Atopic dermatitis

Atopic Dermatitis and COVID 19

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.

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 Ni√±o Jes√∫s, 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, Malm√∂, 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,

Malm√∂, Sweden.

(30)Department of Occupational and Environmental Dermatology, Lund University,

Sk√•ne University Hospital, Malm√∂, 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.

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.

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.

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.

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

DOI: 10.1111/dth.13502

PMID: 32362061