biomedical Research Centre, Manchester, UK.

(3)St John's Institute of Dermatology within the, School of Basic & Medical 

Biosciences, King's College London, London, UK.

(4)NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, 

London, UK.

(5)Hair Restoration Blackrock, Dublin, Ireland.

(6)National and International Skin Registry Solutions (NISR), Charles Institute 

of Dermatology, Dublin, Ireland.

(7)Department of Dermatology, Amsterdam Public Health, Infection and Immunity, 

Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

(8)Department of Dermatology, Aarhus University Hospital, Aarhus C, Denmark.

(9)Faculty of Epidemiology, and Population Health, London School of Hygiene and 

Tropical Medicine, London, UK.

(10)Clinical Medicine, Trinity College Dublin, Dublin, Ireland.

We wish to bring your attention to the PsoPROTECT (Psoriasis Patient Registry 

for Outcomes, Therapy and Epidemiology of Covid‐19 infecTion) and SECURE‐AD 

(Surveillance Epidemiology of Coronavirus Under Research Exclusion‐Atopic 

Dermatitis) registries; two urgent global initiatives that address an unmet need 

for delineating the determinants of COVID‐19 outcomes in the common cutaneous 

immune‐mediated inflammatory diseases (IMIDs) psoriasis and atopic dermatitis.

DOI: 10.1111/bjd.19161

PMCID: PMC7267275

PMID: 32348554

3. Cureus. 2020 Apr 2;12(4):e7506. doi: 10.7759/cureus.7506.

Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: 

Management Tips.

Beiu C(1), Mihai M(1), Popa L(1), Cima L(2), Popescu MN(3).

Author information:

(1)Oncologic Dermatology, Elias Emergency University Hospital, "Carol Davila" 

University of Medicine and Pharmacy, Bucharest, ROU.

(2)Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU.

(3)Physical Medicine and Rehabilitation, "Carol Davila" University of Medicine 

and Pharmacy, Bucharest, ROU.

Coronavirus disease 2019 (COVID-19) continues to spread globally, outpacing the 

capacity and resources of health systems worldwide. A therapeutic vaccine is not 

yet on the rise, and preventive measures are the current approach to restraint 

the transmission of cases. As the virus is highly contagious via respiratory 

route (droplets from infected persons, widely spread by coughing or sneezing) 

and via contact with contaminated surfaces, community transmission and spread 

can be decreased through the practice of regular and diligent hand hygiene. 

Frequent hand washing implies a prolonged exposure to water and other chemical 

or physical agents and may induce several pathophysiologic changes, such as 

epidermal barrier disruption, impairment of keratinocytes, the subsequent 

release of proinflammatory cytokines, activation of the skin immune system, and 

delayed-type hypersensitivity reactions. Adverse dermatologic effects, such as 

excessive skin dryness or even contact dermatitis (particularly the irritant 

subtype and, to a lesser extent, the allergic subtype), can occur, especially in 

individuals with a history of atopic dermatitis. These skin conditions are 

perfectly manageable, and applying a moisturizer immediately after washing hands 

or after using a portable hand sanitizer is the cornerstone in preventing the 

development of eczematous changes in the hands. In the current global context, 

the potential occurrence of these dermatological adverse events should in no way 

cause people to deviate from strict hand hygiene rules.

Copyright © 2020, Beiu et al.

DOI: 10.7759/cureus.7506

PMCID: PMC7195203

PMID: 32373409

Conflict of interest statement: The authors have declared that no competing 

interests exist.

4. Am J Clin Dermatol. 2020 Jun;21(3):307-311. doi: 10.1007/s40257-020-00514-2.

Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic.

Torres T(1)(2), Puig L(3).

Author information:

(1)Department of Dermatology, Centro Hospitalar Universitário Do Porto, Porto, 

Portugal. torres.tiago@outlook.com.

(2)Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 

Portugal. torres.tiago@outlook.com.

(3)Department of Dermatology, Hospital de La Santa Creu I Sant Pau, Barcelona, 

Spain.

Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by a novel 

coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

COVID-19 has spread rapidly worldwide and has been shown to have a wide spectrum 

of severity. COVID-19 has become a public health emergency of relevant 

international concern, and it was declared a pandemic by the World Health 

Organization on 11 March, 2020. SARS-CoV-2 infection in severe cases involves 

the host response as an important contributor to the disease process and tissue 

damage, mainly due to dysregulated and excessive innate immune responses. The 

primary immune response leads to viral clearance in the majority of cases. 

However, in a subgroup of patients, the secondary immune response may be 

exaggerated, leading to inflammatory-induced lung injury and other complications 

including pneumonitis, acute respiratory distress syndrome, respiratory failure, 

shock, organ failure, and potentially death. Several cutaneous immune-mediated 

diseases, including psoriasis, atopic dermatitis, and hidradenitis suppurativa, 

are therapeutically managed with biologic and non-biologic immunosuppressive and 

immunomodulatory drugs. The outbreak of COVID-19 affects the management of these 

chronic conditions, not only for those who are already receiving treatment but 

also for those who are about to start a new treatment to control their disease. 

In this article, the management of cutaneous immune-mediated diseases during the 

COVID-19 pandemic is discussed.

