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Background: Since the COVID-19 pandemic started, great interest has been given to this disease, especially to its possible clinical presentations. Besides classical respiratory symptoms, dermatological manifestations occur quite often among infected and non-infected patients, particularly in children. A prominent IFN-I response, that is generally higher in children compared to adults, may not only cause chilblain lesions, but it could also prevent infection and viral replication, thus justifying the negative swab results, as well as the absence of relevant systemic symptoms in positive cases. Indeed, reports have emerged describing chilblain-like acral lesions in children and adolescents with either proven or suspected infection., Methods: Patients aged from 1 to 18 years old were enrolled in this study from 23 Italian dermatological units and were observed for an overall period of 6 months. Clinical pictures were collected along with data on the location and duration of skin lesions, their association with concomitant local and systemic symptoms, presence of nail and/or mucosal involvement, as well as histological, laboratory and imaging findings., Results: One hundred thirty-seven patients were included, of whom 56.9% were females. Mean age was 11.97±3.66 years. The most commonly affected sites were the feet (77 patients, 56.2%). Lesions (48.5%) featured cyanosis, chilblains, blisters, ecchymosis, bullae, erythema, edema, and papules. Concomitant skin manifestations included maculo-papular rashes (30%), unspecified rashes (25%), vesicular rashes (20%), erythema multiforme (10%), urticaria (10%) and erythema with desquamation (5%). Forty-one patients (29.9%) reported pruritus as the main symptom associated with chilblains, and 56 out of 137 patients also reported systemic symptoms such as respiratory symptoms (33.9%), fever (28%), intestinal (27%), headache (5.5%), asthenia (3.5%), and joint pain (2%). Associated comorbid conditions were observed in 9 patients presenting with skin lesions. Nasopharyngeal swabs turned out positive in 11 patients (8%), whereas the remainder were either negative (101, 73%) or unspecified (25, 18%)., Conclusions: COVID-19 has been credited as the etiology of the recent increase in acro-ischemic lesions. The present study provides a description of pediatric cutaneous manifestations deemed to be potentially associated with COVID-19, revealing a possible association between acral cyanosis and nasopharyngeal swab positivity in children and teenagers. The identification and characterization of newly recognized patterns of skin involvement may aid physicians in diagnosing cases of asymptomatic or pauci-symptomatic COVID patients.

Background: COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID-19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020., Aim: Skin manifestations related to SARS-CoV-2 infection can be divided mainly into five groups: chilblainlike lesions (CBLLs), maculopapular eruptions, urticarial eruptions, vesicular eruptions, and livedo or necrosis. Other skin findings reported are erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C) and rarely with multisystem inflammatory syndrome in adults (MIS-A). Other manifestations such as pityriasis rosea or shingles are also reported., Methods: A total of 60 articles including reviews, studies and case reports were selected for the evaluation in this review., Results: The skin manifestations associated with COVID-19 infection are numerous and can vary widely. The major dermatological patterns of COVID-19 can be classified as inflammatory reactions (maculopapular/morbilliform, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo acemose-like pattern) CONCLUSION: We believe that the dermatologist could play an important role in the response to the SARS-CoV-2 pandemic through early recognition of skin lesions suggestive of COVID-19, particularly in paucisymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Patients with atopic dermatitis (AD) display a defective skin barrier, consequently they may experience inflammatory flares with different exposures, including masks. Actually, beside scattering case reports, no study focused on the possible AD flaring due to masks., Methods: In this multicenter prospective study AD patients with facial manifestation were followed with teledermatology and evaluated by two board-certified dermatologists at the baseline (T0) and after 1 month (T1) in which patients started to wear masks >6 hours per day. Demographics and clinical parameters, included and not limited to Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI), were carefully collected and analyzed., Results: We enrolled 57 AD patients (M/F 28/29, 33.91±12.26 years old) that wore surgical masks (38 [66.7%]), community masks (11 [19.3%] and N95 (8 [14.0%]). Both DLQI and EASI increase during the time period (P<0.0001). DLQI variation was not influenced by age, BMI, and gender, mask type used and AD therapy (P=0.99), whilst EASI variation was significantly influenced by BMI, gender, and therapy (P=0.004)., Conclusions: Mask wearing may prove detrimental to patients with atopic eczema and the same may not necessarily be the case for asthma patients.

Urticaria is a disease characterized by wheals and/or angioedema. Chronic spontaneous urticaria (CSU) occurs for longer than 6 weeks and appears independently of any identifiable exogenous stimulus. During the vaccination campaign for Coronavirus disease 2019 (COVID-19) pandemic, several cutaneous adverse events have been described, among which urticaria lasting less than 6 weeks (acute urticaria, AU). AU due to vaccines can be IgE or non-IgE mediated; the former typically develop within 4 h of drug exposure, the latter occurs later and the mechanism is unclear. In this retrospective study we analyzed the frequency and clinical characteristics of urticaria occurring after COVID-19 vaccine (post-vaccination urticaria relapse) in adult CSU patients treated with antihistamine and omalizumab, and in clinical remission., (© 2022 The Authors. Dermatologic Therapy published by Wiley Periodicals LLC.)

