COVID19 and Dermatology

Covid-19 & Dermatology Recent Updates

1. Dermatol Ther. 2021 Feb 22:e14908. doi: 10.1111/dth.14908. Online ahead of

print.

Management of Melanoma Patients During COVID-19 Pandemic In An Italian Skin

Unit.

Filoni A(1), Paolo DF(1), Cappellesso R(2), Dall'Olmo L(1), Salimian N(3), Spina

R(1), Tropea S(1), Rastrelli M(1)(3), Russano F(1), D'Amico M(1), Collodetto

A(1), Rossi CR(1)(3), Buja A(4), Vecchiato A(1), Alaibac M(5), Mocellin S(1)(3).

Author information:

(1)Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology

(IRCCS), Padova, Italy.

(2)Division of Surgical Pathology and Cytopathology, Department of Medicine,

School of Medicine and Surgery, University of Padua, Padua, Italy.

(3)Department of Surgical, Oncological and Gastroenterological Sciences, Faculty

of Medicine and Surgery, University of Padua, Padua, Italy.

(4)Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and

Surgery, University of Padua, Padua, Italy.

(5)Division of Dermatology, Department of Medicine, University of Padua, Padua,

Italy.

Due to the COVID-19 crisis, many scheduled medical and surgical activities have

been suspended. This interruption to the healthcare system can negatively affect

the diagnosis and management of melanoma. Neglecting melanoma throughout the

outbreak may be associated with increased rates of mortality, morbidity, and

healthcare expenses. We performed a retrospective review of all dermatological

and surgical activity performed in our Melanoma Skin Unit between February 23,

2020 and May 21, 2020 and compared these data with those from the same period in

2019. During the lockdown period, we observed a decrease in dermatologic

follow-up (DFU) (-30.2%) and in surgical follow-up (SFU) (-37%), and no

modification of melanoma diagnosis (-3%). Finally, surgical excisions (SE) (+

31.7%) increased, but sentinel lymph node biopsy (SLNB) (-29%) and lymph node

dissections(LND) (-64%) decreased compared to the same period in 2019. Our

experience supports the continuation of surgical and diagnostic procedures in

patients with melanoma during the COVID-19 pandemic. Surgical and follow-up

procedures for the diagnosis and treatment of melanoma should not be postponed

considering that the pandemic is lasting for an extended period. This article is

DOI: 10.1111/dth.14908

PMID: 33619813

2. Eur J Pharm Sci. 2021 Feb 19:105771. doi: 10.1016/j.ejps.2021.105771. Online

ahead of print.

In silico identification of available drugs targeting cell surface BiP to

disrupt SARS-CoV-2 binding and replication: Drug repurposing approach.

Zhang Y(1), Greer RA(1), Song Y(2), Praveen H(1), Song Y(3).

Author information:

(1)Department of Biomedical Engineering, The University of Alabama at

Birmingham, 1825 University Blvd, Birmingham, AL 35294.

(2)Department of Dermatology, The University of Alabama at Birmingham, 1825

University Blvd, Birmingham, AL 35294.

(3)Department of Biomedical Engineering, The University of Alabama at

Birmingham, 1825 University Blvd, Birmingham, AL 35294. Electronic address:

yhsong@uab.edu.

AIMS: Cell surface binding immunoglobin protein (csBiP) is predicted to be

susceptible to SARS-CoV-2 binding. With a substrate-binding domain (SBD) that

binds to polypeptides and a nucleotide-binding domain (NBD) that can initiate

extrinsic caspase-dependent apoptosis, csBiP may be a promising therapeutic

target for COVID-19. This study aims to identify FDA-approved drugs that can

neutralize viral binding and prevent viral replication by targeting the

functional domains of csBiP.

METHODS: In silico screening of 1999 FDA-approved drugs against the functional

domains of BiP were performed using three molecular docking programs to avoid

bias from individual docking programs. Top ligands were selected by averaging

the ligand rankings from three programs. Interactions between top ligands and

functional domains of BiP were analyzed.

KEY FINDINGS: The top 10 SBD-binding candidates are velpatasvir, irinotecan,

netupitant, lapatinib, doramectin, conivaptan, fenoverine, duvelisib,

irbesartan, and pazopanib. The top 10 NBD-binding candidates are nilotinib,

eltrombopag, grapiprant, topotecan, acetohexamide, vemurafenib, paritaprevir,

pixantrone, azosemide, and piperaquine-phosphate. Among them, Velpatasvir and

paritaprevir are antiviral agents that target the protease of hepatitis C virus.

Netupitant is an anti-inflammatory drug that inhibits neurokinin-1 receptor,

which contributes to acute inflammation. Grapiprant is an anti-inflammatory drug

that inhibits the prostaglandin E2 receptor protein subtype 4, which is

expressed on immune cells and triggers inflammation. These predicted SBD-binding

drugs could disrupt SARS-CoV-2 binding to csBiP, and NBD-binding drugs may

falter viral attachment and replication by locking the SBD in closed

conformation and triggering apoptosis in infected cells.

SIGNIFICANCE: csBiP appears to be a novel therapeutic target against COVID-19 by

preventing viral attachment and replication. These identified drugs could be

repurposed to treat COVID-19 patients.

DOI: 10.1016/j.ejps.2021.105771

PMID: 33617948

Conflict of interest statement: Declaration of Competing Interest The authors

declare no competing interest in this work.

3. Dermatol Pract Concept. 2021 Jan 29;11(1):e2021153. doi: 10.5826/dpc.1101a153.

eCollection 2021 Jan.

Impact of the COVID-19 Pandemic on Dermatology Practice Worldwide: Results of a

Survey Promoted by the International Dermoscopy Society (IDS).

Conforti C(1), Lallas A(2), Argenziano G(3), Dianzani C(4), Di Meo N(1),

Giuffrida R(5), Kittler H(6), Malvehy J(7), Marghoob AA(8), Soyer HP(9)(10),

Zalaudek I(1).

Author information:

(1)Department of Dermatology and Venereology, Dermatology Clinic, Maggiore

Hospital, University of Trieste, Italy.

(2)First Dermatology Department, Aristotle University of Thessaloniki, Greece.

(3)Department of Dermatology, University of Campania, Luigi Vanvitelli, Naples,

Italy.

(4)Dermatology Section, Plastic and Reconstructive Surgery Unit, Campus

Biomedico University, Rome, Italy.

(5)Department of Clinical and Experimental Medicine, Dermatology, University of

Messina, Italy.

(6)Department of Dermatology, Medical University of Vienna, Austria.

(7)Dermatology Department, Melanoma Unit, Hospital Clinic, University of

Barcelona, Spain.

(8)Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer

Center, New York, NY, USA.

(9)The University of Queensland Diamantina Institute, The University of

Queensland, Dermatology Research Centre, Brisbane, QLD, Australia.

(10)Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD

Australia.

INTRODUCTION: The International Dermoscopy Society (IDS) conducted an online

survey to investigate the impact of coronavirus disease 2019 (COVID-19) outbreak

on the daily practice of dermatologists working with skin cancer patients, to

collect data regarding the frequency of skin manifestations noticed by the

members, and to obtain information about the use of teledermatology during the

pandemic.

METHODS: All IDS members were asked to fill in a questionnaire, sent by email. A

questionnaire available in English was sent to all IDS members (≈16.0000

members) by email. The questionnaire was anonymous, with a compiling time of

less than 5 minutes. The survey was open for 30 days (from April 24, 2020 to May

24, 2020) and it could only be filled out once.

RESULTS: Overall, 678 dermatologists responded to the questionnaire; 334 members

stated that there has been a reduction of more than 75% in daily work activity

during the pandemic, 265 dermatologists worked fewer days per week, and 118

experienced telemedicine for the first time. Acrodermatitis was the most

frequently observed skin manifestation (n = 80) followed by urticarial rash (n =

69), morbilliform rash (n = 53) and purpuric manifestation (n = 40). In regard

to the role of teledermatology, 565 dermatologists reported an increased number

of teleconsultations, and the number of melanomas diagnosed during the pandemic

was practically 0 for 385 (56.78%) of respondents.

CONCLUSION: This survey highlights that the outbreak had a negative impact on

most dermatology services, with a significant reduction in consultation time

spent for chronic patients, and an increased risk of missed melanoma and

nonmelanoma skin cancer (NMSC) diagnosis. Moreover, our study confirms earlier

findings of a wide range of skin manifestations associated with COVID-19.

DOI: 10.5826/dpc.1101a153

PMCID: PMC7875667

PMID: 33614221

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

conflicts of interest to disclose.

4. Ther Adv Chronic Dis. 2021 Feb 9;12:2040622320982171. doi:

10.1177/2040622320982171. eCollection 2021.

Early fibroproliferative signs on high-resolution CT are associated with

mortality in COVID-19 pneumonia patients with ARDS: a retrospective study.

Zeng Z(1), Xiang M(2), Guan H(2), Liu Y(2), Zhang H(3), Xia L(2), Zhan J(4), Hu

Q(5).

Author information:

(1)Department and Institute of Infectious Diseases, Tongji Hospital, Tongji

Medical College, Huazhong University of Science and Technology, Wuhan, China.

(2)Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong

University of Science and Technology, Wuhan, China.

(3)Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College,

Huazhong University of Science and Technology, Wuhan, China.

(4)Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong

University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030,

China.

(5)Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong

University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan 430030,

China.

OBJECTIVES: To investigate the chest high-resolution computed tomography (HRCT)

findings in coronavirus disease 2019 (COVID-19) pneumonia patients with acute

respiratory distress syndrome (ARDS) and to evaluate its relationship with

clinical outcome.

MATERIALS AND METHODS: In this retrospective study, 79 COVID-19 patients with

ARDS were recruited. Clinical data were extracted from electronic medical

records and analyzed. HRCT scans, obtained within 3 days before clinical ARDS

onset, were evaluated by three independent observers and graded into six

findings according to the extent of fibroproliferation. Multivariable Cox

proportional hazard regression analysis was used to assess the independent

predictive value of the computed tomography (CT) score and radiological

fibroproliferation. Patient survival was determined by Kaplan-Meier analysis.

RESULTS: Compared with survivors, non-survivors showed higher rates of lung

fibroproliferation, whereas there were no significant differences in the area of

increased attenuation without traction bronchiolectasis or bronchiectasis. A

HRCT score <230 enabled the prediction of survival with 73.5% sensitivity and

93.3% specificity, 100% negative predictive value (NPP), 83.3% positive

predictive value (PPV) and 88.6% accuracy (Area Under the Curve [AUC] = 0.9; 95%

confidence Interval [CI] 0.831-0.968). A multivariate Cox proportional hazards

model showed that the HRCT score is a significant independent risk factor for

mortality (Hazard Ratio [HR] 9.94; 95% CI 4.10-24.12). Kaplan-Meier analysis

revealed that a HRCT score ⩾230 was associated with a higher fatality rate.

Organ injury occurred less frequently in patients with a HRCT score <230

compared to those with a HRCT score ⩾230.

CONCLUSION: Early pulmonary fibroproliferative signs on HRCT are associated with

increased mortality and susceptibility to organ injury in COVID-19 pneumonia

patients with early ARDS.

DOI: 10.1177/2040622320982171

PMCID: PMC7876572

PMID: 33613933

Conflict of interest statement: Conflict of interest statement: The authors

declare that there is no conflict of interest.

5. Int J Womens Dermatol. 2021 Jan 12. doi: 10.1016/j.ijwd.2021.01.007. Online

ahead of print.

The Art of Prevention: COVID-19 Vaccine Preparedness for the Dermatologist.

Rice SM(1), Ferree SD(2)(3), Atanaskova Mesinkovska N(4), Shadi Kourosh A(1)(3).

Author information:

(1)Massachusetts General Hospital Department of Dermatology, Boston MA, United

States.

(2)Cambridge Health Alliance, Cambridge MA, United States.

(3)Harvard Medical School, Boston MA, United States.

(4)University of California Irvine Department of Dermatology, Irvine, CA, United

States.

As COVID-19 vaccinations begin, dermatologists must be aware of the cutaneous

adverse events reported in the clinical trials, including injection site and

hypersensitivity reactions, and emerging evidence of dermal filler injection

reactions following vaccination. The filler reaction may represent development

of a delayed-type hypersensitivity in the setting of another immunologic

trigger, i.e. the vaccine. Upon literature review of similar reactions, their

pathophysiology and management, we present a set of timely clinical

considerations for counseling, prevention and management of the possible

cutaneous sequelae of the COVID-19 vaccine, and encourage documentation of

vaccine-related reactions to aid the safety-data collection in the Vaccine

Adverse Event Reporting System and the American Academy of Dermatology COVID-19

Registry.

DOI: 10.1016/j.ijwd.2021.01.007

PMCID: PMC7802521

PMID: 33457487

Conflict of interest statement: Funding: This research did not receive any

specific grant from funding agencies in the public, commercial, or

not-for-profit sectors.

6. Br J Dermatol. 2021 Feb 20. doi: 10.1111/bjd.19882. Online ahead of print.

Intention of COVID-19 vaccination among psoriatic patients compared to

immunosuppressed patients with other skin diseases and factors influencing their

decision.

Sotiriou E(1), Bakirtzi K(1), Papadimitriou I(1), Paschou E(1), Vakirlis E(1),

Lallas A(1), Ioannides D(1).

Author information:

(1)First Department of Dermatology and Venereology, School of Medicine,

Aristotle University of Thessaloniki.

Psoriasis (Ps) is a chronic, immune-mediated skin disease with systemic

involvement. Therapeutic advancements in its management have considerably

improved disease activity and quality of life, and reduced hospitalization

rates. Nevertheless, prolonged immunosuppression in psoriatic patients may

increase their susceptibility to opportunistic infections.

DOI: 10.1111/bjd.19882

PMID: 33609286

7. Int J Infect Dis. 2021 Feb 16:S1201-9712(21)00140-5. doi:

10.1016/j.ijid.2021.02.054. Online ahead of print.

Convalescent plasma treatment is associated with lower mortality and better

outcomes in high risk COVID-19 patients - propensity score matched case-control

study.

Tworek A(1), Jaroń K(2), Uszyńska-Kałuża B(3), Rydzewski A(4), Gil R(5), Deptała

A(6), Franek E(7), Wójtowicz R(8), Życińska K(9), Walecka I(10), Cicha M(11),

Wierzba W(12), Zaczyński A(13), Król ZJ(13), Rydzewska G(14).

Author information:

(1)Clinical Department of Internal Medicine and Gastroenterology with

Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of

the Interior and Administration, Warsaw, Poland. Electronic address:

adamtworek2@gmail.com.

