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Summary: Since cases first emerged in December 2019, COVID‐19 (a type of coronavirus) has rapidly become pandemic. This fast‐tracked paper (published quickly) from China on COVID‐19 is written by dermatologists at the epicentre of the outbreak in Wuhan. Dermatology clinic staff may be at risk because protective equipment is not routinely available, and skin lesions might possibly transmit the virus indirectly. These authors suggest preventive measures based on experience in this and previous coronavirus outbreaks. Online consultation for non‐urgent patients reduces the numbers of patients attending clinics. Nurse‐led triage, to identify patients with possible COVID‐19, at the entrances of hospital and skin clinics directs patients with a cough or fever to a specific COVID‐19 area and a dermatologist is consulted if the fever might be related to skin disease. Clinic staff wear N95 masks and observe hand hygiene during consultations. Patients are admitted to a ward only if routine blood tests and chest CT scans exclude COVID‐19. Triage will not detect patients who are showing no symptoms but who are developing the disease, so the hospital should provide an on‐call expert team to discuss inpatients suspected or diagnosed with COVID‐19 and refer them to radiology, respiratory or intensive care colleagues as required. Confirmed cases are managed following local policies. Skin disorders in COVID‐19 inpatients can usually be managed remotely using photographs, email and teleconferencing. If necessary a multidisciplinary team (a team of medical staff from different specialties) can meet in the clean area of the isolation ward. If the dermatologist must see the patient, all records should be provided in advance to minimise exposure time. With these precautions, as of 20th February 2020 no infected patients were detected in the Wuhan Dermatology Department. This is a summary of the study: Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department Linked Article: Tao et al. Br J Dermatol 2020; 182:1477–1478 [ABSTRACT FROM AUTHOR]

Long COVID in the skin: a registry analysis of COVID-19. In addition to identifying reactions, dermatologists' engagement with the lay press was critical for public perception regarding vaccine skin reactions and confidence in vaccination. For example, the American Academy of Dermatology and International League of Dermatologic Societies COVID-19 Dermatology Registry (https://www.aad.org/member/practice/coronavirus/registry) is an active and productive global collaboration, containing the details of >2500 cases of dermatological manifestations of COVID-19 and COVID-19 vaccine skin reactions across 72 countries.[3] More than seven registries are now active, some of which are general, while others concentrate on COVID-19 in the context of specific diseases such as psoriasis. [Extracted from the article]

COVID-19-related dermatosis in November 2019: could this case be Italy's patient zero? We analysed skin biopsies of patients from Milan with dermatoses and positive polymerase chain reaction (PCR) swabs for SARS-CoV-2 at different stages of infection.1,2 The results were compared with skin biopsies of 20 patients with dermatoses who had not been diagnosed with COVID-19, but were at high risk of infection. We were not able to detect viral RNA with RT-PCR technology because the viral load was probably too low or degraded by RNA enzymes released after exogenous or cellular destruction.3 By April 2020, the patient had recovered from the dermatosis. [Extracted from the article]