The COVID-19 era represented an important stressful event affecting population in many different ways, with important negative impact on social, working and relational life. Indeed, the home-isolation in addition to the high-level of distress given by fear of infection, has significantly resulted in a large number of psychological-consequences. Moreover, in order to guarantee a continuity of care, different measures have been applied among hospitals such as the implementation of teledermatology services. For these reasons, we implemented at our Dermatological-Clinic psychological video-consultations through our teledermatology-services. Herein we report our experience of 23 psychological-video-consultations, which led to achieve a significant reduction of DLQI (from 4.4 ± 3.9 at baseline to 1.6 ± 2.5 at week-4) in patients suffering from chronic skin conditions during the COVID-19 era.

Competing Interests: A.C. served as advisory board member and consultant receiving fees and speaker's honoraria or has participated in clinical trials for AbbVie, Almirall, Biogen, Fresenius Kabi, Leo Pharma, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi Genzyme, and UCB Pharma. G.F. acted as speaker and consultant for AbbVie and Leo Pharma. G.G. has been principal investigator in clinical trials sponsored by and/or and has received personal fees from AbbVie, Almirall, Amgen, Biogen, Boehringer Ingelheim, Bristol-Meyers Squibb, Celgene, Eli Lilly, Leo Pharma, Novartis, OM Pharma, Pfizer, Regeneron, Samsung, and Sandoz. A.O. has been a scientific consultant/speaker/clinical study investigator for AbbVie, Celgene, Janssen, Leo Pharma, Eli Lilly, MSD, Novartis, Pfizer, Sanofi, Alfasigma, and Almirall. M.T.R. has received personal fee for advisory board meeting from Sanofi, AbbVie, Novartis, and Cantabria. L.B. reports personal fees from speaker and as consultant for AbbVie, Novartis, Janssen-Cilag, Pfizer, UCB, and Leo Pharma, outside the submitted work. L.S. has been principal investigator in clinical trials sponsored by and/or received personal fees from AbbVie, Almirall, Celgene, Eli Lilly, Janssen, Novartis, and Sanofi-Genzyme. G.P. has been principal investigator in clinical trials sponsored by and/or received personal fees from AbbVie, Almirall, Eli Lilly, Leo Pharma, Novartis, and Sanofi. A.P. has served as a speaker and received honoraria from Sanofi-Genzyme for lectures, research grants, and as an advisory board member. C.F. has been speaker for Sanofi and AbbVie. M.C.F. has served on advisory boards, received honoraria for lectures, and research grants from Almirall, AbbVie, Galderma, Leo Pharma, Mylan, Medac Pharma, Celgene, Pierre Fabre, UCB, Eli Lilly, Pfizer, Janssen, Novartis, Sanofi Genzyme, Roche, Sun Pharma, and MSD. F.R. has served on advisory board, received honoraria for lectures and research grants from Novartis, AbbVie, Janssen-Cilag, Eli Lilly, Leo Pharma, and Sanofi-Genzyme. P.A. has received speaker honoraria from Sanofi, AbbVie, Janssen, Celgene, Novartis, and Sandoz. G.M. has been a scientific consultant/clinical study investigator for AbbVie, Eli Lilly, Janssen-Cilag, Leo Pharma, and Novartis. C.P. has been a consultant and held sponsored conferences for AbbVie, Novartis, Pfizer, and Sanofi. I.Z. has been a consultant and/or speaker for Novartis, Celgene, and Amgen. K.P. reports grants and personal fees for advisory board meeting from Almirall, AbbVie, Biogen, Lilly, Celgene, Galderma, Leo Pharma, Novartis, Pierre Fabre, Sanofi, Sandoz, Sun Pharma, and Janssen. S.F. has been principal investigator in clinical trials by AbbVie and Sanofi-Genzyme, has served on advisory board, received honoraria for lectures and research grants from Novartis, Menarini, and Almirall. The remaining authors have no funding or conflicts of interest to declare.

Profound clinical differences between the first and second waves of COVID-19 were observed in Europe. Nitric oxide (NO) may positively impact patients with Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2) infection. It is mainly generated by inducible nitric oxide synthase (iNOS). We studied serum iNOS levels together with serum interleukin (IL)-6 and IL-10 in patients with SARS-CoV-2 infection in the first wave ( n = 35) and second wave ( n = 153). In the first wave, serum iNOS, IL-6, IL-10 levels increased significantly, in line with the World Health Organization (WHO) score severity, while in the second wave, iNOS did not change with the severity. The patients of the second wave showed lower levels of iNOS, IL-6, and IL-10, as compared to the corresponding subgroup of the first wave, suggesting a less severe outcome of COVID-19 in these patients. However, in the severe patients of the second wave, iNOS levels were significantly lower in patients treated with steroids or azithromycin before the hospitalization, as compared to the untreated patients. This suggests an impairment of the defense mechanism against the virus and NO-based therapies as a potential therapy in patients with low iNOS levels.