COVID19 and Dermatology

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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.

Copyright © 2020. Published by Elsevier Ltd.

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.


Copyright © 2020, Kakodkar et al.

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.


This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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).

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

© 2020 Wiley Periodicals, Inc.

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.

Copyright © 2020 Elsevier Inc. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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 .

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

© 2020 Wiley Periodicals, Inc.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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

on dermatology. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

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.

This article is protected by copyright. All rights reserved.

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.

© The Author(s) 2020.

DOI: 10.1007/s13555-020-00377-9 

PMCID: PMC7160052

PMID: 32300516