DOI: 10.1007/s40257-020-00514-2

PMCID: PMC7147535

PMID: 32277351 [Indexed for MEDLINE]

Conflict of interest statement: Tiago Torres has received consultancy and/or 

speaker’s honoraria from and/or participated in clinical trials sponsored by 

AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers 

Squibb, Celgene, Janssen, Biocad, LEO Pharma, Eli Lilly, MSD, Novartis, Pfizer, 

Samsung-Bioepis, Sanofi-Genzyme, and Sandoz. Luis Puig has received consultancy 

and/or speaker’s honoraria from and/or participated in clinical trials sponsored 

by AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, 

Gebro, Janssen, LEO Pharma, Eli Lilly and Company, Merck-Serono, MSD, Mylan, 

Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, and UCB.

5. J Allergy Clin Immunol Pract. 2020 May;8(5):1477-1488.e5. doi: 

10.1016/j.jaip.2020.03.012. Epub 2020 Mar 26.

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic.

Shaker MS(1), Oppenheimer J(2), Grayson M(3), Stukus D(3), Hartog N(4), Hsieh 

EWY(5), Rider N(6), Dutmer CM(5), Vander Leek TK(7), Kim H(8), Chan ES(9), Mack 

D(10), Ellis AK(11), Lang D(12), Lieberman J(13), Fleischer D(5), Golden 

DBK(14), Wallace D(15), Portnoy J(16), Mosnaim G(17), Greenhawt M(18).

Author information:

(1)Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, 

Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH.

(2)UMDMJ Rutgers University School of Medicine, Newark, NJ.

(3)Nationwide Children's Hospital, The Ohio State University School of Medicine, 

Columbus, Ohio.

(4)Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich.

(5)Children's Hospital Colorado, University of Colorado School of Medicine, 

Aurora, Colo.

(6)The Texas Children's Hospital, Section of Immunology, Allergy, and 

Retrovirology and the Baylor College of Medicine, Houston, Texas.

(7)Pediatric Allergy and Asthma, Department of Pediatrics, University of 

Alberta, Edmonton, AB, Canada.

(8)Western University and McMaster University, London, ON, Canada.

(9)BC Children's Hospital, The University of British Columbia, Vancouver, BC, 

Canada.

(10)McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, 

Burlington, ON, Canada.

(11)Division of Allergy and Immunology, Department of Medicine, Queen's 

University, Kingston, ON, Canada.

(12)Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic, 

Cleveland, Ohio.

(13)Division of Allergy and Immunology, The University of Tennessee, Memphis, 

Tenn.

(14)Division of Allergy and Clinical Immunology, John Hopkins University School 

of Medicine, Baltimore, Md.

(15)Nova Southeastern University College of Allopathic Medicine, Fort 

Lauderdale, Fla.

(16)Children's Mercy, University of Missouri-Kansas City School of Medicine, 

Kansas City, Mo.

(17)Division of Pulmonary, Allergy and Critical Care, Department of Medicine, 

NorthShore University Health System, Evanston, Ill.

(18)Children's Hospital Colorado, University of Colorado School of Medicine, 

Aurora, Colo. Electronic address: Matthew.Greenhawt@childrenscolorado.org.

Comment in

J Allergy Clin Immunol Pract. 2020 May;8(5):1475-1476.

J Allergy Clin Immunol Pract. 2020 Jul - Aug;8(7):2452-2453.

J Paediatr Child Health. 2020 Jun;56(6):995.

In the event of a global infectious pandemic, drastic measures may be needed 

that limit or require adjustment of ambulatory allergy services. However, no 

rationale for how to prioritize service shut down and patient care exists. A 

consensus-based ad-hoc expert panel of allergy/immunology specialists from the 

United States and Canada developed a service and patient prioritization 

schematic to temporarily triage allergy/immunology services. Recommendations and 

feedback were developed iteratively, using an adapted modified Delphi 

methodology to achieve consensus. During the ongoing pandemic while social 

distancing is being encouraged, most allergy/immunology care could be 

postponed/delayed or handled through virtual care. With the exception of many 

patients with primary immunodeficiency, patients on venom immunotherapy, and 

patients with asthma of a certain severity, there is limited need for 

face-to-face visits under such conditions. These suggestions are intended to 

help provide a logical approach to quickly adjust service to mitigate risk to 

both medical staff and patients. Importantly, individual community circumstances 

may be unique and require contextual consideration. The decision to enact any of 

these measures rests with the judgment of each clinician and individual health 

care system. Pandemics are unanticipated, and enforced social 

distancing/quarantining is highly unusual. This expert panel consensus document 

offers a prioritization rational to help guide decision making when such 

situations arise and an allergist/immunologist is forced to reduce services or 

makes the decision on his or her own to do so.

Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by 

Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaip.2020.03.012

PMCID: PMC7195089

PMID: 32224232 [Indexed for MEDLINE]

6. J Eur Acad Dermatol Venereol. 2020 Jun 25:10.1111/jdv.16774. doi: 

10.1111/jdv.16774. Online ahead of print.

Cutaneous manifestations of SARS-CoV-2 infection: a clinical update.

Gisondi P(1), PIaserico S(2), Bordin C(1), Alaibac M(2), Girolomoni G(1), Naldi 

L(3)(4).

Author information:

(1)Section of Dermatology and Venereology, Department of Medicine, University of 

Verona, Verona, Italy.

(2)Section of Dermatology, Department of Medicine, University of Padua, Padua, 

Italy.

(3)Division of Dermatology, San Bortolo Hospital, Vicenza, Italy.

(4)Centro Studi GISED, Bergamo, Italy.