(2)Clinical Department of Internal Medicine and Gastroenterology with

Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of

the Interior and Administration, Warsaw, Poland.

(3)Blood Donation Center of Ministry of the Interior and Administration, Warsaw,

Poland.

(4)Department of Internal Medicine, Nephrology and Transplantation Medicine,

Central Clinical Hospital of the Ministry of Interior and Administration,

Warsaw, Poland; Centre of Postgraduate Medical Education, Warsaw, Poland.

(5)Clinical Department of Invasive Cardiology in Central Clinical Hospital of

the Ministry of the Interior and Administration, Warsaw, Poland; Mossakowski

Clinical Research Centre, Polish Academy of Sciences, Warsaw, Poland.

(6)Clinical Department of Oncology and Hematology in Central Clinical Hospital

of the Ministry of the Interior and Administration, Warsaw, Poland; Medical

University of Warsaw.

(7)Mossakowski Clinical Research Centre, Polish Academy of Sciences, Warsaw,

Poland; Clinical Department of Internal Medicine, Endocrinology and Diabetology

in Central Clinical Hospital of the Ministry of the Interior and Administration,

Warsaw, Poland.

(8)Clinical Department of Anesthesiology and Intensive Care Central Clinical

Hospital of the Ministry of the Interior and Administration, Warsaw, Poland.

(9)Medical University of Warsaw; Clinical Department of Rheumatology, Connective

Tissue Diseases and Rare Diseases, Central Clinical Hospital of the Ministry of

the Interior and Administration, Warsaw, Poland.

(10)Dermatology Department, Central Clinical Hospital of the Ministry of the

Interior and Administration, Warsaw, Poland; Dermatology Department Centre of

Postgraduate Medical Education, Warsaw.

(11)Diagnostic Laboratory of Central Clinical Hospital of the Ministry of the

Interior and Administration, Warsaw, Poland.

(12)Central Clinical Hospital of the Ministry of the Interior and

Administration, Warsaw, Poland; University of Humanities and Economics in Łódź,

Satellite Campus in Warsaw, Warsaw, Poland.

(13)Central Clinical Hospital of the Ministry of the Interior and

Administration, Warsaw, Poland.

(14)Clinical Department of Internal Medicine and Gastroenterology with

Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of

the Interior and Administration, Warsaw, Poland; Collegium Medicum, Jan

Kochanowski University, Kielce.

OBJECTIVE: The aim of the study was to investigate efficacy and safety of

convalescent plasma (CP) transfusion in a group of high-risk COVID-19 patients.

METHODS: This prospective study included 204 patients from a single

tertiary-care hospital, hospitalized with COVID-19, of whom 102 were treated

with CP administration and standard care (PG) and 102 others who received

standard care only (CG). The CG was selected from 336 hospitalized patients

using the propensity score matching (PSM) technique using age, MEWS score, and

comorbidities. The primary outcome was mortality rate; secondary outcomes were

the requirement of ventilator, length of ventilator need, length of intensive

care unit (ICU) stay, and length of overall hospital confinement. Additionally,

parameters predicting death in COVID-19 patients were identified.

RESULTS: Findings confirmed a significantly lower mortality rate in the PG

versus the CG (13.7% vs. 34.3 %, p=0.001) and a significant difference in

cumulative incidence of death between the two groups (p<0.001). CP treatment was

associated to lower risk of death (OR=0.25 CI95 [0.06; 0.91], p=0.041). There

were no significant differences in ICU stay, ventilator time, and

hospitalization time between the two groups.

CONCLUSIONS: A significantly lower mortality rate was observed in the group of

patients treated with CP. Age, presence of cardiac insufficiency, active cancer,

requirement of ventilator, and length of hospitalization were significantly

increasing the risk of death in both groups. Our study shows, that CP brings

better outcomes when administrated in the earlier stage of high-risk COVID-19

disease.

DOI: 10.1016/j.ijid.2021.02.054

PMCID: PMC7885631

PMID: 33607305

8. Dermatitis. 2021 Feb 16. doi: 10.1097/DER.0000000000000721. Online ahead of

print.

Hand Dermatitis in the Time of COVID-19: A Review of Occupational Irritant

Contact Dermatitis.

Kersh AE(1), Johansen M, Ojeaga A, de la Feld S.

Author information:

(1)From the Department of Dermatology, Perelman School of Medicine at the

University of Pennsylvania, Philadelphia Department of Dermatology, Emory

University Hospital Emory University School of Medicine, Atlanta, GA Department

of Dermatology, Saint Louis University School of Medicine, MO.

Occupational contact dermatitis accounts for 95% of all cases of occupational

skin disease with irritant contact dermatitis (ICD) constituting 80% to 90% of

these cases. Health care workers, hairdressers, and food service workers are

typically most affected by occupational ICD of the hands as these occupations

require frequent hand hygiene and/or prolonged exposure to water, also known as

"wet work." In the context of the current COVID-19 pandemic, frequent hand

hygiene has become a global recommendation for all individuals, and new

workplace guidelines for hand sanitization and surface sterilization are

affecting occupations not previously considered at risk of excessive wet work

including grocery or retail workers, postal workers, sanitization workers, and

others. In this review, we discuss the etiology and pathogenesis of occupational

ICD with additional focus on treatment and interventions that can be made at an

institutional and even national level for education and prevention of ICD

resulting from frequent hand hygiene.

DOI: 10.1097/DER.0000000000000721

PMID: 33606414

Conflict of interest statement: The authors have no funding or conflicts of

interest to declare.

9. Dermatol Ther. 2021 Feb 18:e14902. doi: 10.1111/dth.14902. Online ahead of

print.

A Convolutional Neural Network architecture for the recognition of cutaneous

manifestations of COVID-19.

Mathur J(1), Chouhan V(1), Pangti R(2), Kumar S(1), Gupta S(2).

Author information:

(1)Nurithm Labs Private Limited, Noida, India.

(2)Department of Dermatology and Venereology, All India Institute of Medical

Sciences, New Delhi, India.

BACKGROUND: During the COVID-19 pandemic, dermatologists reported an array of

different cutaneous manifestations of the disease. It is challenging to

discriminate COVID-19-related cutaneous manifestations from other closely

resembling skin lesions.

OBJECTIVES: To generate and evaluate a novel CNN (Convolutional Neural Network)

ensemble architecture for detection of COVID-19-associated skin lesions from

clinical images.

METHODS: An ensemble model of three different CNN-based algorithms was trained

with clinical images of skin lesions from confirmed COVID-19 positive patients,

healthy controls as well as 18 other common skin conditions, which included

close mimics of COVID-19 skin lesions such as urticaria, varicella, pityriasis

rosea, herpes zoster, bullous pemphigoid and psoriasis.

RESULTS: The multi-class model demonstrated an overall top-1 accuracy of 86.7%

for all 20 diseases. The sensitivity and specificity of COVID-19-rash detection

were found to be 84.2±5.1% and 99.5±0.2%, respectively. The positive predictive

value, NPV and area under curve values for COVID-19-rash were 88.0±5.6%,

99.4±0.2% and 0.97±0.25, respectively. The binary classifier had a mean

sensitivity, specificity and accuracy of 76.81±6.25%, 99.77±0.14% and

98.91±0.17%, respectively for COVID-19 rash. The model was robust in detection

of all skin lesions on both white and skin of color, although only a few images

of COVID-19-associated skin lesions from skin of color were available.

CONCLUSIONS: To our best knowledge, this is the first machine learning-based

study for automated detection of COVID-19 based on skin images and may provide a

useful decision support tool for physicians to optimize contact-free COVID-19

triage, differential diagnosis of skin lesions and patient care. This article is

DOI: 10.1111/dth.14902

PMID: 33604961

10. Schizophr Bull. 2021 Feb 19:sbab012. doi: 10.1093/schbul/sbab012. Online ahead

of print.

COVID-19 Prevalence and Mortality Among Schizophrenia Patients: A Large-Scale

Retrospective Cohort Study.

Tzur Bitan D(1)(2), Krieger I(2), Kridin K(3), Komantscher D(4), Scheinman Y(4),

Weinstein O(4)(5), Cohen AD(4)(6), Cicurel AA(7)(8), Feingold D(1).

Author information:

(1)Department of Behavioral Sciences, Ariel University, Ariel, Israel.

(2)Shalvata Mental Health Center, affiliated with the Sackler School of

Medicine, Tel Aviv University, Tel Aviv, Israel.

(3)Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck,

Germany.

(4)Department of Quality Measurements and Research, Clalit Health Services, Tel

Aviv, Israel.

(5)Hospital Division, Clalit Health Services, Tel Aviv, Israel.

(6)Siaal Research Center for Family Medicine and Primary Care, Faculty of Health

Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.

(7)Division of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel.

(8)Division of Community Health, Faculty of Health Sciences, Ben-Gurion

University of the Negev, Beer Sheva, Israel.

OBJECTIVE: Individuals with schizophrenia may be at an increased risk for

COVID-19 morbidity due to the disease characteristics. In this study, we aimed

to explore the odds of significant COVID-19 morbidity and mortality among

schizophrenia patients while controlling for potential sociodemographic and

medical confounders.

METHODS: Schizophrenia patients and age-and-sex matched controls (total n = 51

078) were assessed for frequency of COVID-19 positivity, hospitalizations, and

mortality. The odds for COVID-19-associated hospitalization and mortality were

calculated using logistic regression models, while controlling for age, sex,

marital status, sector, socioeconomic status, diabetes, ischemic heart disease,

hypertension, hyperlipidemia, obesity, smoking, and chronic obstructive

pulmonary disease.

RESULTS: Individuals with schizophrenia were less likely to test positive for

COVID-19; however, they were twice as likely to be hospitalized for COVID-19 (OR

2.15 95% CI 1.63-2.82, P < .0001), even after controlling for sociodemographic

and clinical risk factors (OR 1.88 95% CI 1.39-2.55, P < .0001). Furthermore,

they were 3 times more likely to experience COVID-19 mortality (OR 3.27 95% CI

1.39-7.68, P < .0001), compared to controls.

CONCLUSIONS: We found evidence of associations between schizophrenia and

increased COVID-19 morbidity and mortality compared to controls regardless of

sociodemographic and medical factors. As these patients present with a

combination of potential risk factors for mortality, efforts should be made to

minimize the effects of the pandemic on this vulnerable population.

please email: journals.permissions@oup.com.

DOI: 10.1093/schbul/sbab012

PMID: 33604657

Covid-19 & Dermatologic symptoms

1. Dermatol Ther. 2020 Jul 25. doi: 10.1111/dth.14068. Online ahead of print.

What the physicians should know about mast cells, dendritic cells, urticaria and

omalizumab during COVID-19 or asymptomatic infections due to SARS-CoV-2?

Criado PR(1)(2), Pagliari C(3), Criado RFJ(1), Marques GF(2), Junior WB(2).

Author information:

(1)Dermatology Department, Centro Universitário Saúde ABC, Santo André, São

Paulo, Brazil.

(2)Dermatology Department, Faculdade de Medicina da Universidade de São Paulo,

São Paulo, Brazil.

(3)Pathology Department, Faculdade de Medicina da Universidade de São Paulo, São

Paulo, Brazil.

COVID-19 pandemic presents several dermatological manifestations described in

the present indexed literature, with around 700 cases reported until May 2020,

some described as urticaria or urticarial rashes. Urticaria is constituted by

evanescent erythematous-edematous lesions (wheals and flare), which does not

persist in the same site for more than 24-48 hours and appears in other

topographic localization, resolving without residual hyper pigmentation. During

the SARS-CoV-2 infection, some cytokines are synthesized, including Interferon

type I, TNF-α, and chemokines which may induce mast cells and basophils

degranulation by mechanisms similar to the autoinflammatory monogenic or

polygenic diseases. In this article we discuss the spectrum of the urticaria and

urticarial-like lesions in the COVID-19's era, besides other aspects related to

innate and adaptative immune response to viral infections, interactions between

dermal dendritic cells and mast cells, degranulation of mast cells by different

stimuli. Plasmacytoid dendritic cells share in allergic patients expression of

the high affinity IgE receptors on cell membranes and demonstrated a low pattern

of type I interferon secretion in viral infections. We discuss the previous

descriptions of the effects of omalizumab, a monoclonal antibody directed to IgE

and high affinity IgE receptors, to improve the interferon responses and enhance

their antiviral effects. This article is protected by copyright. All rights

reserved.

DOI: 10.1111/dth.14068

PMID: 32713127

2. Dermatol Ther. 2020 Jul 25:e14063. doi: 10.1111/dth.14063. Online ahead of

print.

Management of Patients with Behçet's Disease During the COVID-19 Pandemic.

Dursun R(1), Temiz SA(1), Özer İ(1), Daye M(1), Ataseven A(1).

Author information:

(1)Department of Dermatology, Necmettin Erbakan University Meram Medical

Faculty.

Behçet's disease is a disease characterized by chronic inflammatory vasculitis.

In the clinical symptoms of Behçet's disease, many immunosuppressive and

immunomodulatory drugs are used. The suspicion that drugs used in chronic

disease treatments such as Behçet's disease during pandemic will increase the

risk of transmission of COVID-19 disease, and that the disease may progress more

lethally in these patients after the infection caused clinicians to worry. As

far as we know, there is no study in the literature about the management of

patients with Behçet's disease in the pandemic period. 54 patients with Behçet's

disease who were admitted to the dermatology outpatient clinic between 11 March

and 14 July 2020 were retrospectively analyzed. In this pandemic period, 44 of

54 patients were recommended to continue their previous treatment. While the

dose of medication used by 7 patients was reduced, it was decided to change the

treatment of 3 patients. No life-threatening activation was observed. None of

the patients developed COVID-19 disease. This article is important in terms of

being the first study in the literature examining the treatment of patients with

Behçet's disease during the COVID-19. In this period, we know that the treatment

practices in chronic diseases change frequently daily, and in this respect, we

hope that our study will provide a perspective to other dermatology clinics in

terms of the treatment of Behçet's disease during the pandemic. This article is

DOI: 10.1111/dth.14063

PMID: 32710599

3. Nat Commun. 2020 Jul 24;11(1):3774. doi: 10.1038/s41467-020-17703-6.

Patients with immune-mediated inflammatory diseases receiving cytokine

inhibitors have low prevalence of SARS-CoV-2 seroconversion.

