Cutaneous manifestations in patients with COVID-19 : a preliminary review of an emerging issue

Background: The infection caused by the recently identified SARS-CoV-2, called COronaVIrus Disease-19 (COVID-19), has rapidly spread throughout the world. With the exponential increase of patients worldwide, the clinical spectrum of COVID-19 is being better defined and new symptoms are emerging. Numerous reports are documenting the occurrence of different cutaneous manifestations in COVID-19 patients. Objectives: To provide a brief overview of the COVID-19-associated cutaneous lesions. Methods: Literature search was performed in the PubMed, Scopus and Web of Science databases up to 30 April 2020. This narrative review summarizes the available data regarding clinical and histological features of COVID-19-associated skin manifestations. Results: Literature reports showed a great heterogeneity in COVID-19-associated cutaneous manifestations, as well as in their latency periods and associated extracutaneous symptoms. Pathogenic mechanisms are unknown, although the role of hyperactive immune response, complement activation and microvascular injury has been hypothesized. Based on our experience and the literature data, we subdivided the reported cutaneous lesions into six main clinical patterns: i) urticarial rash, ii) confluent erythematous/maculo-papular/morbilliform rash, iii) papulovesicular exanthem, iv) chilblain-like acral pattern, v) livedo reticularis/racemosa-like pattern, vi) purpuric "vasculitic" pattern. These six patterns can be merged into two main settings: the first one - inflammatory/exanthematous - including the first three groups cited above and the second one including the vasculopathic/vasculitic lesions of the last three aforementioned groups. Conclusions: The possible presence of cutaneous findings leading to suspect COVID-19 puts dermatologists in a relevant position. Further studies are needed to delineate the diagnostic and prognostic value of such cutaneous manifestations

once weekly administration of high dosage etanercept in patients with plaque psoriasis results of a pilot experience power study

Abstract Etanercept is a soluble tumour necrosis factor receptor fusion protein which is approved for the treatment of plaque psoriasis at the dose of either 25mg twice weekly (BIW) or, for the initial 12 weeks, 50mg BIW. Alternative dosing regimens have not been evaluated in psoriasis. In this study, we compare the efficacy and tolerability of two etanercept dosing regimens--50mg BIW and 100mg once weekly (OW)--for 12 weeks in 108 patients with moderate-to-severe recalcitrant psoriasis. Efficacy measures included Psoriasis Area and Severity Index (PASI), severity of pruritus recorded on a visual analogue scale (VAS) and the influence on quality of life assessed by means of Dermatology Life Quality Index (DLQI). Both etanercept regimens caused a significant change in all the efficacy parameters after 4 weeks and 12 weeks, at a comparable rate. At week 12, a PASI improvement of at least 50% from baseline (PASI 50) was achieved by 74% of patients treated with 50mg BIW and 78% of patients treated with 100mg OW. A PASI 75 response was obtained in 54% and 50% of patients treated with 50mg BIW and 100mg OW, respectively. Treatment was well tolerated with similar type and frequency of adverse events between the two groups

Linee guida sulla isotretinoina - consensus

Qualche anno addietro, si sparse la notizia che l'isotretinoina orale sarebbe stata ritirata dal commercio. In quel periodo fu pubblicato sugli Annales de Dermatologie un articolo scritto da un dermatologo francese preoccupato per quanto sarebbe successo a noi dermatologi, privati della isotretinoina orale, nella gestione dei pazienti con acne grave. Si prospettava un quadro di desolante ritorno al passato con \uec pazienti vittime di decisioni amministrative, scientificamente morto discutibili, prese con superficialit\ue0. Fortunatamente questo non accadde vista la infondatezza delle argomentazioni accusatorie avanzate. Da questa vicenda emerse la consapevolezza che alla base di quanto successo c'era una preoccupante disinformazione sulle caratteristiche del farmaco estesa ad ampie fasce di soggetti coinvolti nella gestione e nell'utilizzo del prodotto, medici di medicina generale, pediatri, farmacisti e pazienti. Alla luce di questo abbiamo sentito l'esigenza di colmare questa lacuna e di preparare una nota informativa, chiara e completa, sulle caratteristiche dell'isotretinoina orale. Tale documento era diretto, con modalit\ue0 e contenuti opportunamente adattati, alle singole categorie sopra riportate. L'obiettivo finale era quello di evitare che, a pazienti effettivamente bisognosi di tale trattamento, esso fosse negato con motivazioni inconsistenti o per disinformazione. Il lavoro congiunto di un board di dermatologi, appartenenti alle Societ\ue0 pi\uf9 rappresentative della Dermatologia Italiana, ha portato alla definizione di due documenti informativi sull'isotretinoina orale. Il primo \ue8 indirizzato a medici di medicina generale, pediatri e farmacisti ed il secondo ai pazienti. \uc8 in programmazione per il prossimo futuro la preparazione di linee guida aggiornate sull'utilizzo del farmaco ad uso dei dermatologi