On 11 March 2020, the World Health Organization (WHO) has declared the novel 

coronavirus disease (COVID-19) a global pandemic, caused by the severe acute 

respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). A consistent number of 

case reports and clinical series have been already published describing a 

complex spectrum of skin manifestations associated with the SARS-CoV-2 

infection. We carried out a review of the English-language literature up to 20 

May 2020, reporting original cases or case series of the cutaneous 

manifestations of SARS-CoV-2 virus infection. The following databases were 

consulted: PubMed, Embase, Google Scholar and ResearchGate. The search of papers 

was conducted by using the key term 'COVID-19' or 'SARS-CoV-2' or 'coronavirus' 

combined with each of the following: 'skin', 'cutaneous', 'dermatologic' or 

'dermatology', 'manifestation', 'lesions', or 'rash'. The patterns of 

dermatological manifestations associated with SARS-CoV-2 infection could be 

classified into four categories: exanthema (varicella-like, papulo-vesicular and 

morbilliform rash), vascular (chilblain-like, purpuric/petechial and livedoid 

lesions), urticarial and acro-papular eruption. Lastly, other skin 

manifestations to be considered are the cutaneous adverse reactions to the drugs 

prescribed for the treatment of COVID-19. Whether SARS-CoV-2 infection can 

directly cause a worsening of chronic inflammatory diseases such as psoriasis or 

atopic dermatitis remains to be determined. Dermatology's outlook in the 

COVID-19 pandemic is multidimensional.

© 2020 European Academy of Dermatology and Venereology.

DOI: 10.1111/jdv.16774

PMCID: PMC7362144

PMID: 32585074

Atopic Dermatitis and Its Associations

1. Dermatol Ther. 2020 May 27:e13687. doi: 10.1111/dth.13687. Online ahead of 

print.

Considerations for safety in the use of systemic medications for psoriasis and 

atopic dermatitis during the COVID-19 pandemic.

Ricardo JW(1), Lipner SR(1).

Author information:

(1)Department of Dermatology, Weill Cornell Medicine, New York, New York, USA.

Coronavirus disease 2019 (COVID-19) is responsible for at least 2 546 527 cases 

and 175 812 deaths as of April 21, 2020. Psoriasis and atopic dermatitis (AD) 

are common, chronic, inflammatory skin conditions, with immune dysregulation as 

a shared mechanism; therefore, mainstays of treatment include systemic 

immunomodulating therapies. It is unknown whether these therapies are associated 

with increased COVID-19 susceptibility or worse outcomes in infected patients. 

In this review, we discuss overall infection risks of nonbiologic and biologic 

systemic medications for psoriasis and AD and provide therapeutic 

recommendations. In summary, in patients with active infection, systemic 

conventional medications, the Janus kinase inhibitor tofacitinib, and biologics 

for psoriasis should be temporarily held until there is more data; in uninfected 

patients switching to safer alternatives should be considered. Interleukin 

(IL)-17, IL-12/23, and IL-23 inhibitors are associated with low infection risk, 

with IL-17 and IL-23 favored over IL-12/23 inhibitors. Pivotal trials and 

postmarketing data also suggest that IL-17 and IL-23 blockers are safer than 

tumor necrosis factor alpha blockers. Apremilast, acitretin, and dupilumab have 

favorable safety data and may be safely initiated and continued in uninfected 

patients. Without definitive COVID-19 data, these recommendations may be useful 

in guiding treatment of psoriasis and AD patients during the COVID-19 pandemic.

© 2020 Wiley Periodicals LLC.

DOI: 10.1111/dth.13687

PMCID: PMC7283778

PMID: 32458536


2. Br J Dermatol. 2020 Apr 29:10.1111/bjd.19161. doi: 10.1111/bjd.19161. Online 

ahead of print.

Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an 

opportunity to inform care during a pandemic.

Mahil SK(1), Yiu ZZN(2), Mason KJ(2), Dand N(3), Coker B(4), Wall D(5)(6), 

Fletcher G(6), Bosma A(7), Capon F(3), Iversen L(8), Langan SM(1)(9), Di Meglio 

P(3), Musters AH(7), Prieto-Merino D(9), Tsakok T(1), Warren RB(2), Flohr C(1), 

Spuls PI(7), Griffiths CEM(2), Barker J(1), Irvine AD(10), Smith CH(1); 

Secure-AD and PsoProtect study groups.

Author information:

(1)St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust 

and King's College London, London, UK.

(2)Dermatology Centre, Salford Royal NHS Foundation Trust, The University of 

Manchester, Manchester Academic Health Science Centre, NIHR Manchester 

Biomedical Research Centre, Manchester, UK.

(3)St John's Institute of Dermatology within the, School of Basic & Medical 

Biosciences, King's College London, London, UK.

(4)NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, 

London, UK.

(5)Hair Restoration Blackrock, Dublin, Ireland.

(6)National and International Skin Registry Solutions (NISR), Charles Institute 

of Dermatology, Dublin, Ireland.

(7)Department of Dermatology, Amsterdam Public Health, Infection and Immunity, 

Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

(8)Department of Dermatology, Aarhus University Hospital, Aarhus C, Denmark.

(9)Faculty of Epidemiology, and Population Health, London School of Hygiene and 

Tropical Medicine, London, UK.

(10)Clinical Medicine, Trinity College Dublin, Dublin, Ireland.

We wish to bring your attention to the PsoPROTECT (Psoriasis Patient Registry 

for Outcomes, Therapy and Epidemiology of Covid‐19 infecTion) and SECURE‐AD 

(Surveillance Epidemiology of Coronavirus Under Research Exclusion‐Atopic 

Dermatitis) registries; two urgent global initiatives that address an unmet need 

for delineating the determinants of COVID‐19 outcomes in the common cutaneous 

immune‐mediated inflammatory diseases (IMIDs) psoriasis and atopic dermatitis.