Simon D(1)(2), Tascilar K(1)(2), Krönke G(1)(2), Kleyer A(1)(2), Zaiss MM(1)(2),

Heppt F(2)(3), Meder C(2)(3), Atreya R(2)(4), Klenske E(2)(4), Dietrich

P(2)(4)(5), Abdullah A(2)(4), Kliem T(2)(4), Corte G(1)(2), Morf H(1)(2),

Leppkes M(2)(4), Kremer AE(2)(4), Ramming A(1)(2), Pachowsky M(1)(2)(6), Schuch

F(7), Ronneberger M(7), Kleinert S(7), Maier C(8), Hueber AJ(1)(2)(9), Manger

K(10), Manger B(1)(2), Berking C(2)(3), Tenbusch M(8), Überla K(8), Sticherling

M(2)(3), Neurath MF(2)(4), Schett G(11)(12).

Author information:

(1)Department of Internal Medicine 3, Friedrich-Alexander University (FAU)

Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054,

Erlangen, Germany.

(2)Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and

Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.

(3)Department of Dermatology, FAU Erlangen-Nuremberg and Universitätsklinikum

Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.

(4)Department of Internal Medicine 1, FAU Erlangen-Nuremberg and

Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.

(5)Institute of Biochemistry, Emil-Fischer-Zentrum, FAU Erlangen-Nuremberg,

Fahrstraße 17, 91054, Erlangen, Germany.

(6)Department of Orthopedic and Trauma Surgery, FAU Erlangen-Nuremberg and

Universitätsklinikum Erlangen, Krankenhausstraße 12, 91054, Erlangen, Germany.

(7)Rheumatology Clinical Practice Erlangen, Möhrendorferstraße 1c, 91056,

Erlangen, Germany.

(8)Institute of Clinical and Molecular Virology, FAU Erlangen-Nuremberg and

Universitätsklinikum Erlangen, Schlossgarten 4, 91054, Erlangen, Germany.

(9)Rheumatology Section, Sozialstiftung Bamberg, Buger Straße 80-82, 96049,

Bamberg, Germany.

(10)Rheumatology Practice Bamberg, Hainstraße 6, 96047, Bamberg, Germany.

(11)Department of Internal Medicine 3, Friedrich-Alexander University (FAU)

Erlangen-Nuremberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054,

Erlangen, Germany. georg.schett@uk-erlangen.de.

(12)Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and

Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.

georg.schett@uk-erlangen.de.

Immune-mediated inflammatory diseases (IMIDs) of the joints, gut and skin are

treated with inhibitors of inflammatory cytokines. These cytokines are involved

in the pathogenesis of coronavirus disease 2019 (COVID-19). Investigating

anti-SARS-CoV-2 antibody responses in IMIDs we observe a reduced incidence of

SARS-CoV-2 seroconversion in IMID patients treated with cytokine inhibitors

compared to patients receiving no such inhibitors and two healthy control

populations, despite similar social exposure. Hence, cytokine inhibitors seem to

at least partially protect from SARS-CoV-2 infection.

DOI: 10.1038/s41467-020-17703-6

PMID: 32709909

4. J Am Acad Dermatol. 2020 Jul 21:S0190-9622(20)32256-8. doi:

10.1016/j.jaad.2020.07.057. Online ahead of print.

Hand Hygiene During COVID-19: Recommendations from the American Contact

Dermatitis Society.

Rundle CW(1), Presley CL(2), Militello M(2), Barber C(3), Powell DL(4), Jacob

SE(5), Atwater AR(6), Watsky KL(7), Yu J(8), Dunnick CA(9).

Author information:

(1)Department of Dermatology, University of Colorado Anschutz Medical Campus,

Aurora, CO.

(2)Rocky Vista University College of Osteopathic Medicine, Parker, CO.

(3)Michigan State University College of Human Medicine, Grand Rapids, MI.

(4)Department of Dermatology, University of Utah, Salt Lake City, UT.

(5)Loma Linda Veterans Affairs Medical Center, Loma Linda, CA,; Clinical

Professor, Medicine and Pediatrics, University of California, Riverside;

Professor of Dermatology, Loma Linda University Center, Loma Linda, CA.

(6)Department of Dermatology, Duke University Medical Center, Durham, NC.

(7)Department of Dermatology, Yale University School of Medicine, New Haven, CT.

(8)Department of Dermatology, Massachusetts General Hospital, Harvard Medical

School, Boston, MA.

(9)Department of Dermatology, University of Colorado Anschutz Medical Campus,

Aurora, CO; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO.

Electronic address: cory.dunnick@cuanschutz.edu.

The recent coronavirus 2019 (COVID-19) pandemic has resulted in increased hand

hygiene and hand cleansing awareness. To prevent virus transmission, the Center

for Disease Control (CDC) recommends frequent hand washing with soap and water.

Hand hygiene products are available in a variety of forms and while each of

these formulations may be effective against COVID-19, they may also alter skin

barrier integrity and function. As health care workers and the general

population focus on stringent hand hygiene, the American Contact Dermatitis

Society (ACDS) anticipates an increase in both irritant contact and allergic

contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have

the least sensitizing and irritancy potential when compared to soaps and

synthetic detergents. This article provides an overview of the most frequently

used hand hygiene products and their associations with contact dermatitis as

well as recommendations from the ACDS on how to treat and prevent further

dermatitis.

DOI: 10.1016/j.jaad.2020.07.057

PMCID: PMC7373692

PMID: 32707253

5. Cell Host Microbe. 2020 Jul 18:S1931-3128(20)30401-7. doi:

10.1016/j.chom.2020.07.005. Online ahead of print.

Retrospective Multicenter Cohort Study Shows Early Interferon Therapy Is

Associated with Favorable Clinical Responses in COVID-19 Patients.

Wang N(1), Zhan Y(2), Zhu L(3), Hou Z(4), Liu F(5), Song P(5), Qiu F(5), Wang

X(6), Zou X(6), Wan D(7), Qian X(7), Wang S(8), Guo Y(8), Yu H(8), Cui M(9),

Tong G(10), Xu Y(11), Zheng Z(12), Lu Y(13), Hong P(14).

Author information:

(1)Department of Research, Sun Yat-sen University (SYSU) Seventh Hospital,

Shenzhen, Guangdong 518107, China.

(2)Department of Rehabilitation Medicine, Xiangyang Central Hospital, Xiangyang,

Hubei 441021, China; College of Medicine, Hubei University of Arts and Science,

Xiangyang, Hubei 441053, China.

(3)Department of Dermatology, SYSU Seventh Hospital, Shenzhen, Guangdong 518107,

China.

(4)Division of Quality Control, Xiangyang Central Blood Station, Xiangyang,

Hubei 441000, China.

(5)Department of Infectious Diseases, Fever Clinic, Suizhou Zengdu Hospital,

Suizhou, Hubei 441300, China.

(6)Intensive Care Unit, Suizhou Zengdu Hospital, Suizhou, Hubei 441300, China.

(7)Department of Respiratory Medicine, Suizhou Zengdu Hospital, Suizhou, Hubei

441300, China.

(8)Department of Rehabilitation Medicine, Xiangyang Central Hospital, Xiangyang,

Hubei 441021, China.

(9)Department of Pathology, Mount Sinai St. Luke's Roosevelt Hospital Center,

New York, NY 10025, USA.

(10)Department of Oncology, Peking University Shenzhen Hospital, Shenzhen,

Guangdong 518036, China.

(11)Department of Research, Sun Yat-sen University (SYSU) Seventh Hospital,

Shenzhen, Guangdong 518107, China; Department of Dermatology, SYSU Seventh

Hospital, Shenzhen, Guangdong 518107, China.

(12)Department of Nephrology, Center of Nephrology and Urology, SYSU Seventh

Hospital, Shenzhen, Guandgong, 518107, China.

(13)Department of Research, Sun Yat-sen University (SYSU) Seventh Hospital,

Shenzhen, Guangdong 518107, China; Department of Biomedical Science, City

University of Hong Kong, Kowloon, Hong Kong SAR, China.

(14)Department of Research, Sun Yat-sen University (SYSU) Seventh Hospital,

Shenzhen, Guangdong 518107, China; Division of Research and Development, US

Department of Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY

11209, USA; Department of Cell Biology, State University of New York Downstate

Health Sciences University, Brooklyn, NY 11203, USA. Electronic address:

peng.hong@downstate.edu.

Interferons (IFNs) are widely used in treating coronavirus disease 2019

(COVID-19) patients. However, a recent report of ACE2, the host factor mediating

SARS-Cov-2 infection, identifying it as interferon-stimulated raised

considerable safety concern. To examine the association between the use and

timing of IFN-α2b and clinical outcomes, we analyzed in a retrospective

multicenter cohort study of 446 COVID-19 patients in Hubei, China. Regression

models estimated that early administration (≤5 days after admission) of IFN-α2b

was associated with reduced in-hospital mortality in comparison with no

admission of IFN-α2b, whereas late administration of IFN-α2b was associated with

increased mortality. Among survivors, early IFN-α2b was not associated with

hospital discharge or computed tomography (CT) scan improvement, whereas late

IFN-α2b was associated with delayed recovery. Additionally, early IFN-α2b and

umifenovir alone or together were associated with reduced mortality and

accelerated recovery in comparison with treatment with lopinavir/ritonavir

(LPV/r) alone. We concluded that administration of IFN-α2b during the early

stage of COVID-19 could induce favorable clinical responses.

DOI: 10.1016/j.chom.2020.07.005

PMCID: PMC7368656

PMID: 32707096

Conflict of interest statement: Declaration of Interests The authors declare no

competing interests.

6. J Dermatolog Treat. 2020 Jul 24:1-14. doi: 10.1080/09546634.2020.1800578. Online

ahead of print.

The impact of COVID-19 pandemic in a cohort of Italian psoriatic patients

treated with biological therapies.

Pirro F(1)(2), Caldarola G(1)(2), Chiricozzi A(1)(2), Tambone S(1)(2), Mariani

M(3), Calabrese L(1)(2), D'Urso DF(1)(2), De Simone C(1)(2), Peris K(1)(2).

Author information:

(1)Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.

(2)Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

(3)Section of Hygiene, University Department of Health Sciences and Public

Health, Università Cattolica del Sacro Cuore, Rome, Italy.

Background. The beginning of 2020 has been marked by COVID-19 pandemic, with a

strong impact on several national health systems worldwide.Objective. To

describe the impact of COVID-19 pandemic in a cohort of Italian psoriatic

patients treated with biologics.Methods. A telephone survey was conducted in May

4-10, 2020 about the Italian lockdown period (March 09th - May 03rd 2020) in a

cohort of psoriatic patients treated with biologics, asking about any exposure

to COVID-19, disease status, continuation of therapy, work activity and

psychological status through Hospital Anxiety and Depression Scale (HADS),

Perceived Stress Scale (PSS) and Brief Resilience Scale (BRS).Results. 226

patients were interviewed, with no COVID-19 positive cases. Sixty-three of 226

(27.9%) described worsening of the disease with a correlation to drug withdrawal

[43/226 (19%)]. Correlation was also found between the worsening of psoriasis

and HADS anxiety, HADS depression, BRS and PSS abnormal scores considered both

as categorical and continuous variables. No correlation was found between

worsening of psoriasis and work activity. Conclusion. Uncertainty about whether

biologics could increase the risk of SARS-CoV-2 infection led to drug withdrawal

with subsequent worsening of psoriasis. Moreover, psychological status also had

a direct influence on the clinical course of the disease.

DOI: 10.1080/09546634.2020.1800578

PMID: 32705945

Vascular skin presentation & Covid-19

1. J Eur Acad Dermatol Venereol. 2020 Apr 27:10.1111/jdv.16544. doi:

10.1111/jdv.16544. Online ahead of print.

Vascular skin symptoms in COVID-19: a French observational study.

Bouaziz JD(1), Duong T(2), Jachiet M(1), Velter C(1)(2), Lestang P(3), Cassius

C(1), Arsouze A(1), Domergue Than Trong E(3), Bagot M(1), Begon E(4), Sulimovic

L(1)(3)(5), Rybojad M(1).

Author information:

(1)Dermatology Department, Paris University, Saint-Louis Hospital, Paris,

France.

(2)Dermatology Department, Henri Mondor hospital, Créteil, France.

(3)On behalf of the SNDV (syndicat national des

dermatologues-vénéréologues)/Corona group.

(4)Dermatology Department, Renée Dubos hospital, Pontoise, France.

(5)President of the SNDV (syndicat national des dermatologues-vénéréologues).

Coronavirus 19 (COVID-19) was declared as a pandemic viral infection by the

World Health organization on March 11th 2020. Usual clinical manifestations of

COVID-19 infection include fever, fatigue, myalgia, headache, diarrhea, dry

cough, dyspnea that may lead to acute respiratory distress syndrome and death

(1). Skin symptoms of COVID-19 have been poorly described but may include

erythematous rash, urticaria and chicken pox like lesions (2-7).

Angiotensin-converting enzyme 2 (ACE2) is a cellular receptor for COVID-19.

DOI: 10.1111/jdv.16544

PMCID: PMC7267662

PMID: 32339344

2. Cleve Clin J Med. 2020 May 14. doi: 10.3949/ccjm.87a.ccc031. Online ahead of

print.

Skin manifestations of COVID-19.

Young S(1), Fernandez AP(1).

Author information:

(1)Department of Dermatology, Dermatology & Plastic Surgery Institute, Cleveland

Clinic.

Cutaneous manifestations, a well-known effect of viral infections, are beginning

to be reported in patients with COVID-19 disease. These manifestations most

often are morbilliform rash, urticaria, vesicular eruptions, acral lesions, and

livedoid eruptions. Some of these cutaneous manifestations arise before the

signs and symptoms more commonly associated with COVID-19, suggesting that they

could be presenting signs of COVID-19. utaneous manifestations are well known to

occur in the setting of viral illnesses, and occasionally these manifestations

have diagnostic or prognostic value. With COVID-19, although we are at a

relatively early point in the pandemic, cutaneous manifestations in infected

patients are beginning to emerge from around the world. In this article, we

describe some of the current cutaneous abnormalities observed in patients with

COVID-19.

DOI: 10.3949/ccjm.87a.ccc031

PMID: 32409442

3. Transl Res. 2020 Jun;220:1-13. doi: 10.1016/j.trsl.2020.04.007. Epub 2020 Apr

15.

Complement associated microvascular injury and thrombosis in the pathogenesis of

severe COVID-19 infection: A report of five cases.

Magro C(1), Mulvey JJ(2), Berlin D(3), Nuovo G(4), Salvatore S(1), Harp J(5),

Baxter-Stoltzfus A(1), Laurence J(6).

Author information:

(1)Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New

York, New York.

(2)Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center,

New York, New York.

(3)Department of Medicine, Division of Pulmonary and Critical Care Medicine,

Weill Cornell Medicine, New York, New York.

(4)The Ohio State University Comprehensive Cancer Center, Columbus Ohio and

Discovery Life Sciences, Powell, Ohio.

(5)Department of Dermatology, Weill Cornell Medicine.