Resistant cases of psoriatic arthritis : how to manage them

Psoriasis is a chronic, genetically determined and immunomediated inflammatory skin disease that affects 2%-3% of the Caucasian population. Psoriatic arthritis (PsA), which occurs in up to one-third of patients with psoriasis, has a heterogeneous pattern expressed by various manifestations, including mono-oligoarthritis, an erosive and destructive polyarthritis indistinguishable from rheumatoid arthritis (RA), and spondyloarthropathy with axial involvement or enthesitis. Early detection of inflamed joints or axial involvement in patients with PsA is important in order to reduce inflammation and prevent joint destruction, deformity, and functional disability. The treatment of moderate-severe PsA has tended to include the same disease modifying antirheumatic drugs used to treat RA, but there is much less evidence supporting their efficacy and essentially none demonstrating that they slow radiographic joint destruction in PsA. A number of clinical trials have shown that tumor necrosis factor antagonists are generally safe and efficacious in the treatment of PsA, and can inhibit the progression of radiographic damage

The Role of Platelets in Chronic Urticaria

Background: Platelets are implicated in many pathophysiological processes, including inflammation and immunity. Ever-growing evidence suggests the active involvement of platelets in the pathogenesis of various inflammatory disorders, including cutaneous inflammatory diseases. A limited number of studies have investigated the role of platelets in chronic urticaria (CU). In this review, we summarize the current knowledge regarding the role of platelets in chronic spontaneous and inducible urticarias. Methods: A literature search was performed using PubMed and Google Scholar, and the references of relevant literature were reviewed. Results: Overall, in CU patients, conflicting results have been obtained from the assessment of platelet indices, such as mean platelet volume, platelet count and distribution width, as well as markers of platelet aggregation and activation. Nevertheless, a few studies showed significant changes of such parameters in CU patients compared to controls, in apparent correlation with clinical severity, autoreactivity and/or inflammatory status. Conclusions: In the absence of definitive conclusions, the pathogenic role of platelets in CU needs to be further explored. Platelets might represent a link between inflammation, coagulation and histamine release in the pathophysiological network of CU

Treatment and Prophylaxis of Pityriasis Versicolor with Oral Fluconazole

Treatment with oral antifungals is usually preferred when pityriasis versicolor (PV) affects large body surface areas, especially in chronic or recurrent cases. In this study, we evaluated the effectiveness of fluconazole in the treatment and prophylaxis of patients with chronic or recurrent, mostly extensive, PV. Treatment regimen consisted of fluconazole 100mg once daily for 10 consecutive days; 3–4 weeks after the end of treatment, patients were evaluated for clinical and mycological response (visit T1). Patients with mycological eradication received fluconazole 200mg/day (100mg twice a day) for two consecutive days per month for 5 months. Clinical and mycological evaluations were performed after 2 months (T2) and 5 months (T3) from visit T1. Mycological efficacy was assessed using microscopic examination and represented the primary efficacy parameter; therefore, positive microscopy at any visit was reason for withdrawal from the study. At visit T1 60 subjects were evaluated; most patients (94 %) were clinically cured or improved. Similar clinical response rates were observed at visits T2 and T3. The proportion of patients with eradication of Malassezia was 92 % at T1 visit, 88 % at T2 visit, and 91 % at T3 visit. No relevant adverse events occurred. The results of this open preliminary study suggest that an oral treatment with fluconazole 100mg/day for 10 days is effective in PV. A maintenance monthly treatment with fluconazole 200mg/day for two consecutive days can be very useful to prevent recurrence of PV