DOI: 10.1111/bjd.19161

PMCID: PMC7267275

PMID: 32348554


3. Cureus. 2020 Apr 2;12(4):e7506. doi: 10.7759/cureus.7506.

Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: 

Management Tips.

Beiu C(1), Mihai M(1), Popa L(1), Cima L(2), Popescu MN(3).

Author information:

(1)Oncologic Dermatology, Elias Emergency University Hospital, "Carol Davila" 

University of Medicine and Pharmacy, Bucharest, ROU.

(2)Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU.

(3)Physical Medicine and Rehabilitation, "Carol Davila" University of Medicine 

and Pharmacy, Bucharest, ROU.

Coronavirus disease 2019 (COVID-19) continues to spread globally, outpacing the 

capacity and resources of health systems worldwide. A therapeutic vaccine is not 

yet on the rise, and preventive measures are the current approach to restraint 

the transmission of cases. As the virus is highly contagious via respiratory 

route (droplets from infected persons, widely spread by coughing or sneezing) 

and via contact with contaminated surfaces, community transmission and spread 

can be decreased through the practice of regular and diligent hand hygiene. 

Frequent hand washing implies a prolonged exposure to water and other chemical 

or physical agents and may induce several pathophysiologic changes, such as 

epidermal barrier disruption, impairment of keratinocytes, the subsequent 

release of proinflammatory cytokines, activation of the skin immune system, and 

delayed-type hypersensitivity reactions. Adverse dermatologic effects, such as 

excessive skin dryness or even contact dermatitis (particularly the irritant 

subtype and, to a lesser extent, the allergic subtype), can occur, especially in 

individuals with a history of atopic dermatitis. These skin conditions are 

perfectly manageable, and applying a moisturizer immediately after washing hands 

or after using a portable hand sanitizer is the cornerstone in preventing the 

development of eczematous changes in the hands. In the current global context, 

the potential occurrence of these dermatological adverse events should in no way 

cause people to deviate from strict hand hygiene rules.

Copyright © 2020, Beiu et al.

DOI: 10.7759/cureus.7506

PMCID: PMC7195203

PMID: 32373409

Conflict of interest statement: The authors have declared that no competing 

interests exist.


4. Am J Clin Dermatol. 2020 Jun;21(3):307-311. doi: 10.1007/s40257-020-00514-2.

Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic.

Torres T(1)(2), Puig L(3).

Author information:

(1)Department of Dermatology, Centro Hospitalar Universitário Do Porto, Porto, 

Portugal. torres.tiago@outlook.com.

(2)Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 

Portugal. torres.tiago@outlook.com.

(3)Department of Dermatology, Hospital de La Santa Creu I Sant Pau, Barcelona, 

Spain.

Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by a novel 

coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

COVID-19 has spread rapidly worldwide and has been shown to have a wide spectrum 

of severity. COVID-19 has become a public health emergency of relevant 

international concern, and it was declared a pandemic by the World Health 

Organization on 11 March, 2020. SARS-CoV-2 infection in severe cases involves 

the host response as an important contributor to the disease process and tissue 

damage, mainly due to dysregulated and excessive innate immune responses. The 

primary immune response leads to viral clearance in the majority of cases. 

However, in a subgroup of patients, the secondary immune response may be 

exaggerated, leading to inflammatory-induced lung injury and other complications 

including pneumonitis, acute respiratory distress syndrome, respiratory failure, 

shock, organ failure, and potentially death. Several cutaneous immune-mediated 

diseases, including psoriasis, atopic dermatitis, and hidradenitis suppurativa, 

are therapeutically managed with biologic and non-biologic immunosuppressive and 

immunomodulatory drugs. The outbreak of COVID-19 affects the management of these 

chronic conditions, not only for those who are already receiving treatment but 

also for those who are about to start a new treatment to control their disease. 

In this article, the management of cutaneous immune-mediated diseases during the 

COVID-19 pandemic is discussed.

DOI: 10.1007/s40257-020-00514-2

PMCID: PMC7147535

PMID: 32277351 [Indexed for MEDLINE]

Conflict of interest statement: Tiago Torres has received consultancy and/or 

speaker’s honoraria from and/or participated in clinical trials sponsored by 

AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, Bristol Myers 

Squibb, Celgene, Janssen, Biocad, LEO Pharma, Eli Lilly, MSD, Novartis, Pfizer, 

Samsung-Bioepis, Sanofi-Genzyme, and Sandoz. Luis Puig has received consultancy 

and/or speaker’s honoraria from and/or participated in clinical trials sponsored 

by AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, 

Gebro, Janssen, LEO Pharma, Eli Lilly and Company, Merck-Serono, MSD, Mylan, 

Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, and UCB.


5. J Allergy Clin Immunol Pract. 2020 May;8(5):1477-1488.e5. doi: 

10.1016/j.jaip.2020.03.012. Epub 2020 Mar 26.

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic.

Shaker MS(1), Oppenheimer J(2), Grayson M(3), Stukus D(3), Hartog N(4), Hsieh 

EWY(5), Rider N(6), Dutmer CM(5), Vander Leek TK(7), Kim H(8), Chan ES(9), Mack 

D(10), Ellis AK(11), Lang D(12), Lieberman J(13), Fleischer D(5), Golden 

DBK(14), Wallace D(15), Portnoy J(16), Mosnaim G(17), Greenhawt M(18).

Author information:

(1)Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, 

Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH.

(2)UMDMJ Rutgers University School of Medicine, Newark, NJ.