(6)Department of Medicine, Division of Hematology and Medical Oncology, Weill

Cornell Medicine, New York, New York. Electronic address:

jlaurenc@med.cornell.edu.

Acute respiratory failure and a systemic coagulopathy are critical aspects of

the morbidity and mortality characterizing infection with severe acute

respiratory distress syndrome-associated coronavirus-2, the etiologic agent of

Coronavirus disease 2019 (COVID-19). We examined skin and lung tissues from 5

patients with severe COVID-19 characterized by respiratory failure (n= 5) and

purpuric skin rash (n = 3). COVID-19 pneumonitis was predominantly a

pauci-inflammatory septal capillary injury with significant septal capillary

mural and luminal fibrin deposition and permeation of the interalveolar septa by

neutrophils. No viral cytopathic changes were observed and the diffuse alveolar

damage (DAD) with hyaline membranes, inflammation, and type II pneumocyte

hyperplasia, hallmarks of classic acute respiratory distress syndrome, were not

prominent. These pulmonary findings were accompanied by significant deposits of

terminal complement components C5b-9 (membrane attack complex), C4d, and mannose

binding lectin (MBL)-associated serine protease (MASP)2, in the

microvasculature, consistent with sustained, systemic activation of the

complement pathways. The purpuric skin lesions similarly showed a

pauci-inflammatory thrombogenic vasculopathy, with deposition of C5b-9 and C4d

in both grossly involved and normally-appearing skin. In addition, there was

co-localization of COVID-19 spike glycoproteins with C4d and C5b-9 in the

interalveolar septa and the cutaneous microvasculature of 2 cases examined. In

conclusion, at least a subset of sustained, severe COVID-19 may define a type of

catastrophic microvascular injury syndrome mediated by activation of complement

pathways and an associated procoagulant state. It provides a foundation for

further exploration of the pathophysiologic importance of complement in

COVID-19, and could suggest targets for specific intervention.

DOI: 10.1016/j.trsl.2020.04.007

PMCID: PMC7158248

PMID: 32299776

4. J Dermatol Sci. 2020 May;98(2):75-81. doi: 10.1016/j.jdermsci.2020.04.011. Epub

2020 Apr 29.

Cutaneous manifestations of COVID-19: Report of three cases and a review of

literature.

Sachdeva M(1), Gianotti R(2), Shah M(1), Bradanini L(3), Tosi D(4), Veraldi

S(5), Ziv M(6), Leshem E(7), Dodiuk-Gad RP(8).

Author information:

(1)Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

(2)Institute of Dermatological Sciences, University of Milan, Italy; Department

of Pathophysiology and Transplantation, Università degli Studi, Foundation

IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

(3)Department of Biomedical and Clinical Sciences "Luigi Sacco", University of

Milan, Italy.

(4)Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco

Hospital, Milan, Italy.

(5)Department of Pathophysiology and Transplantation, Università degli Studi,

Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

(6)Dermatology Department, Emek Medical Center, Israel.

(7)Institute for Travel and Tropical Medicine, Sheba Medical Centre, Israel;

School of Medicine, Tel Aviv University, Israel.

(8)Dermatology Department, Emek Medical Center, Israel; Bruce Rappaport Faculty

of Medicine, Technion - Institute of Technology, Israel; Department of Medicine,

University of Toronto, Toronto, Ontario, Canada. Electronic address:

rdodiukgad@gmail.com.

BACKGROUND: Various cutaneous manifestations have been observed in patients with

COVID-19 infection. However, overall similarities in the clinical presentation

of these dermatological manifestations have not yet been summarized.

OBJECTIVE: This review aims to provide an overview of various cutaneous

manifestations in patients with COVID-19 through three case reports and a

literature review.

METHODS: A literature search was conducted using PubMed, OVID, and Google search

engines for original and review articles. Studies written in the English

language that mentioned cutaneous symptoms and COVID-19 were included.

RESULTS: Eighteen articles and three additional cases reported in this paper

were included in this review. Of these studies, 6 are case series and 12 are

case report studies. The most common cutaneous manifestation of COVID-19 was

found to be maculopapular exanthem (morbilliform), presenting in 36.1% (26/72)

patients. The other cutaneous manifestations included: a papulovesicular rash

(34.7%, 25/72), urticaria (9.7%, 7/72), painful acral red purple papules (15.3%,

11/72) of patients, livedo reticularis lesions (2.8%, 2/72) and petechiae (1.4%,

1/72). Majority of lesions were localized on the trunk (66.7%, 50/72), however,

19.4% (14/72) of patients experienced cutaneous manifestations in the hands and

feet. Skin lesion development occurred before the onset of respiratory symptoms

or COVID-19 diagnosis in 12.5% (9/72) of the patients, and lesions spontaneously

healed in all patients within 10 days. Majority of the studies reported no

correlation between COVID-19 severity and skin lesions.

CONCLUSION: Infection with COVID-19 may result in dermatological manifestations

with various clinical presentations, which may aid in the timely diagnosis of

this infection.

DOI: 10.1016/j.jdermsci.2020.04.011

PMCID: PMC7189855

PMID: 32381430

Conflict of interest statement: Declaration of Competing Interest None. The

authors have no conflict of interest to declare.

5. J Eur Acad Dermatol Venereol. 2020 Jun;34(6):e252-e254. doi: 10.1111/jdv.16470.

Epub 2020 Jun 4.

Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety

concerns of clinical images and skin biopsies.

Fernandez-Nieto D(1), Ortega-Quijano D(1), Segurado-Miravalles G(1),

Pindado-Ortega C(1), Prieto-Barrios M(1), Jimenez-Cauhe J(1).

Author information:

(1)Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain.

Comment on

J Eur Acad Dermatol Venereol. 2020 May;34(5):e212-e213.

We have read with great interest the article: Cutaneous manifestations in

COVID‐19: a first perspective by Recalcati S.1 This article is the first report

of the cutaneous manifestations in Coronavirus Disease 2019 (COVID‐19) patients

during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic

in Lombardy, Italy.

DOI: 10.1111/jdv.16470

PMCID: PMC7262048

PMID: 32294262

6. Dermatol Ther. 2020 Apr 20:e13430. doi: 10.1111/dth.13430. Online ahead of

print.

Challenges of COVID-19 pandemic for dermatology.

Wollina U(1).

Author information:

(1)Department of Dermatology and Allergology, Städtisches Klinikum Dresden,

Academic Teaching Hospital, Dresden, Germany.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new

coronavirus responsible for the pandemic named coronavirus disease 2019

(COVID-19). The disease causes SARS with a significant morbidity and mortality.

We provide a review with a focus on COVID-19 in dermatology. We discuss triage

of suspected infectious patients, protection of medical doctors and nurses. We

discuss the available data on cutaneous symptoms, although disease-specific

symptoms have yet not been observed. COVID-19 is a challenge for the treatment

of dermatologic patients, either with severe inflammatory disorders or with skin

cancer. The consequences for systemic treatment are obvious but it will be most

important to collect the clinical data for a better decision process. Last but

not least, education in dermatology for students will not be temporarily

possible in the classical settings. COVID-19, although not a skin disease, by

itself has an immense impact on dermatology.

DOI: 10.1111/dth.13430

PMCID: PMC7235502

PMID: 32314460

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

interest.

7. J Am Acad Dermatol. 2020 May 29:S0190-9622(20)30984-1. doi:

10.1016/j.jaad.2020.05.109. Online ahead of print.

Pernio-like skin lesions associated with COVID-19: a case series of 318 patients

from 8 countries.

Freeman EE(1), McMahon DE(2), Lipoff JB(3), Rosenbach M(3), Kovarik C(3),

Takeshita J(3), French LE(4), Thiers BH(5), Hruza GJ(6), Fox LP(7); American

Academy of Dermatology Ad Hoc Task Force on Covid-19.

Author information:

(1)Department of Dermatology, Massachusetts General Hospital, Harvard Medical

School, Boston, MA; Medical Practice Evaluation Center, Mongan Institute,

Massachusetts General Hospital, Boston, MA. Electronic address:

efreeman@mgh.harvard.edu.

(2)Department of Dermatology, Massachusetts General Hospital, Harvard Medical

School, Boston, MA.

(3)Department of Dermatology, University of Pennsylvania, Philadelphia, PA.

(4)Department of Dermatology, University Hospital, Munich University of Ludwig

Maximilian, Munich, Germany.

(5)Department of Dermatology and Dermatologic Surgery, Medical University of SC,

Charleston, SC.

(6)Department of Dermatology, St. Louis University, St. Louis, MO.

(7)Department of Dermatology, University of California San Francisco, San

Francisco, CA.

BACKGROUND: Increasing evidence suggests pernio-like lesions are cutaneous

manifestations of COVID-19.

OBJECTIVE: To describe clinical and pathologic findings of pernio-like lesions

in confirmed or suspected COVID-19 cases.

METHODS: An international dermatology registry was circulated to healthcare

providers worldwide through the American Academy of Dermatology (AAD),

International League of Dermatologic Societies (ILDS), and other organizations.

RESULTS: We documented 505 patients with dermatologic manifestations associated

with COVID-19, including 318 (63%) with pernio-like lesions. Patients with

pernio-like lesions were generally young and healthy, with relatively mild

COVID-19. Of 318 cases confirmed or suspected as COVID-19 by providers,

twenty-three cases (7%) were laboratory-confirmed COVID-19 positive, and 20

others (6%) were close contacts of confirmed COVID-19 cases. Given current

testing criteria, many patients lacked COVID-19 testing access. For 55% of

patients, pernio-like lesions were their only symptom. In patients with other

COVID-19 symptoms, pernio-like lesions typically appeared after other symptoms.

Pernio-like lesions lasted a median of 14 days (IQR 10-21).

LIMITATIONS: A case series cannot estimate population level incidence or

prevalence. Additionally, there may be confirmation bias in reporting. We cannot

exclude an epiphenomenon.

CONCLUSIONS: Pernio-like skin changes of the feet and hands, without another

explanation, may suggest COVID-19 infection and should prompt confirmatory

testing.

DOI: 10.1016/j.jaad.2020.05.109

PMCID: PMC7260509

PMID: 32479979

Vitamin D and COVID 19

1. Nutrients. 2020 Apr 2;12(4):E988. doi: 10.3390/nu12040988. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths.

Grant WB(1), Lahore H(2), McDonnell SL(3), Baggerly CA(3), French CB(3), Aliano

JL(3), Bhattoa HP(4).

Author information:

(1)Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San

Francisco, CA 94164-1603, USA.

(2)2289 Highland Loop, Port Townsend, WA 98368, USA.

(3)GrassrootsHealth, Encinitas, CA 92024, USA.

(4)Department of Laboratory Medicine, Faculty of Medicine, University of

Debrecen, Nagyerdei Blvd 98, H-4032 Debrecen, Hungary.

The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of

influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of proinflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas

others did not. Evidence supporting the role of vitamin D in reducing risk of

COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome;

and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60 ng/mL (100-150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.

DOI: 10.3390/nu12040988

PMID: 32252338 [Indexed for MEDLINE]

2. Am J Physiol Endocrinol Metab. 2020 May 1;318(5):E589. doi:

10.1152/ajpendo.00138.2020. COVID-19 and vitamin D-Is there a link and an opportunity for intervention?

Jakovac H(1).

Author information:

(1)Department of Physiology and Immunology, Medical Faculty, University of

Rijeka, Rijeka, Croatia.

DOI: 10.1152/ajpendo.00138.2020

PMID: 32297519 [Indexed for MEDLINE]

The recent outbreak and rapid spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are a global threat and primary concern worldwide, with a still uncertain outcome. With the lack of effective therapy, chemoprevention, and vaccination, focusing on the immediate repurposing of existing drugs gives hope of curbing the pandemic. Here, I underline that so far there are no reports on the vitamin D status among affected persons. On the other hand, a large number of well-established data showed antiviral effects of vitamin D, which can interfere directly with viral replication, but also can act in an immunomodulatory and anti-inflammatory way (7). The latter effects could be crucial for their assumptive beneficial effects during SARS-CoV-2 infection, since it seems that SARS-CoV-2 initially uses immune evasion mechanisms, which in some patients is followed by immune hyperreaction and cytokine storm (1), as a common pathogenic mechanism of acute respiratory disease syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) development, regardless of the etiological factor. In that sense, the protective effect of vitamin D has been reported in many conditions associated with pneumonia, cytokine hyperproduction, and ARDS (2, 8, 10), and vitamin D was recently proposed as a repurposed drug for influenza A H5N1 virus-induced lung injury (3). Additionally, some studies suggest the effectiveness of vitamin D as an adjuvant therapy along with antiretroviral agents in HIV-infected patients (5). Furthermore, vitamin D pretreatment was beneficial in animal models of ARDS, reducing lung permeability by modulation of renin-angiotensin system activity and ACE2 expression (9). The role of vitamin D in the context of viral infections is also supported by findings of certain vitamin D receptor gene (VDR) alleles that are associated with increased susceptibility to respiratory infections (6), as well as with the progression of HIV infection (4).

3. Med Hypotheses. 2020 Apr 23;140:109767. doi: 10.1016/j.mehy.2020.109767. Online

ahead of print.Vitamin D: A simpler alternative to tocilizumab for trial in COVID-19?

Silberstein M(1).

Author information:

(1)School of Molecular and Life Sciences, Curtin University, Perth, WA,

Australia. Electronic address: m.silberstein@curtin.edu.au.

There is anecdotal evidence that tocilizumab, an immunosuppressant drug, may be a potential therapeutic option for patients with severe manifestations of coronavirus disease 2019 (COVID-19). Like tocilizumab, Vitamin D appears to modulate the activity of an interleukin (IL-6), which may explain the seasonal

variation in prevalence of influenza. While most cases of COVID-19 have, thus far, occurred in the Northern Hemisphere winter, limiting the ability to assess seasonal variation, there remains substantial variation in the severity of this condition that has yet to be explained. A retrospective comparison of Vitamin D levels in previously obtained blood samples between survivors and confirmed fatalities could establish a rationale for implementation of widespread Vitamin D supplementation. This would be far cheaper and simpler than tocilizumab as a therapeutic option to trial.

DOI: 10.1016/j.mehy.2020.109767

PMCID: PMC7177149

PMID: 32353742

Conflict of interest statement: Declaration of Competing Interest The authors

declare that they have no known competing financial interests or personal

relationships that could have appeared to influence the work reported in this

paper.

4. Cureus. 2020 Apr 6;12(4):e7560. doi: 10.7759/cureus.7560. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19).

Kakodkar P(1), Kaka N(1), Baig MN(2).

Author information:

(1)Medicine, National University of Ireland Galway, Galway, IRL.

(2)Orthopaedics, University Hospital Galway, Galway, IRL.

Coronavirus disease 2019 (COVID-19) is a declared global pandemic. There are multiple parameters of the clinical course and management of the COVID-19 that need optimization. A hindrance to this development is the vast amount of misinformation present due to scarcely sourced manuscript preprints and social media. This literature review aims to presents accredited and the most current studies pertaining to the basic sciences of SARS-CoV-2, clinical presentation and disease course of COVID-19, public health interventions, and current epidemiological developments. The review on basic sciences aims to clarify the

jargon in virology, describe the virion structure of SARS-CoV-2 and present pertinent details relevant to clinical practice. Another component discussed is the brief history on the series of experiments used to explore the origins and evolution of the phylogeny of the viral genome of SARS-CoV-2. Additionally, the

clinical and epidemiological differences between COVID-19 and other infections causing outbreaks (SARS, MERS, H1N1) are elucidated. Emphasis is placed on evidence-based medicine to evaluate the frequency of presentation of various symptoms to create a stratification system of the most important epidemiological

risk factors for COVID-19. These can be used to triage and expedite risk assessment. Furthermore, the limitations and statistical strength of the diagnostic tools currently in clinical practice are evaluated. Criteria on rapid screening, discharge from hospital and discontinuation of self-quarantine are clarified. Epidemiological factors influencing the rapid rate of spread of the SARS-CoV-2 virus are described. Accurate information pertinent to improving prevention strategies is also discussed. The penultimate portion of the review aims to explain the involvement of micronutrients such as vitamin C and vitamin

D in COVID19 treatment and prophylaxis. Furthermore, the biochemistry of the major candidates for novel therapies is briefly reviewed and a summary of their current status in the clinical trials is presented. Lastly, the current scientific data and status of governing bodies such as the Center of Disease

Control (CDC) and the WHO on the usage of controversial therapies such as angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen), and corticosteroids usage in COVID-19 are discussed. The composite collection of accredited studies on each of these subtopics of COVID-19 within this review will enable clarification and focus on the current

status and direction in the planning of the management of this global pandemic.

DOI: 10.7759/cureus.7560

PMCID: PMC7138423

PMID: 32269893

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

interests exist.

5. Obesity (Silver Spring). 2020 Apr 16. doi: 10.1002/oby.22838. Online ahead of

print. Considerations for obesity, vitamin D, and physical activity amidst the COVID-19

pandemic.

Carter SJ(1), Baranauskas MN(1), Fly AD(2).

Author information:

(1)Department of Kinesiology, School of Public Health, Indiana University,

Bloomington, 47405, USA.

(2)Department of Applied Health Sciences, School of Public Health, Indiana

University, Bloomington, 47405, USA.

As the biomedical community races to disentangle the unknowns associated with

severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - the virus

responsible for causing coronavirus disease (COVID-19) - the link between

diminished immune function and individuals with obesity raises important

questions about the possibility for greater viral pathogenicity in this

population. Increased adiposity may undermine the pulmonary microenvironment

wherein viral pathogenesis and immune cell trafficking could contribute to a

maladaptive cycle of local inflammation and secondary injury. A further

challenge to those with obesity during the current pandemic may involve vitamin

D deficiency/insufficiency. In the interest of personal and public health, we

caution decision/policy makers alike not to pin all hope on a proverbial 'silver

bullet.' Until further breakthroughs emerge, we should remember that modifiable

lifestyle factors like diet and physical activity should not be marginalized.

Decades of empirical evidence supports both as key factors promoting health and

wellness.

DOI: 10.1002/oby.22838

PMID: 32299148

6. Aliment Pharmacol Ther. 2020 May;51(10):993-995. doi: 10.1111/apt.15752. Epub

2020 Apr 12. Letter: Covid-19, and vitamin D.

Panarese A(1), Shahini E(2).

Author information:

(1)Department of Gastroenterology and Digestive Endoscopy, National Institute of

Gastroenterology, "Saverio De Bellis" Research Hospital, Castellana Grotte

(Bari), Italy.

(2)Istituto di Candiolo, FPO-IRCCS, Candiolo (Torino), Italy.

Comment in

Aliment Pharmacol Ther. 2020 May;51(10):995-996.

Comment on

Aliment Pharmacol Ther. 2020 May;51(9):843-851.

DOI: 10.1111/apt.15752

PMID: 32281109 [Indexed for MEDLINE]

Vitamin D has immuno‐modulatory properties, that include downregulation of pro‐inflammatory cytokines,3-7 and has been shown to attenuate lipopolysaccharide‐induced acute lung injury in mice by blocking effects on the angiopoietin (Ang)‐2‐Tie‐2 signalling pathway and on the renin‐angiotensin pathway.8 Tsujino I et al have recently shown, both in a mouse model of bleomycin‐induced interstitial pneumonia and in human cell lines, that vitamin D3 is locally activated in lung tissue and has a preventive effect on experimental interstitial pneumonitis.9 Although it is more likely that any protective effect of vitamin D against Covid19 is related to suppression of cytokine response and reduced severity/risk for ARDS, there is also evidence from a meta‐analysis that regular oral vitamin D2/D3 intake (in doses up to 2000 IU/d without additional bolus), is safe and protective against acute respiratory tract infection, especially in subjects with vitamin D deficiency.10

7. Clin Rheumatol. 2020 Apr 10:1-8. doi: 10.1007/s10067-020-05073-9. Online ahead

of print. Rheumatologists' perspective on coronavirus disease 19 (COVID-19) and potential

therapeutic targets.

Misra DP(1), Agarwal V(2), Gasparyan AY(3), Zimba O(4).

Author information:

(1)Department of Clinical Immunology and Rheumatology, Sanjay Gandhi

Postgraduate Institute of Medical Sciences, Lucknow, India.

durgapmisra@gmail.com.

(2)Department of Clinical Immunology and Rheumatology, Sanjay Gandhi

Postgraduate Institute of Medical Sciences, Lucknow, India.

(3)Departments of Rheumatology and Research and Development, Dudley Group NHS

Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells

Hall Hospital, Dudley, West Midlands, UK.

(4)Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical

University, Lviv, Ukraine.

The ongoing pandemic coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of global concern. Environmental factors such as air pollution and smoking and comorbid conditions (hypertension, diabetes mellitus and underlying cardio-respiratory

illness) likely increase the severity of COVID-19. Rheumatic manifestations such as arthralgias and arthritis may be prevalent in about a seventh of individuals. COVID-19 can result in acute interstitial pneumonia, myocarditis, leucopenia (with lymphopenia) and thrombocytopenia, also seen in rheumatic diseases like

lupus and Sjogren's syndrome. Severe disease in a subset of patients may be driven by cytokine storm, possibly due to secondary hemophagocytic lymphohistiocytosis (HLH), akin to that in systemic onset juvenile idiopathic arthritis or adult-onset Still's disease. In the absence of high-quality evidence in this emerging disease, understanding of pathogenesis may help postulate potential therapies. Angiotensin converting enzyme 2 (ACE2) appears important for viral entry into pneumocytes; dysbalance in ACE2 as caused by ACE inhibitors or ibuprofen may predispose to severe disease. Preliminary evidence

suggests potential benefit with chloroquine or hydroxychloroquine. Antiviral drugs like lopinavir/ritonavir, favipiravir and remdesivir are also being explored. Cytokine storm and secondary HLH might require heightened immunosuppressive regimens. Current international society recommendations suggest that patients with rheumatic diseases on immunosuppressive therapy should not stop glucocorticoids during COVID-19 infection, although minimum possible doses may be used. Disease-modifying drugs should be continued; cessation may be considered during infection episodes as per standard practices. Development of a vaccine may be the only effective long-term protection against this disease. Key Points• Patients with coronavirus disease 19 (COVID-19) may have features mimicking rheumatic diseases, such as arthralgias, acute interstitial pneumonia, myocarditis, leucopenia, lymphopenia, thrombocytopenia and cytokine storm with features akin to secondary hemophagocytic lymphohistiocytosis.• Although preliminary results may be encouraging, high-quality clinical trials are needed to better understand the role of drugs commonly used in rheumatology like hydroxychloroquine and tocilizumab in COVID-19.• Until further evidence emerges, it may be cautiously recommended to continue glucocorticoids and other disease-modifying antirheumatic drugs (DMARDs) in patients receiving these therapies, with discontinuation of DMARDs during infections as per standard practice.

DOI: 10.1007/s10067-020-05073-9

PMCID: PMC7145936

PMID: 32277367

Conflict of interest statement: Durga Prasanna Misra declares that he has no

conflict of interest, including no relationship with pharmaceutical companies.

Vikas Agarwal declares that he has no conflict of interest, including no

relationship with pharmaceutical companies. Olena Zimba declares that she has no

conflict of interest, including no relationship with pharmaceutical companies.

Armen Yuri Gasparyan declares that he has no conflict of interest, including no

relationship with pharmaceutical companies.

Cutaneous Manifestations of COVID19

Adebanjo GAR(1), Parisella FR(2), Pezzuto A(3), Rello J(4)(5)(6). Cutaneous manifestations in COVID-19: the experiences of Barcelona and Rome. Tammaro A(1), J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16530. [Epub ahead of print]

Author information:

(1)NESMOS Dermatology Department, Sapienza University of Rome, Rome, Italy.

(2)University of Queensland, Brisbane, Australia.

(3)Cardiovascular-Respiratory Science Department, Sant'Andrea Hospital, Sapienza

University of Rome, Rome, Italy.

(4)Centro de Investigación Biomedica en Red de Enfermedades Respirorias

(CIBERES), Instituto Salud Carlos III, Madrid, Spain.

(5)Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS). Vall d'Hebron

Institut of Research (VHIR), Barcelona, Spain.

(6)Clinical Research, CHU Nîmes, Université Montpellier-Nimes, Nîmes, France.

In December 2019, a new virus called severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) causing Coronavirus disease 2019 (COVID-19) emerged in

Wuhan, Hubei Province, China. SARS-CoV-2 is transmitted through respiratory

droplets and object infected with droplets containing the virus. The diagnosis is

made employing quantitative reverse transcriptase polymerase chain reaction to

identify the viral nucleic acid in respiratory specimens or blood samples.

DOI: 10.1111/jdv.16530

PMID: 32330340

Recalcati S(1), Barbagallo T(1), Frasin LA(1), Prestinari F(1), Cogliardi A(2),

Provero MC(2), Dainese E(3), Vanzati A(3), Fantini F(1). Acral cutaneous lesions in the Time of COVID-19. J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16533. [Epub ahead of print]

Author information:

(1)Dermatology Unit, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy.

(2)Pediatric Unit, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy.

(3)Surgical Pathology Division, Department of Oncology, ASTT Lecco, Alessandro

Manzoni Hospital, Lecco, Italy.

Coronavirus disease 2019 (COVID-19) has become a pandemic condition, yet little

is known about its dermatologic manifestations. We report here on peculiar

(perniosis-like) skin lesions, unreported in the previous years, observed in

young outpatients visited in our Dermatologic Unit in the last 4 weeks of

COVID-19 pandemic (March-April 2020). Similar cases were referred to us in the

same period by Pediatricians and Dermatologists from Italy and European

countries.

DOI: 10.1111/jdv.16533

PMID: 32330324

van Damme C(1), Berlingin E(1), Saussez S(2), Accaputo O(1). Acute urticaria with pyrexia as the first manifestations of a COVID-19 infection. J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16523. [Epub ahead ofprint]

Author information:

(1)Dermatology Department, Ambroise Paré University Hospital Center, Boulevard

Kennedy, 2, B7000, Mons, Belgium.

(2)Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine,

Research Institute for Health Sciences and Technology, University of Mons

(UMONS), Avenue du Champ de Mars, 8, B7000, Mons, Belgium.

The coronavirus disease 2019 (COVID-19) affects principally the respiratory tract

but recent studies described that COVID-19 could present a broader clinical

spectrum from the absence of any symptoms to heart 1 , digestive 2 or

Ear-Nose-Throat (including anosmia and ageusia) 3 manifestations. Here we report

two cases of peculiar skin manifestation.

DOI: 10.1111/jdv.16523

PMID: 32329915

Hedou M(1), Carsuzaa F(2), Chary E(2), Hainaut E(1), Cazenave-Roblot F(3), Masson

Regnault M(1). Comment on "Cutaneous manifestations in COVID-19: a first perspective " by Recalcati S. J Eur Acad Dermatol Venereol. 2020 Apr 21. doi: 10.1111/jdv.16519. [Epub ahead of print]

Author information:

(1)Dermatologie, Centre hospitalo-universitaire de Poitiers, POITIERS, France.

(2)ORL, chirurgie cervico-maxillo-faciale et audiophonologie, Centre

hospitalo-universitaire de Poitiers, POITIERS, France.

(3)Maladies infectieuses, Centre hospitalo-universitaire de Poitiers, POITIERS,

France.

Since the coronavirus disease 2019 (COVID 19) outbreak was first reported in the

Chinese city of Wuhan on December 31, 2019, it has stricken more than 1,000,000

persons worldwide, of whom over 50,000 have died (1). Having been infected by

severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), patients with

COVID-19 mainly present with fever and respiratory symptoms (2). Isolated sudden

onset anosmia has also frequently been reported (3). Less frequently, rhinorrhea,

diarrhoea and dysgeusia may be associated. While only a few reports have evoked

cutaneous manifestations (4), we read with interest an initial study on the topic

entitled "Cutaneous manifestations in COVID-19: a first perspective " by

Recalcati S. (5).

DOI: 10.1111/jdv.16519 PMID: 32314436

Marzano AV(1), Genovese G(2), Fabbrocini G(3), Pigatto P(4), Monfrecola G(3),

Piraccini BM(5), Veraldi S(2), Rubegni P(6), Cusini M(7), Caputo V(8),

Rongioletti F(9), Berti E(2), Calzavara-Pinton P(10). Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol. 2020 Apr 16. pii: S0190-9622(20)30657-5. doi:10.1016/j.jaad.2020.04.044. [Epub ahead of print]

Author information:

(1)Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,

Milan, Italy; Department of Physiopathology and Transplantation, Università degli

Studi di Milano, Milan, Italy. Electronic address: angelo.marzano@unimi.it.

(2)Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,

Milan, Italy; Department of Physiopathology and Transplantation, Università degli

Studi di Milano, Milan, Italy.

(3)Section of Dermatology, Department of Clinical Medicine and Surgery,

University of Naples Federico II, Naples, Italy.

(4)Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

(5)Department of Dermatology, University of Bologna, Bologna, Italy.

(6)Dermatology Unit, Department of Medical, Surgical and Neurosciences,

University of Siena, Siena, Italy.