(3)Nationwide Children's Hospital, The Ohio State University School of Medicine, 

Columbus, Ohio.

(4)Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich.

(5)Children's Hospital Colorado, University of Colorado School of Medicine, 

Aurora, Colo.

(6)The Texas Children's Hospital, Section of Immunology, Allergy, and 

Retrovirology and the Baylor College of Medicine, Houston, Texas.

(7)Pediatric Allergy and Asthma, Department of Pediatrics, University of 

Alberta, Edmonton, AB, Canada.

(8)Western University and McMaster University, London, ON, Canada.

(9)BC Children's Hospital, The University of British Columbia, Vancouver, BC, 

Canada.

(10)McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, 

Burlington, ON, Canada.

(11)Division of Allergy and Immunology, Department of Medicine, Queen's 

University, Kingston, ON, Canada.

(12)Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic, 

Cleveland, Ohio.

(13)Division of Allergy and Immunology, The University of Tennessee, Memphis, 

Tenn.

(14)Division of Allergy and Clinical Immunology, John Hopkins University School 

of Medicine, Baltimore, Md.

(15)Nova Southeastern University College of Allopathic Medicine, Fort 

Lauderdale, Fla.

(16)Children's Mercy, University of Missouri-Kansas City School of Medicine, 

Kansas City, Mo.

(17)Division of Pulmonary, Allergy and Critical Care, Department of Medicine, 

NorthShore University Health System, Evanston, Ill.

(18)Children's Hospital Colorado, University of Colorado School of Medicine, 

Aurora, Colo. Electronic address: Matthew.Greenhawt@childrenscolorado.org.

Comment in

J Allergy Clin Immunol Pract. 2020 May;8(5):1475-1476.

J Allergy Clin Immunol Pract. 2020 Jul - Aug;8(7):2452-2453.

J Paediatr Child Health. 2020 Jun;56(6):995.

In the event of a global infectious pandemic, drastic measures may be needed 

that limit or require adjustment of ambulatory allergy services. However, no 

rationale for how to prioritize service shut down and patient care exists. A 

consensus-based ad-hoc expert panel of allergy/immunology specialists from the 

United States and Canada developed a service and patient prioritization 

schematic to temporarily triage allergy/immunology services. Recommendations and 

feedback were developed iteratively, using an adapted modified Delphi 

methodology to achieve consensus. During the ongoing pandemic while social 

distancing is being encouraged, most allergy/immunology care could be 

postponed/delayed or handled through virtual care. With the exception of many 

patients with primary immunodeficiency, patients on venom immunotherapy, and 

patients with asthma of a certain severity, there is limited need for 

face-to-face visits under such conditions. These suggestions are intended to 

help provide a logical approach to quickly adjust service to mitigate risk to 

both medical staff and patients. Importantly, individual community circumstances 

may be unique and require contextual consideration. The decision to enact any of 

these measures rests with the judgment of each clinician and individual health 

care system. Pandemics are unanticipated, and enforced social 

distancing/quarantining is highly unusual. This expert panel consensus document 

offers a prioritization rational to help guide decision making when such 

situations arise and an allergist/immunologist is forced to reduce services or 

makes the decision on his or her own to do so.

Copyright © 2020 American Academy of Allergy, Asthma & Immunology. Published by 

Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jaip.2020.03.012

PMCID: PMC7195089

PMID: 32224232 [Indexed for MEDLINE]


6. J Eur Acad Dermatol Venereol. 2020 Jun 25:10.1111/jdv.16774. doi: 

10.1111/jdv.16774. Online ahead of print.

Cutaneous manifestations of SARS-CoV-2 infection: a clinical update.

Gisondi P(1), PIaserico S(2), Bordin C(1), Alaibac M(2), Girolomoni G(1), Naldi 

L(3)(4).

Author information:

(1)Section of Dermatology and Venereology, Department of Medicine, University of 

Verona, Verona, Italy.

(2)Section of Dermatology, Department of Medicine, University of Padua, Padua, 

Italy.

(3)Division of Dermatology, San Bortolo Hospital, Vicenza, Italy.

(4)Centro Studi GISED, Bergamo, Italy.

On 11 March 2020, the World Health Organization (WHO) has declared the novel 

coronavirus disease (COVID-19) a global pandemic, caused by the severe acute 

respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). A consistent number of 

case reports and clinical series have been already published describing a 

complex spectrum of skin manifestations associated with the SARS-CoV-2 

infection. We carried out a review of the English-language literature up to 20 

May 2020, reporting original cases or case series of the cutaneous 

manifestations of SARS-CoV-2 virus infection. The following databases were 

consulted: PubMed, Embase, Google Scholar and ResearchGate. The search of papers 

was conducted by using the key term 'COVID-19' or 'SARS-CoV-2' or 'coronavirus' 

combined with each of the following: 'skin', 'cutaneous', 'dermatologic' or 

'dermatology', 'manifestation', 'lesions', or 'rash'. The patterns of 

dermatological manifestations associated with SARS-CoV-2 infection could be 

classified into four categories: exanthema (varicella-like, papulo-vesicular and 

morbilliform rash), vascular (chilblain-like, purpuric/petechial and livedoid 

lesions), urticarial and acro-papular eruption. Lastly, other skin 

manifestations to be considered are the cutaneous adverse reactions to the drugs 

prescribed for the treatment of COVID-19. Whether SARS-CoV-2 infection can 

directly cause a worsening of chronic inflammatory diseases such as psoriasis or 

atopic dermatitis remains to be determined. Dermatology's outlook in the 

COVID-19 pandemic is multidimensional.