(7)Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,

Milan, Italy.

(8)Unit of Pathology, Grande Ospedale Metropolitano Niguarda, Milan, Italy.

(9)Unit of Dermatology, Department of Medical Sciences and Public Health,

Cagliari, Italy.

(10)Department of Dermatology, University of Brescia, Brescia, Italy.

DOI: 10.1016/j.jaad.2020.04.044

PMCID: PMC7161488

PMID: 32305439

Alramthan A(1), Aldaraji W(1). A case of COVID-19 presenting in clinical picture resembling chilblains disease. First report from the Middle East.Clin Exp Dermatol. 2020 Apr 17. doi: 10.1111/ced.14243. [Epub ahead of print]

Author information:

(1)Department of Dermatology, Quttainah Medical Center, Quttainah, Kuwait.

Clinical characteristics of COVID-19 disease were identified in a cohort study

involving 1099 patients from China. COVID-19 most commonly present with fever,

cough, fatigue, and congestion. Two out of 1099 patients were reported to have

skin rash, but time of onset and clinical description of rash were missing

(Reference B). Another study focused primarily on cutaneous manifestations

associated with COVID-19 evaluated 88 patients from Italy. 18 out of the 88

patients developed cutaneous manifestations, but only 8 patients developed skin

lesions at onset of disease.

DOI: 10.1111/ced.14243

PMID: 32302422

Goren A(1), Vaño-Galván S(2), Wambier CG(3), McCoy J(1), Gomez-Zubiaur A(4),

Moreno-Arrones OM(2), Shapiro J(5), Sinclair RD(6), Gold MH(7), Kovacevic M(8),

Mesinkovska NA(9), Goldust M(10), Washenik K(5)(11). A preliminary observation: Male pattern hair loss among hospitalized COVID-19 patients in Spain - A potential clue to the role of androgens in COVID-19 severity. J Cosmet Dermatol. 2020 Apr 16. doi: 10.1111/jocd.13443. [Epub ahead of print]

Author information:

(1)Applied Biology, Inc., Irvine, CA, USA.

(2)Dermatology Department, Ramon y Cajal Hospital, IRYCIS, University of Alcala,

Madrid, Spain.

(3)Department of Dermatology, The Warren Alpert Medical School of Brown

University, Providence, RI, USA.

(4)Department of Dermatology, Principe de Asturias Hospital, Alcala de Henares,

Spain.

(5)Ronald O. Perelman Department of Dermatology, New York University School of

Medicine, New York, NY, USA.

(6)Sinclair Dermatology, Melbourne, Vic., Australia.

(7)Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser &

Rejuvenation Center, Nashville, TN, USA.

(8)Department of Dermatology and Venereology, Clinical Hospital Center Sestre

Milosrdnice, Zagreb, Croatia.

(9)Department of Dermatology, School of Medicine of the University of California

Irvine, Irvine, CA, USA.

(10)Department of Dermatology, University Hospital Basel, Basel, Switzerland.

(11)Bosley Medical Group, Beverly Hills, CA, USA.

A preliminary observation of high frequency of male pattern hair loss among

admitted COVID-19 patients and suggest that androgen expression might be a clue

to COVID-19 severity.

DOI: 10.1111/jocd.13443

PMID: 32301221

Magro C(1), Mulvey JJ(2), Berlin D(3), Nuovo G(4), Salvatore S(1), Harp J(5),

Baxter-Stoltzfus A(1), Laurence J(6). Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020 Apr 15. pii: S1931-5244(20)30070-0. doi:10.1016/j.trsl.2020.04.007. [Epub ahead of print]

Author information:

(1)Department of Pathology and Laboratory Medicine, Weill Cornell Medicine.

(2)Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center.

(3)Department of Medicine, Division of Pulmonary and Critical Care Medicine,

Weill Cornell Medicine, New York, New York.

(4)The Ohio State University Comprehensive Cancer Center, Columbus Ohio and

Discovery Life Sciences, Powell, Ohio.

(5)Department of Dermatology, Weill Cornell Medicine.

(6)Department of Medicine, Division of Hematology and Medical Oncology, Weill

Cornell Medicine, New York, New York. Electronic address:

jlaurenc@med.cornell.edu.

Acute respiratory failure and a systemic coagulopathy are critical aspects of the

morbidity and mortality characterizing infection with severe acute respiratory

distress syndrome-associated coronavirus-2, the etiologic agent of Coronavirus

disease 2019 (COVID-19). We examined skin and lung tissues from 5 patients with

severe COVID-19 characterized by respiratory failure (n= 5) and purpuric skin

rash (n = 3). The pattern of COVID-19 pneumonitis was predominantly a

pauci-inflammatory septal capillary injury with significant septal capillary

mural and luminal fibrin deposition and permeation of the interalveolar septa by

neutrophils. No viral cytopathic changes were observed and the diffuse alveolar

damage (DAD) with hyaline membranes, inflammation, and type II pneumocyte

hyperplasia, hallmarks of classic acute respiratory distress syndrome, were not

prominent. These pulmonary findings were accompanied by significant deposits of

terminal complement components C5b-9 (membrane attack complex), C4d, and mannose

binding lectin (MBL)-associated serine protease (MASP)2, in the microvasculature,

consistent with sustained, systemic activation of the alternative and

lectin-based complement pathways. The purpuric skin lesions similarly showed a

pauci-inflammatory thrombogenic vasculopathy, with deposition of C5b-9 and C4d in

both grossly involved and normally-appearing skin. In addition, there was

co-localization of COVID-19 spike glycoproteins with C4d and C5b-9 in the

interalveolar septa and the cutaneous microvasculature of 2 cases examined. In

conclusion, at least a subset of sustained, severe COVID-19 may define a type of

catastrophic microvascular injury syndrome mediated by activation of complement

pathways and an associated procoagulant state. It provides a foundation for

further exploration of the pathophysiologic importance of complement in COVID-19,

and could suggest targets for specific intervention.

DOI: 10.1016/j.trsl.2020.04.007

PMCID: PMC7158248

PMID: 32299776

Ali FR(1), Al-Niaimi F(2). Non-cutaneous considerations of COVID19 for dermatology practices. J Cosmet Dermatol. 2020 Apr 16. doi: 10.1111/jocd.13444. [Epub ahead of print]

Author information:

(1)Vernova Healthcare Community Interest Company, Macclesfield, Cheshire, SK11

6JL, UK.

(2)152 Harley Street, London, W1G 7LH, UK.

COVID19 presents many pressing challenges to the global dermatological community

and our patients with ongoing skin needs, which must be considered by every

dermatology provider. Many of these are logistical and administrative, distinct

from physical manifestations, and could be summarised by the acronym COVID.

DOI: 10.1111/jocd.13444

PMID: 32298514

Henry D(1), Ackerman M(1), Sancelme E(1), Finon A(1), Esteve E(1). Urticarial eruption in COVID-19 infection. J Eur Acad Dermatol Venereol. 2020 Apr 15. doi: 10.1111/jdv.16472. [Epub ahead of

print]

Author information:

(1)Department of Dermatology, CHR Orléans, Orléans, France.

Coronavirus disease (COVID-19) is spreading quickly across the world, until a

pandemic condition was announced by the WHO on March. Many clinical

manifestations of this virus are described and new symptoms are emerging

particularly outside respiratory sphere, such as anosmia and ageusia which are

recent ORL published symptoms. About skin manifestation, few cases of rashes on

patients with laboratory-confirmed Covid-19 were described in two Chineses

cohorts.

DOI: 10.1111/jdv.16472

PMID: 32294273

Su CJ(1), Lee CH(1). Viral exanthem in COVID-19, a clinical enigma with biological significance.

J Eur Acad Dermatol Venereol. 2020 Apr 15. doi: 10.1111/jdv.16469. [Epub ahead of print]

Author information:

(1)Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung

University College of Medicine, Kaohsiung, Taiwan.

Since December 2019, the COVID-19 (1) has spread throughout the world at a

staggering speed. As of March 30, 2020, the confirmed case number has reached

693,224 globally and the COVID-19 has claimed 33,106 lives(2). Current researches

emphasize on understanding of transmission patterns, severity, clinical features,

and risk factors for infection, but the data remain limited.

DOI: 10.1111/jdv.16469

PMID: 32294270

Estébanez A(1), Pérez-Santiago L(2), Silva E(1), Guillen-Climent S(1),

García-Vázquez A(1), Ramón MD(1). . J Eur Acad Dermatol Venereol. 2020 Apr 15. doi: 10.1111/jdv.16474. [Epub ahead of print] Cutaneous manifestations in COVID-19: a new contribution.

Author information:

(1)Department of Dermatology, Clinical University Hospital, University of

Valencia, Valencia, Spain.

(2)Department of Surgery, Clinical University Hospital, University of Valencia,

Valencia, Spain.

We have read with great interest Dr Recalcati's review about skin manifestations

in COVID-19 as it is the first report on this subject1 . In a recent review on

clinical characteristics of coronavirus disease 2019 in China, rash was observed

in 0,2% of cases2 . However, from the trained eyes of a dermatologist, this

percentage may be higher.

DOI: 10.1111/jdv.16474

PMID: 32294264

Fernandez-Nieto D(1), Ortega-Quijano D(1), Segurado-Miravalles G(1),

Pindado-Ortega C(1), Prieto-Barrios M(1), Jimenez-Cauhe J(1). Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies. J Eur Acad Dermatol Venereol. 2020 Apr 15. doi: 10.1111/jdv.16470. [Epub ahead of print]

Author information:

(1)Dermatology Department, Ramon y Cajal University Hospital, Madrid, Spain.

We have read with great interest the article: Cutaneous manifestations in

COVID-19: a first perspective by Recalcati S.1 This article is the first report

of the cutaneous manifestations in Coronavirus Disease 2019 (COVID-19) patients

during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic

in Lombardy, Italy.

DOI: 10.1111/jdv.16470

PMID: 32294262

Mahé A(1), Birckel E(1), Krieger S(1), Merklen C(1), Bottlaender L(1). A distinctive skin rash associated with Coronavirus Disease 2019 ? J Eur Acad Dermatol Venereol. 2020 Apr 15. doi: 10.1111/jdv.16471. [Epub ahead of print]

Author information:

(1)Hôpital Pasteur, Colmar, France.

A skin rash has been reported in 2 out of 1.099 patients presenting with

Coronavirus disease 2019 in China [1], as in 14 of 48 patients with the same

disease in Italia, but unfortunately without further description of its semiology

[2]. We wish to report here the case of a woman who presented, coincidently with

Covid-19, a skin rash that had an original picture.

DOI: 10.1111/jdv.16471

PMID: 32294259

Joob B(1), Wiwanitkit V(2). Various forms of skin rash in COVID-19 : a reply.

. J Am Acad Dermatol. 2020 Apr 10. pii: S0190-9622(20)30612-5. doi:10.1016/j.jaad.2020.04.035. [Epub ahead of print]

Author information:

(1)Sanitation 1 Medical Academic Center, Bangkok Thailand. Electronic address:

beuyjoob@hotmail.com.

(2)Honoary professor, dr DY Patil University, Pune, India; visiting professor,

Hainan Medical University, Haikou, China.

DOI: 10.1016/j.jaad.2020.04.035

PMCID: PMC7151475

PMID: 32283235

Jimenez-Cauhe J(1), Ortega-Quijano D(2), Prieto-Barrios M(2), Moreno-Arrones

OM(2), Fernandez-Nieto D(2). Reply to "COVID-19 can present with a rash and be mistaken for Dengue": Petechial rash in a patient with COVID-19 infection. J Am Acad Dermatol. 2020 Apr 10. pii: S0190-9622(20)30556-9. doi:10.1016/j.jaad.2020.04.016. [Epub ahead of print]

Author information:

(1)Servicio de Dermatologia, Hospital Universitario Ramon y Cajal, IRYCIS,

Madrid, Spain. Electronic address: jjimenezc92@gmail.com.

(2)Servicio de Dermatologia, Hospital Universitario Ramon y Cajal, IRYCIS,

Madrid, Spain.

DOI: 10.1016/j.jaad.2020.04.016

PMCID: PMC7151451

PMID: 32283233

Zhang Y(1), Cao W(2), Xiao M(3), Li YJ(4), Yang Y(5), Zhao J(6), Zhou X(7), Jiang

W(8), Zhao YQ(1), Zhang SY(9), Li TS(2). [Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia].Zhonghua Xue Ye Xue Za Zhi. 2020 Mar 28;41(0):E006. doi:10.3760/cma.j.issn.0253-2727.2020.0006. [Epub ahead of print]

[Article in Chinese; Abstract available in Chinese from the publisher]

Author information:

(1)Department of Hematology, Peking Union Medical College Hospital, Chinese

Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,

China.

(2)Department of Infection Disease, Peking Union Medical College Hospital,

Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing

100730, China.

(3)Department of Laboratory Medicine, Peking Union Medical College Hospital,

Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing

100730, China.

(4)Department of General Medicine, Peking Union Medical College Hospital, Chinese

Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,

China.

(5)Department of orthopedics, Peking Union Medical College Hospital, Chinese

Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,

China.

(6)Department of Respiratory and Critical Care Medicine Peking Union Medical

College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical

College, Beijing 100730, China.

(7)Department of Intensive Care Unit, Peking Union Medical College Hospital,

Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing

100730, China.

(8)Department of Medical Intensive Care Unit, Peking Union Medical College

Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,

Beijing 100730, China.

(9)Department of Cardiology, Peking Union Medical College Hospital, Chinese

Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,

China.

Objective: To investigate the clinical and coagulation characteristics of the

critical Coronavirus disease 2019 (COVID-19) patients with acro-ischemia in the

intensive care unit (ICU). Methods: The retrospective study included 7 critical

COVID-19 patients with acro-ischemia in a single center in Wuhan, from Feb 4 to

Feb 15, 2020. The clinical and laboratory data before and during the ICU stay

were analyzed. Results: The median age of 7 patients was 59 years and 4 of them

were men. 3 of them were associated with underlying comorbidities. Fever, cough,

dyspnea and diarrhea were common clinical symptoms. All patients had

acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry

gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were

significantly elevated in most patients. Prothrombin time (PT) were prolonged in

4 patients. D-dimer and FDP levels increased progressively when COVID-2019

exacerbated, and 4 patients were diagnosed with definite disseminated

intravascular coagulation (DIC). 6 patients received low molecular weight heparin

(LMWH) treatment, after which their D-dimer and FDP decreased, but there was no

significant improvement in clinical symptoms. 5 patients died finally and the

median time from acro-ischemia to death was 12 days. Conclusions: The existence

of hypercoagulation status in critical COVID-2019 patients should be monitored

closely, and anticoagulation therapy can be considered in selected patients. More

clinical data is needed to investigate the role of anticoagulation in COVID-2019

treatment.

Publisher: 目的：总结合并肢端缺血的新型冠状病毒肺炎（COVID-19）患者的临床和凝血参数特征。方法：

回顾性分析2020年2月5日至2020年2月15日，北京协和医院国家医疗队在武汉收治的7例危重型COVID-19患者临床及实验室资料。结果：

7例患者中男性4例，女性3例，中位年龄59（49～71）岁；3例合并基础病。临床表现为发热7例、干咳6例、呼吸困难4例、腹泻4例。所有患者均存在不同程度的肢端缺血

，表现为肢端青斑/青紫、血疱、干性坏疽等。7例患者入住重症监护室时均存在D-二聚体显著升高，血小板计数均正常，6例纤维蛋白原升高及纤维蛋白降解产物（FDP）升高，

4例凝血酶原时间（PT）延长。随病情进展，D-二聚体及FDP进行性升高，4例患者符合2017年中国弥散性血管内凝血诊断标准。其中6例患者接受低分子肝素治疗，治疗后

D-二聚体及FDP下降，但临床症状无明显好转。中位随访26天，5例患者死亡，从肢端缺血症状出现至死亡的中位时间为12（7～16）d。结论：

部分危重型COVID-19患者存在明显高凝倾向，应关注此类患者凝血参数，及时识别高凝期并予抗凝治疗。肢端缺血表现为预后不良提示。抗凝治疗能否改善预后仍需更多临床数

据。.

DOI: 10.3760/cma.j.issn.0253-2727.2020.0006

PMID: 32220276

Recalcati S(1) Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020 Mar 26. doi: 10.1111/jdv.16387. [Epub ahead of print]

Author information:

(1)Department of Dermatology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco,

Italy.

In December 2019 unexplained pneumonia cases were initially reported in Wuhan,

China. The pathogen, a novel coronavirus named severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2), was isolated from lower respiratory tract samples of

infected patients and the resultant disease was termed as COVID-19 (Coronavirus

Disease 2019)1 . By Feb 15, COVID-19 has rapidly spread throughout China and

across the world, until a pandemic condition was announced by March 112 .

DOI: 10.1111/jdv.16387

PMID: 32215952

Amatore F(1), Macagno N(2), Mailhe M(3)(4), Demarez B(1), Gaudy-Marqueste C(1),

Grob JJ(1), Raoult D(3)(4), Brouqui P(3)(5)(4), Richard MA(5). SARS-CoV-2 infection presenting as a febrile rash. J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16528. [Epub ahead of print]

Author information:

(1)Department of Dermatology, Timone Hospital, Assistance Publique des Hôpitaux

de Marseille, Aix-Marseille University, Marseille, France.

(2)Department of Pathology, Timone Hospital, Assistance Publique des Hôpitaux de

Marseille, Aix-Marseille University, Marseille, France.

(3)IHU-Méditerranée Infection, Marseille, France.

(4)Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France.

(5)CEReSS-EA 3279, Research Centrer in Health Services and Quality of Life Aix

Marseille University, Dermatology Department, Universitary Hospital Timone,

Assistance Publique Hôpitaux de Marseille, 13385, Marseille, France.

The World Health Organization (WHO) has declared that Coronavirus disease 2019

(Covid-19) is a public health emergency of international concern as it continues

to spread worldwide.1 After a median incubation period of 4 days, fever and cough

are the two most common manifestations of severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) infection.

DOI: 10.1111/jdv.16528

PMID: 32330336

Avellana Moreno R(1), Villa E(2), Avellana Moreno V(3), Estela Villa C(4),

Aparicio M(5), Fontanella A(5). Cutaneous manifestation of COVID-19 in images: A case report.

J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16531. [Epub ahead of print]

Author information:

(1)Hospital Clínico San Carlos, Madrid, Spain.

(2)Hospital Virgen de la Luz, Cuenca, Spain.

(3)Medicina Familiar y Comunitaria, Centro de Salud Guayaba. Dirección

asistencial Centro, Madrid, Spain.

(4)Hospital Cayetano Heredia, Lima, Perú.

(5)Hospital Nisa Pardo de Aravaca, Madrid, Spain.

In December 2019, China reported the first group of pneumonia cases associated

with a new coronavirus, 2019-SARS-CoV-21 . Currently, the novel coronavirus

infection has become a pandemic2 . Significant research efforts are taking place

around the world to better understand the transmission dynamics, the spectrum of

clinical disease, possible treatment options, and prevention measures.

DOI: 10.1111/jdv.16531

PMID: 32330339

Duong TA(1)(2), Velter C(1), Rybojad M(3), Comte C(3), Bagot M(3)(4), Sulimovic L(5), Bouaziz JD(3)(4). Did Whatsapp® reveal a new cutaneous COVID-19 manifestation? J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16534. [Epub ahead of print]

Author information:

(1)Dermatology Department, Henri Mondor hospital, Créteil, France.

(2)Chaire Avenir Santé numérique, Equipe 8 IMRB, Inserm, Université Paris Est

Créteil, Créteil, France.

(3)Dermatology Department and Paris University, Saint-Louis Hospital, Paris,

France.

(4)INSERM U976 Human Immunology, Pathophysiology and Immunotherapy, Université de

Paris, Paris, France.

(5)President of the SNDV (syndicat national des dermatologues vénéréologues)/on

behalf of SNDV Corona group, paris, France.

In March 2020, Europe became the epicenter of COVID-19 pandemic. Several

countries organized nationwide population containment, starting on March 9th in

Italy and March 17th in France1 . For the continuity of care and to avoid in

person consultation and disease propagation, the French ministry of health

released incentives to facilitate live interactive consultation for COVID and

non-COVID patients.

DOI: 10.1111/jdv.16534

PMID: 32330322

Dermatological Complications from PPE

Jiang Q(1), Song S(2), Zhou J(3), Liu Y(4), Chen A(5), Bai Y(6), Wang J(7), Jiang

Z(8), Zhang Y(9), Liu H(10), Hua J(11), Guo J(12), Han Q(13), Tang Y(14), Xue

J(15). The prevalence, characteristics and prevention status of skin injury caused by

personal protective equipment among medical staff in fighting COVID-19: A

multi-center, cross-sectional study. Adv Wound Care (New Rochelle). 2020 Apr 22. doi: 10.1089/wound.2020.1212. [Epub ahead of print]

Author information:

(1)Nanjing Jinling Hospital, 144990, Department of Burns and Plastic Surgery,

Nanjing, China; jiangqixia1963@163.com.

(2)Medical School of Nanjing University, 117559, Nanjing, Jiangsu, China;

song_siping@163.com.

(3)Nanjing Jinling Hospital, 144990, Department of Burn and Plastic Surgery ,

Nanjing, Jiangsu, China; zhoujihong1968@163.com.

(4)Nanjing Jinling Hospital, 144990, Teaching and Research Office of Medical

Statistics, Nanjing, China; liu_yuxiu@163.com.

(5)Wenzhou Medical University Second Affiliated Hospital, 26452, Wenzhou,

Zhejiang, China; cah@wzhealth.com.

(6)Zhejiang Top-medical Dressing Co., Ltd., Zhejiang, China;

baiyuxuan_8896@163.com.

(7)Shanghai Yangpu District Central Hospital, 74683, Shanghai, Shanghai, China;

jinjieaa1024@gmail.com.

(8)Affiliated Hospital of Zunyi Medical College, 159358, Zunyi, Guizhou, China;

jzxhl@126.com.

(9)Dongguan Hospital of Traditional Chinese Medicine, 477091, Dongguan,

Guangdong, China; zhangyanghongdlyy@163.com.

(10)Nanjing Medical University Affiliated Wuxi People's Hospital, 261546, Wuxi,

Jiangsu, China; liuhy4091@sina.com.

(11)Affiliated Hospital of Jiangnan University, Zigong, Sichuan, China;

Jiangsuhuajiao@163.com.

(12)Shanxi Medical University Second Affiliated Hospital, 74761, Taiyuan, Shanxi

, China; gjlgbd@126.com.

(13)Zhongshan Hospital Xiamen University, 66366, Xiamen, China;

hanqiuying@xmzsh.com.

(14)Chongqing Medical University First Affiliated Hospital, 117972, Chongqing,

Sichuan, China; tangyongli628@163.com.

(15)Nanjing Jinling Hospital, 144990, Nanjing, Jiangsu, China; 1553783252@qq.com.

OBJECTIVE: To investigate the prevalence, characteristics and preventive status

of skin injuries caused by personal protective equipment (PPE) in medical staff.

APPROACH: A cross-sectional survey was conducted online for understanding skin

injuries among medical staff fighting against COVID-19 in February 8-22, 2020.

Participants voluntarily answered and submitted the questionnaire with cellphone.

The questionnaire items included demographic data, grade of PPE and daily wearing

time, skin injuries types, anatomical sites, and preventive measures. Univariable

analyses and logistic regression analyses were employed to explore the risk

factors associated with skin injuries.

RESULTS: A total of 4,308 respondents were collected from 161 hospitals and 4,306

respondents were valid. The overall prevalence of skin injuries was 42.8% (95% CI

41.30%-44.30%) with three types of device-related pressure injuries, moist

associated skin damage and skin tear. Co-skin injuries and multiple locations

injuries were 27.4% and 76.8%, respectively. The logistic regression analysis

indicated that sweating (95%CI for OR 87.52-163.11), daily wearing time (95% CI

for OR1.61-3.21), male (95% CI for OR 1.11-2.13) and grade 3 PPE (95% CI for

OR1.08-2.01) were associated with skin injuries. Only 17.7% respondents took

prevention and 45.0% skin injuries were treated.

INNOVATION: This the first cross-sectional survey to understand skin injuries in

medical staff caused by PPE, which is expected to be a benchmark.

CONCLUSION: The skin injuries among medical staff are serious, with insufficient

prevention and treatment. A comprehensive program should be taken in future.

DOI: 10.1089/wound.2020.1212

PMID: 32320359

Gheisari M(1), Araghi F(1), Moravvej H(1), Tabary M(2), Dadkhahfar S(1). Skin Reactions to Non-glove Personal Protective Equipment: An Emerging Issue in the COVID-19 Pandemic. J Eur Acad Dermatol Venereol. 2020 Apr 17. doi: 10.1111/jdv.16492. [Epub ahead of print]

Author information:

(1)Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran,

Iran.

(2)School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Protecting healthcare workers (HCWs) is crucial during Corona Virus Disease 2019

pandemic and requires wearing personal protective equipment (PPE) [1]. While most

of the studies have focused on the skin reactions caused by gloves, other PPE

such as gowns, respirator masks, face shields and goggles are also worn by HCWs

for long hours during the current epidemic and skin irritations caused by these

equipment may cause discouragement of health workers from using them [2]. In this

letter we have focused on the reaction caused by non-glove PPE.

DOI: 10.1111/jdv.16492

PMID: 32302444

Lin P(1)(2)(3), Zhu S(4), Huang Y(5), Li L(6), Tao J(7), Lei T(8), Song J(9), Liu

D(10), Chen L(11), Shi Y(8), Jiang S(8), Liu Q(9), Xie J(9), Chen H(10), Duan

Y(10), Xia Y(10), Zhou Y(10), Mei Y(11), Zhou X(11), Wu J(11), Fang M(12), Meng

Z(13), Li H(1)(2)(3). Adverse Skin Reactions Among Healthcare Workers During the Coronavirus Disease 2019 Outbreak: A Survey in Wuhan and Its Surrounding Regions. Br J Dermatol. 2020 Apr 7. doi: 10.1111/bjd.19089. [Epub ahead of print]

Author information:

(1)Department of Dermatology and Venerology, Peking University First Hospital,

Beijing, China.

(2)Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.

(3)National Clinical Research Center for Skin and Immune Diseases, Beijing,

China.

(4)Department of Biostatistics, Peking University First Hospital, Beijing, China.

(5)Division of Dermatology, Department of Medicine, University of Toronto,

Toronto, Canada.

(6)Department of Infection Management, Peking University First Hospital, Beijing,

China.

(7)Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong

University of Science and Technology, Wuhan, Hubei, China.

(8)Department of Dermatology and Venerology, Renmin Hospital of Wuhan University,

Wuhan, Hubei, China.

(9)Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan,

Hubei, China.

(10)Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong

University of Science and Technology, Wuhan, Hubei, China.

(11)Department of Dermatology, Wuhan First Hospital, Wuhan, Hubei, China.

(12)Department of Dermatology, Xiaogan Central Hospital, Xiaogan, Hubei, China.

(13)Department of Dermatology, Renmin Hospital Hubei University of Medicine,

Shiyan, Hubei, China.

During the outbreak of coronavirus disease 2019 (COVID-19), healthcare workers

(HCWs) caring for COVID-19 patient have to wear personal protective equipment

(PPE) and are therefore susceptible to PPE-related adverse skin reactions.

However, little is known about the prevalence and characteristics of these

adverse skin reactions and their associated risk factors.

DOI: 10.1111/bjd.19089

PMID: 32255197

Elston DM(1). Occupational skin disease among health care workers during the coronavirus

(COVID-19) epidemic. J Am Acad Dermatol. 2020 May;82(5):1085-1086. doi: 10.1016/j.jaad.2020.03.012. Epub 2020 Mar 18.

Author information:

(1)Department of Dermatology and Dermatologic Surgery, Medical University of

South Carolina, Charleston, South Carolina. Electronic address: elstond@musc.edu.

Comment on

J Am Acad Dermatol. 2020 May;82(5):1215-1216.

DOI: 10.1016/j.jaad.2020.03.012

PMCID: PMC7156807

PMID: 32171807

Yan Y(1), Chen H(2), Chen L(3), Cheng B(4), Diao P(5), Dong L(6), Gao X(7), Gu

H(8), He L(9), Ji C(4), Jin H(10), Lai W(11), Lei T(12), Li L(5), Li L(13), Li

R(1), Liu D(2), Liu W(14), Lu Q(15), Shi Y(12), Song J(16), Tao J(6), Wang B(17),

Wang G(18), Wu Y(1), Xiang L(19), Xie J(16), Xu J(19), Yao Z(20), Zhang F(21),

Zhang J(22), Zhong S(1), Li H(23), Li H(1). Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatol Ther. 2020 Mar 13:e13310. doi: 10.1111/dth.13310. [Epub ahead of print]

Author information:

(1)Department of Dermatology, Peking University First Hospital, National Clinical

Research Center for Skin and Immune Diseases, Beijing Key Laboratory of Molecular

Diagnosis on Dermatoses, Xicheng District, Beijing, China.