© 2020 European Academy of Dermatology and Venereology.

DOI: 10.1111/jdv.16774

PMCID: PMC7362144

PMID: 32585074

COVID-19 and Atopic Dermatitis

1. Br J Dermatol. 2020 Apr 29. doi: 10.1111/bjd.19161. Online ahead of print.

Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an 

opportunity to inform care during a pandemic.

Mahil SK(1), Yiu ZZN(2), Mason KJ(2), Dand N(3), Coker B(4), Wall D(5)(6), 

Fletcher G(6), Bosma A(7), Capon F(3), Iversen L(8), Langan SM(1)(9), Di Meglio 

P(3), Musters A(7), Prieto-Merino D(9), Tsakok T(1), Warren RB(2), Flohr C(1), 

Spuls P(7), Griffiths CEM(2), Barker J(1), Irvine AD(10), Smith CH(1); 

Secure-AD, PsoPROTECT study groups.

Author information:

(1)St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation 

Trust, London, SE1 9RT, UK.

(2)Dermatology Centre, Salford Royal NHS Foundation Trust, The University of 

Manchester, Manchester Academic Health Science Centre, NIHR Manchester 

Biomedical Research Centre, Manchester, M13 9PT, UK.

(3)Department of Medical and Molecular Genetics, School of Basic & Medical 

Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, 

UK.

(4)NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, 

London, SE1 9RT, UK.

(5)Hair Restoration Blackrock, Dublin, Ireland.

(6)National and International Skin Registry Solutions (NISR), Charles Institute 

of Dermatology, Dublin, Ireland.

(7)Department of Dermatology, Amsterdam Public Health, Infection and Immunity, 

UMC, University of Amsterdam, Amsterdam, The Netherlands.

(8)Department of Dermatology, Aarhus University Hospital, Aarhus C, Denmark.

(9)Faculty of Epidemiology, and Population Health, London , School of Hygiene 

and Tropical Medicine, London, UK.

(10)St. James's Hospital, James's Street, Dublin, Ireland.

We wish to bring your attention to the PsoPROTECT (Psoriasis Patient Registry 

for Outcomes, Therapy and Epidemiology of Covid-19 infecTion) and SECURE-AD 

(Surveillance Epidemiology of Coronavirus Under Research Exclusion-Atopic 

Dermatitis) registries; two urgent global initiatives that address an unmet need 

for delineating the determinants of COVID-19 outcomes in the common cutaneous 

immune-mediated inflammatory diseases (IMIDs) psoriasis and atopic dermatitis.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/bjd.19161

PMID: 32348554


2. J Eur Acad Dermatol Venereol. 2020 Mar 29. doi: 10.1111/jdv.16411. Online ahead 

of print.

European Task Force on Atopic Dermatitis (ETFAD) statement on severe acute 

respiratory syndrome coronavirus 2 (SARS-Cov-2)-infection and atopic dermatitis.

Wollenberg A(1)(2), Flohr C(3), Simon D(4), Cork MJ(5), Thyssen JP(6)(7), Bieber 

T(8), de Bruin-Weller MS(9), Weidinger S(10), Deleuran M(11), Taieb A(12), Paul 

C(13), Trzeciak M(14), Werfel T(15), Seneschal J(16), Barbarot S(17), Darsow 

U(18), Torrelo A(19), Stalder JF(20), Svensson √Ö(21), Hijnen D(22), Gelmetti 

C(23), Szalai Z(24), Gieler U(25), De Raeve L(26), Kunz B(27), Spuls P(28), von 

Kobyletzki LB(29)(30), F√∂lster-Holst R(10), Chernyshov PV(31), Cristen-Zaech 

S(32), Heratizadeh A(15), Ring J(33)(34), Vestergaard C(11).

Author information:

(1)Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, 

Germany.

(2)Department of Dermatology I, M√ºnchen Klinik Thalkirchner Strasse, Munich, 

Germany.

(3)St John's Institute of Dermatology, King's College London and Guy's & St 

Thomas' NHS Foundation Trust, London, UK.

(4)Department of Dermatology, Inselspital, Bern University Hospital, University 

of Bern, Bern, Switzerland.

(5)Sheffield Dermatology Research. Department of Infection, Immunity and 

Cardiovascular Disease, The University of Sheffield, Sheffield, UK.

(6)Department of Dermatology and Allergy, Herlev and Gentofte Hospital, 

Hellerup, Denmark.

(7)Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark.

(8)Department of Dermatology and Allergy, Christine K√ºhne-Center for Allergy 

Research and Education, University Hospital of Bonn, Germany.

(9)National Expertise Center of Atopic Dermatitis, Department of Dermatology and 

Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.

(10)Department of Dermatology and Allergy, University Hospital 

Schleswig-Holstein, Kiel, Germany.

(11)Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.

(12)University of Bordeaux, Bordeaux, France.

(13)Department of Dermatology, Toulouse University, Toulouse, France.

(14)Department of Dermatology, Venereology and Allergology, Medical University 

of Gdansk, Gdansk, Poland.

(15)Department of Dermatology and Allergy, Hannover Medical School, Hannover, 

Germany.

(16)Department of Adult and Pediatric Dermatology, CHU Bordeaux, University of 

Bordeaux, Bordeaux, France.

(17)Department of Dermatology, CHU, Nantes, France.

(18)Department of Dermatology and Allergy, Technical University of Munich, 

Munich, Germany.

(19)Department of Dermatology, Hospital Infantil Niño Jesús, Madrid, Spain.

(20)Department of Dermatology, Nantes Universit√©, CHU Nantes, UMR 1280 PhAN, 

INRAE, F-44000, Nantes, France.

(21)Department of Dermatology, Skane University hospital, Malmö, Sweden.

(22)Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, 

The Netherlands.

(23)Department of Pathophysiology and Transplantation, University of Milan, 

Head, Unit of Pediatric Dermatology, Milan, Italy.

(24)Department of Dermatology of Heim, P√°l National Children's Institute 

Budapest, Budapest, Hungary.

(25)Department of Dermatology, University of Gie√üen and Marburg GmbH, Gie√üen, 

Germany.

(26)Department of Dermatology, Universitair Ziekenhuis Brussel (UZB), Free 

University of Brussels (VUB), Brussels, Belgium.

(27)Dermatologicum, Hamburg, Germany.

(28)Department of Dermatology, Amsterdam Public Health, Infection and Immunity, 

Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

(29)University Healthcare Research Center, Faculty of Medicine, Lund University, 

Malmö, Sweden.

(30)Department of Occupational and Environmental Dermatology, Lund University, 

Skåne University Hospital, Malmö, Sweden.

(31)Department of Dermatology and Venereology, National Medical University, 

Kiev, Ukraine.

(32)Pediatric Dermatology Unit, Departments of Dermatology and Pediatrics, 

Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

(33)Department of Dermatology and Allergy Biederstein, School of Medicine, 

Technical University of Munich, Munich, Germany.

(34)Christiane-K√ºhne Center for Allergy Research and Education (CK-Care), Davos, 

Switzerland.

Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory 

comorbidities.1,2 Severely affected patients are often treated with 

immune-modulating systemic drugs.3,4 On March 11th 2020, the World Health 

Organization declared the 2019 novel coronavirus severe acute respiratory 

syndrome (SARS-Cov-2) epidemic to be a pandemic. The number of cases worldwide 

is increasing exponentially and poses a major health threat, especially for 

those who are elderly, immuno-compromised, or have comorbidities. This also 

applies to AD patients on systemic immune-modulating treatment. In these days of 

uncertainty, reallocation of medical resources, curfew, hoarding, and shutdown 

of normal social life, patients, caregivers and doctors ask questions regarding 

the continuation of systemic immune-modulating treatment of AD patients. The 

ETFAD decided to address some of these questions here.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/jdv.16411

PMID: 32223003


3. J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16527. Online ahead 

of print.

Safety of dupilumab in severe atopic dermatitis and infection of Covid-19: two 

case reports.

Ferrucci S(1), Romagnuolo M(1)(2), Angileri L(1)(2), Berti E(1)(2), Tavecchio 

S(1)(2).

Author information:

(1)Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 

Via Pace, 9, 20122, Milan, Italy.

(2)Department of Physiopathology and Transplantation, Universit√† degli Studi di 

Milano, Milan, Italy.

Dupilumab is a fully human monoclonal antibody against the alfa subunit of 

interleukin (IL)-4 receptor that blocks signalling from both IL-4 and IL-13, 

which are key type 2 cytokines in the pathophysiology of atopic dermatitis (AD). 

It shows good efficacy with a rapid response and good safety with few side 

effects. In a paper of Deleuran et al. the authors showed long term safety and 

efficacy of dupilumab; they reported viral upper respiratory tract infection, 

cough and influenza in about 2% of patients.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/jdv.16527

PMID: 32330323


4. Am J Clin Dermatol. 2020 Apr 10. doi: 10.1007/s40257-020-00514-2. Online ahead 

of print.

Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic.

Torres T(1)(2), Puig L(3).

Author information:

(1)Department of Dermatology, Centro Hospitalar Universit√°rio Do Porto, Porto, 

Portugal. torres.tiago@outlook.com.

(2)Instituto de Ci√™ncias Biom√©dicas Abel Salazar, University of Porto, Porto, 

Portugal. torres.tiago@outlook.com.

(3)Department of Dermatology, Hospital de La Santa Creu I Sant Pau, Barcelona, 

Spain.

Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by a novel 

coronavirus called severe acute respiratory syndrome coronavirus 2¬†(SARS-CoV-2). 

COVID-19 has spread rapidly worldwide and has been shown to have a wide spectrum 

of severity. COVID-19 has become a public health emergency of relevant 

international concern, and it was declared a pandemic by the World Health 

Organization on 11 March, 2020. SARS-CoV-2 infection in severe cases involves 

the host response as an important contributor to the disease process and tissue 

damage, mainly due to dysregulated and excessive innate immune responses. The 

primary immune response leads to viral clearance in the majority of cases. 

However, in a subgroup of patients, the secondary immune response may be 

exaggerated, leading to inflammatory-induced lung injury and other complications 

including pneumonitis, acute respiratory distress syndrome, respiratory failure, 

shock, organ failure, and potentially death. Several cutaneous immune-mediated 

diseases, including psoriasis, atopic dermatitis, and hidradenitis suppurativa, 

are therapeutically managed with biologic and non-biologic immunosuppressive and 

immunomodulatory drugs. The outbreak of COVID-19 affects the management of these 

chronic conditions, not only for those who are already receiving treatment but 

also for those who are about to start a new treatment to control their disease. 

In this article, the management of cutaneous immune-mediated diseases during the 

COVID-19 pandemic is discussed.

DOI: 10.1007/s40257-020-00514-2

PMID: 32277351


5. J Eur Acad Dermatol Venereol. 2020 Apr 27. doi: 10.1111/jdv.16552. Online ahead 

of print.