(2)Department of Dermatology, Tongji Hospital of Tongji Medical College, Huazhong

University of Science and Technology, Hankou, Wuhan, People's Republic of China.

(3)Department of Dermatology, Wuhan No.1 Hospital, Wuhan, Hubei, People's

Republic of China.

(4)Department of Dermatology, First Affiliated Hospital of Fujian Medical

University, Fuzhou, Fujian, People's Republic of China.

(5)Department of Dermatology, West China Hospital of Sichuan University, Wuhou

District, Chengdu City, Sichuan Province, People's Republic of China.

(6)Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong

University of Science and Technology, Wuhan, Hubei Province, People's Republic of

China.

(7)Department of Dermatology, Chinese Medical University First Hospital,

Shenyang, Liaoning Province, People's Republic of China.

(8)Hospital for Skin Diseases, Chinese Academy of Medical Sciences, Nanjing,

Jiangsu Province, People's Republic of China.

(9)Department of Dermatology, First Affiliated Hospital of Kunming Medical

University, Wuhua District, Kunming, Yunnan Province, People's Republic of China.

(10)Department of Dermatology, Peking Union Medical College Hospital, Dongcheng

District, Beijing, China.

(11)Department of Dermatology, The Third Affiliated Hospital, Sun Yat-Sen

University, Tianhe District, Guangzhou, Guangdong, China.

(12)Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, China.

(13)Department of Infection Control, Peking University First Hospital, Xicheng

District, Beijing, China.

(14)Department of Dermatology, Air Force General Hospital of PLA, Haidian

District, Beijing, People's Republic of China.

(15)Department of Dermatology, The Second Xiangya Hospital of Central South

University, Changsha, China.

(16)Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuchang

District, Wuhan, Hubei Province, China.

(17)Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union

Medical College, Shijingshan District, Beijing, China.

(18)Department of Dermatology, Xijing Hospital, Air Force Medical University of

PLA, Xi'an, Shaanxi, China.

(19)Department of Dermatology, Huashan Hospital, Fudan University, Shanghai,

China.

(20)Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong

University School of Medicine, Yangpu District, Shanghai, People's Republic of

China.

(21)Shandong Academy of Medical Sciences, Ji'nan, Shandong Province, People's

Republic of China.

(22)Department of Dermatology, Peking University People's Hospital, Xicheng

District, Beijing, People's Republic of China.

(23)Department of Dermatology, Hainan Hospital of PLA General Hospital, Sanya,

Hainan Province, China.

Health professions preventing and controlling Coronavirus Disease 2019 are prone

to skin and mucous membrane injury, which may cause acute and chronic dermatitis,

secondary infection and aggravation of underlying skin diseases. This is a

consensus of Chinese experts on protective measures and advice on hand-cleaning-

and medical-glove-related hand protection, mask- and goggles-related face

protection, UV-related protection, eye protection, nasal and oral mucosa

protection, outer ear, and hair protection. It is necessary to strictly follow

standards of wearing protective equipment and specification of sterilizing and

cleaning. Insufficient and excessive protection will have adverse effects on the

skin and mucous membrane barrier. At the same time, using moisturizing products

is highly recommended to achieve better protection.

DOI: 10.1111/dth.13310

PMID: 32170800

Other Dermatology -Covid Associated issues

Tagliaferri L(1), Di Stefani A(2), Schinzari G(3)(4), Fionda B(1), Rossi E(3), Del Regno L(2), Gentileschi S(5)(6), Federico F(7)(8), Valentini V(1)(9), Tortora G(3)(4), Peris K(2)(10); Gemelli Skin-Cancer Multidisciplianry Tumour Board (S-MDTB). Skin cancer triage and management during COVID-19 pandemic. J Eur Acad Dermatol Venereol. 2020 Apr 25. doi: 10.1111/jdv.16529. [Epub ahead of

print]

Author information:

(1)Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di

Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART

(Advanced Radiation Therapy), Interventional Oncology Centre (IOC), Rome, Italy.

(2)Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Dermatologia,

Rome, Italy.

(3)Fondazione Policlinico Universitario A. Gemelli IRCCS, Oncologia Medica,

Dipartimento di Scienze Mediche e Chirurgiche, Rome, Italy.

(4)Università Cattolica del Sacro Cuore, Oncologia Medica, Rome, Italy.

(5)Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze

della Salute della Donna, del Bambino e di Sanità Pubblica, Unità di Chirurgia

Plastica, Rome, Italy.

(6)Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Rome,

Italy.

(7)Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Patologia,

Rome, Italy.

(8)Università Cattolica del Sacro Cuore, Istituto di Patologia, Rome, Italy.

(9)Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy.

(10)Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy.

The worldwide medical community is striving to pursue the most appropriate

clinical choices in the worst event of pandemic of the modern times [1], with

over 1 million patients affected by COVID-19 (i.e., swab positive patients with

or without symptoms) reported so far [1]. In this context, the aim of the ideal

management of cancer patients is to achieve the best possible balance between the

two different issues to be considered, which include the risk of cancer

progression and the risk of infectious disease.

DOI: 10.1111/jdv.16529

PMID: 32333832

Garcovich S(1)(2), Bersani FS(3), Chiricozzi A(1)(2), De Simone C(1)(2). Mass quarantine measures in the time of COVID-19 pandemic: psycho-social implications for chronic skin conditions and a call for qualitative studies. J Eur Acad Dermatol Venereol. 2020 Apr 24. doi: 10.1111/jdv.16535. [Epub ahead of print]

Author information:

(1)Dermatology, Department of Medical and Surgical Sciences, Università Cattolica

del Sacro Cuore, Rome, Italy.

(2)Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

(3)Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.

During the ongoing COVID-19 pandemic almost all European countries are adopting

mass quarantine or isolation measures as a public health strategy to limit the

spread of the contagion. Italy, as the first European country to be deeply

affected by such pandemic, is currently approaching the fourth week of total

lockdown, with restrictive measures on the population and profound challenge for

the national health-care system.

DOI: 10.1111/jdv.16535

PMID: 32330329

Conforti C(1), Giuffrida R(2), Di Meo N(1), Zalaudek I(1). Management of advanced melanoma in the COVID-19 era Dermatol Ther. 2020 Apr 22:eacronym. doi: 10.1111/dth.13444. [Epub ahead of

print]

Author information:

(1)Department of Dermatology and Venereology, University of Trieste, Ospedale

Maggiore, Trieste, Italy.

(2)Department of Clinical and Experimental Medicine, Section of Dermatology,

University of Messina, Messina, Italy.

DOI: 10.1111/dth.13444

PMID: 32323399

Reynolds SD(1), Mathur AN(1), Chiu YE(2), Brandling-Bennett HA(3), Pope E(4),

Siegel MP(5), Holland KE(2), Paller AS(6), Siegfried EC(7), Tom WL(8),

Lara-Corrales I(4), Tollefson MM(9), Maguiness S(10), Eichenfield LF(8), Sugarman

J(1), Frieden IJ(1), Oza VS(11), Cipriano SD(12), Huang JT(13), Shah SD(1),

Lauren CT(14), Castelo-Soccio L(15), McMahon P(15), Cordoro KM(1). Systemic Immunosuppressive Therapy for Inflammatory Skin Diseases in Children:

Expert-Consensus-Based Guidance for Clinical Decision Making During the COVID-19

Pandemic. Pediatr Dermatol. 2020 Apr 22. doi: 10.1111/pde.14202. [Epub ahead of print]

Author information:

(1)Department of Dermatology, University of California, San Francisco School of

Medicine, San Francisco, CA, USA.

(2)Departments of Dermatology and Pediatrics, Medical College of Wisconsin,

Milwaukee, WI, USA.

(3)Division of Dermatology, Department of Pediatrics, Seattle Children's

Hospital, University of Washington, Seattle, WA, USA.

(4)Dermatology Section, Hospital for Sick Children, Toronto, Ontario, Canada.

(5)Pediatric Dermatology Research Alliance.

(6)Departments of Dermatology and Pediatrics, Northwestern University, Chicago,

IL, USA.

(7)Department of Pediatrics, Saint Louis University and Cardinal Glennon

Children's Hospital, St.Louis, MO, USA.

(8)Division of Pediatric and Adolescent Dermatology, University of California,

San Diego and Rady Children's Hospital, San Diego, California, USA.

(9)Departments of Dermatology and Pediatrics, Mayo Clinic and Mayo Clinic

Children's Center, Rochester, MN, USA.

(10)Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.

(11)Ronald O Perelman Department of Dermatology, NYU Grossman School of Medicine,

New York, NY, USA.

(12)Department of Dermatology, University of Utah, Salt Lake City, UT, USA.

(13)Dermatology Program, Boston Children's Hospital, Department of Dermatology,

Harvard Medical School, Boston, MA, USA.

(14)Departments of Dermatology and Pediatrics, Columbia University Vagelos

College of Physicians and Surgeons, New York, NY, USA.

(15)Children's Hospital of Philadelphia, Philadelphia, PA, USA.

BACKGROUND/OBJECTIVES: The COVID-19 pandemic has raised questions about the

approach to management of systemic immunosuppressive therapies for dermatologic

indications in children. Given the absence of data to address concerns related to

SARS-CoV-2 infection while on these agents in an evidence-based manner, a

Pediatric Dermatology COVID-19 Response Task Force (PDCRTF) was assembled to

offer time-sensitive guidance for clinicians.

METHODS: A survey was distributed to an expert panel of 37 pediatric

dermatologists on the PDCRTF to assess expert opinion and current practice

related to three primary domains of systemic therapy: initiation, continuation,

and laboratory monitoring.

RESULTS: Nearly all respondents (97%) reported that the COVID-19 pandemic had

impacted their decision to initiate immunosuppressive medications. The majority

of pediatric dermatologists (87%) reported that they were pausing or reducing the

frequency of laboratory monitoring for certain immunosuppressive medications. In

asymptomatic patients, continuing therapy was the most popular choice across all

medications queried. The majority agreed that patients on immunosuppressive

medications who have a household exposure to COVID-19 or test positive for acute

infection should temporarily discontinue systemic and biologic medications, with

the exception of systemic steroids, which may require tapering.

CONCLUSIONS: The ultimate decision regarding initiation, continuation and

laboratory monitoring of immunosuppressive therapy during the pandemic requires

careful deliberation, consideration of the little evidence available, and

discussion with families. Consideration of an individual's adherence to COVID-19

preventive measures, risk of exposure, and the potential severity if infected

must be weighed against the dermatological disease, medication, and risks to the

patient of tapering or discontinuing therapies.

DOI: 10.1111/pde.14202

PMID: 32320494

Gisondi P(1), Piaserico S(2), Conti A(3), Naldi L(4)(5). Dermatologists and SARS-CoV-2: The impact of the pandemic on daily practice. J Eur Acad Dermatol Venereol. 2020 Apr 22. doi: 10.1111/jdv.16515. [Epub ahead of print]

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

Wollina U(1). Challenges of Covid-19 Pandemic for Dermatology.

Dermatol Ther. 2020 Apr 20. doi: 10.1111/dth.13430. [Epub ahead of print]

Author information:

(1)Department of Dermatology and Allergology, Städtisches Klinikum Dresden,

Academic Teaching Hospital, Friedrichstrasse 41, Dresden.

SARS-CoV-2 is a new corona virus responsible for the pandemic named Coronavirus

Disease 2019 (COVID-19). The disease causes severe acute respiratory syndromes

with a significant morbidity and mortality. We provide a review with a focus on

COVID-19 in dermatology. We discuss triage of suspected infectious patients,

protection of medical doctors and nurses. We discuss the available data on

cutaneous symptoms, although disease-specific symptoms have yet not been

observed. COVID-19 is a challenge for the treatment of dermatologic patients,

either with severe inflammatory disorders or with skin cancer. The consequences

for systemic treatment are obvious but it will be most important to collect the

clinical data for a better decision process. Last but not least education in

dermatology for students will be temporarily not be possible in the classical

settings. COVID-19, although not a skin disease by itself has an immense impact

DOI: 10.1111/dth.13430

PMID: 32314460

Marasca C(1), Ruggiero A(1), Fontanella G(1), Ferrillo M(1), Fabbrocini G(1),

Villani A(1). Telemedicine and support groups in order to improve the adherence to treatment

and health related quality of life in patients affected by inflammatory skin

conditions during COVID-19 emergency. Clin Exp Dermatol. 2020 Apr 18. doi: 10.1111/ced.14245. [Epub ahead of print]

Author information:

(1)Section of Dermatology, Department of Clinical Medicine and Surgery,

University of Naples Federico II, Napoli, Italy.

We have read with great interest the article by Deepak et al. which reported the

measures applied during the COVID-19 emergency in order to answer to the request

of consultations. Particularly they described the growing importance that

telemedicine is having during this emergency, focusing on the use of mobile

technology (particularly the use of WhatsApp) as a method to communicate via text

messages, voice messages, photos and videos, which is rapidly expanding within

the field of telemedicine.

DOI: 10.1111/ced.14245

PMID: 32304587

Brownstone ND(1), Thibodeaux QG(1), Reddy VD(1), Myers BA(1), Chan SY(1), Bhutani

T(1), Liao W(1). Novel Coronavirus Disease (COVID-19) and Biologic Therapy in Psoriasis: Infection

Risk and Patient Counseling in Uncertain Times. Dermatol Ther (Heidelb). 2020 Apr 16:1-11. doi: 10.1007/s13555-020-00377-9. [Epub ahead of print]

Author information:

(1)Department of Dermatology, Psoriasis and Skin Treatment Center, University of

California San Francisco, San Francisco, CA USA.

With the emergence of the novel coronavirus disease (COVID-19) viral pandemic,

there is uncertainty whether biologic agents for psoriasis may place patients at

a higher risk for infection or more severe disease course. This commentary offers

patient counseling recommendations based on the current available evidence. While

there are currently no specific data for psoriasis biologics and COVID-19, data

are presented here from phase III clinical trials of psoriasis biologics on rates

of upper respiratory infection, influenza, and serious infection. Overall these

data reveal that on the whole, psoriasis biologics do not show major increases in

infection risk compared to placebo during the course of these trials. However, as

the COVID-19 virus is a novel pathogen that is associated with mortality in a

subset of patients, a cautious approach is warranted. We discuss factors that may

alter the benefit-risk ratio of biologic use during this time of COVID-19

outbreak. Ultimately, treatment decisions should be made on the basis of dialogue

between patient and provider, considering each patient's individualized

situation. Once this pandemic has passed, it is only a matter of time before a

new viral disease reignites the same issues discussed here.

DOI: 10.1007/s13555-020-00377-9

PMCID: PMC7160052

PMID: 32300516