No evidence of increased risk for COVID-19 infection in patients treated with 

Dupilumab for atopic dermatitis in a high-epidemic area - Bergamo, Lombardy, 

Italy.

Carugno A(1), Raponi F(1), Locatelli AG(1), Vezzoli P(1), Gambini DM(1), Di 

Mercurio M(1), Robustelli Test E(2), Sena P(1).

Author information:

(1)UOC Dermatologia, ASST Papa Giovanni XXIII Bergamo Hospital, Lombardy, 

Bergamo, Italy.

(2)Dermatology Clinic, Department of Medical Sciences and Public Health, 

University of Cagliari, Cagliari, Italy.

Atopic dermatitis (AD) is a chronic inflammatory skin disease. Patients with AD 

have increased infection risk, including skin infections and systemic 

infections. Dupilumab, a fully human monoclonal antibody, blocks the shared 

receptor component for interleukin-4 (IL-4) and IL-13. Dupilumab is approved for 

inadequately controlled moderate-to-severe AD.1.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/jdv.16552

PMID: 32339362


6. J Eur Acad Dermatol Venereol. 2020 Apr 22. doi: 10.1111/jdv.16515. Online ahead 

of print.

Dermatologists and SARS-CoV-2: The impact of the pandemic on daily practice.

Gisondi P(1), Piaserico S(2), Conti A(3), Naldi L(4)(5).

Author information:

(1)Department of Medicine, Section of Dermatology and Venereology, University of 

Verona, Verona, Italy.

(2)Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy.

(3)Department of Surgical, Medical, Dental and Morphological Sciences related to 

Transplant, Oncology and Regenerative Medicine, Dermatology Unit, University of 

Modena and Reggio Emilia, Modena, Italy.

(4)Study Centre of the Italian Group for the Epidemiologic Research in 

Dermatology (GISED), Bergamo, Italy.

(5)Department of Dermatology, San Bortolo Hospital, Vicenza, Italy.

Since the first case of "pneumonia of unknown aetiology" was diagnosed at the 

Wuhan Jinyintan Hospital in China on 30 December 2019, what was recognised 

thereafter as "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) has 

spread over the four continents, causing the respiratory manifestations of 

Coronavirus disease-19 (COVID- 19) and satisfying the epidemiological criteria 

for a label of "pandemic." The ongoing SARS-CoV-2 pandemic is having a huge 

impact on dermatological practice including the marked reduction of face-to-face 

consultations in favour of teledermatology, the uncertainties concerning the 

outcome of COVID-19 infection in patients with common inflammatory disorders 

such as psoriasis or atopic dermatitis receiving 

immunosuppressive/immunomodulating systemic therapies; the direct involvement of 

dermatologists in COVID-19 care for patients assistance and new research needs 

to be addressed. It is not known yet, if skin lesions and derangement of the 

skin barrier could make it easier for SARS-CoV-2 to transmit via indirect 

contact; it remains to be defined if specific mucosal or skin lesions are 

associated with SARS-CoV-2 infection, although some unpublished observations 

indicate the occurrence of a transient varicelliform exanthema during the early 

phase of the infection. SARS-CoV-2 is a new pathogen for humans that is highly 

contagious, can spread quickly, and is capable of causing enormous health, 

economic and societal impacts in any setting. The consequences may continue long 

after the pandemic resolves, and new management modalities for dermatology may 

originate from the COVID-19 disaster. Learning from experience may help to cope 

with future major societal changes.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/jdv.16515

PMID: 32320091


7. Dermatol Ther. 2020 May 2. doi: 10.1111/dth.13502. Online ahead of print.

Dupilumab and COVID-19: what should we expect?

Patruno C(1), Stingeni L(2), Fabbrocini G(3), Hansel K(2), Napolitano M(4).

Author information:

(1)Department of Health Sciences, University Magna Graecia of Catanzaro, 

Catanzaro, Italy.

(2)Dermatology Section, Department of Medicine, University of Perugia, Perugia, 

Italy.

(3)Section of Dermatology, Department of Clinical Medicine and Surgery, 

University of Naples Federico II, Naples, Italy.

(4)Department of Health Sciences Vincenzo Tiberio, University of Molise, 

Campobasso, Italy.

COVID-19 is a pandemic disease caused by SARS-CoV-2 with high morbidity and 

mortality. There are very limited data on the interference of immunomodulating 

drugs on the risk of infection and on the course of the disease. In particular, 

there are no current clinical data about the interference exerted by dupilumab, 

a biologic drugs blocking IL-4 and IL-13, used for adult atopic dermatitis (AD). 

The pathogenesis of COVID-19 is complex, characterized by an immune response 

mainly Th1/Th17. The hyper-activation of these cells may cause the release of 

proinflammatory cytokines that may result in lung impairment. IL-4 and IL-13 are 

Th2 cytokines, thus being part of a pathway not considered implicated in host 

defense mechanism against viral infections. Indeed, viral infections, including 

respiratory infections, have not been reported as a significant adverse event in 

clinical trials. Furthermore, dupilumab has been proven to be efficacious also 

in exacerbations of asthma, and it is known that viral infections can worsen 

asthma. Therefore, the current data seem to suggest that treatment with 

dupilumab should not be stopped during COVID-19 pandemic. Obviously, a careful 

assessment is mandatory for each individual patient and further studies are 

necessary to characterize the immunologic responses in COVID-19. This article is 

protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

DOI: 10.1111/dth.13502

PMID: 32362061


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