Background: There are two distinctive acral manifestations of COVID‐19 embodying disparate clinical phenotypes. One is perniosis occurring in mildly symptomatic patients, typically children and young adults; the second is the thrombotic retiform purpura of critically ill adults with COVID‐19. Objectives: To compare the clinical and pathological profiles of these two different cutaneous manifestations of COVID‐19. Methods: We compared the light microscopic, phenotypic, cytokine and SARS‐CoV‐2 protein and RNA profiles of COVID‐19‐associated perniosis with that of thrombotic retiform purpura in critical patients with COVID‐19. Results: Biopsies of COVID‐19‐associated perniosis exhibited vasocentric and eccrinotropic T‐cell‐ and monocyte‐derived CD11c+, CD14+ and CD123+ dendritic cell infiltrates. Both COVID‐associated and idiopathic perniosis showed striking expression of the type I interferon‐inducible myxovirus resistance protein A (MXA), an established marker for type I interferon signalling in tissue. SARS‐CoV‐2 RNA, interleukin‐6 and caspase 3 were minimally expressed and confined to mononuclear inflammatory cells. The biopsies from livedo/retiform purpura showed pauci‐inflammatory vascular thrombosis without any MXA decoration. Blood vessels exhibited extensive complement deposition with endothelial cell localization of SARS‐CoV‐2 protein, interleukin‐6 and caspase 3; SARS‐CoV‐2 RNA was not seen. Conclusions: COVID‐19‐associated perniosis represents a virally triggered exaggerated immune reaction with significant type I interferon signaling. This is important to SARS‐CoV‐2 eradication and has implications in regards to a more generalized highly inflammatory response. We hypothesize that in the thrombotic retiform purpura of critically ill patients with COVID‐19, the vascular thrombosis in the skin and other organ systems is associated with a minimal interferon response. This allows excessive viral replication with release of viral proteins that localize to extrapulmonary endothelium and trigger extensive complement activation. What is already known about this topic? Acral perniotic‐like lesions are seen in mildly symptomatic patients with COVID‐19 – typically children – while acral retiform purpura associated with pauci‐inflammatory thrombosis is a manifestation of patients who are critically ill with COVID‐19. What does this study add? This study emphasizes that the disparate clinical and pathological manifestations of two distinct forms of acral disease in the setting of COVID‐19 are reflective of differences in interferon signalling.In the mild perniotic presentation, interferon signalling is robust, inflammation is striking and viral load in tissue samples is expectedly minimal.In contrast, in retiform purpura of severe COVID‐19, interferon signalling is absent, viral protein localization to endothelium is extensive and complement deposition with vascular thrombosis is impressive. Linked Comment:Bessis. Br J Dermatol 2021; 184:11–12. [ABSTRACT FROM AUTHOR]

Summary: 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 patients with COVID‐19. Objectives: To provide a brief overview of cutaneous lesions associated with COVID‐19. Methods: A 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 the clinical and histological features of COVID‐19‐associated skin manifestations. Results: The 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 roles of a hyperactive immune response, complement activation and microvascular injury have 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–maculopapular–morbilliform rash; (iii) papulovesicular exanthem; (iv) chilblain‐like acral pattern; (v) livedo reticularis–livedo racemosa‐like pattern; and (vi) purpuric 'vasculitic' pattern. These six patterns can be merged into two main groups: the first – inflammatory and exanthematous – includes the first three groups listed above, and the second includes the vasculopathic and vasculitic lesions of the last three 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 values of such cutaneous manifestations. What is already known about this topic? The infection caused by the SARS‐CoV‐2, called coronavirus disease‐19 (COVID‐19), has rapidly spread throughout the world, becoming pandemic.The heterogeneous spectrum of COVID‐19‐associated cutaneous manifestations is based on preliminary reports of different types of skin lesions, leading to a need for clarity. What does this study add? A summary of the clinical and histological features of COVID‐19‐associated skin manifestations is provided.Six main clinical patterns can be identified: (i) urticarial rash; (ii) confluent erythematous–maculopapular–morbilliform rash; (iii) papulovesicular exanthem; (iv) chilblain‐like acral pattern; (v) livedo reticularis–livedo racemosa‐like pattern; and (vi) purpuric 'vasculitic' pattern. Plain language summary available online [ABSTRACT FROM AUTHOR]

Linked Article:Visconti et al. Br J Dermatol 2022; 187:900–908. [ABSTRACT FROM AUTHOR]

Linked Article: Cherrie et al. Br J Dermatol 2021; 185:363–370. [ABSTRACT FROM AUTHOR]

Social media (SoMe) has become a multipurpose tool for academic dermatology, with increasing popularity within medical journals. As guardians of some of the most intrusive patient images, dermatologists and dermatology journals thus have a unique opportunity to set the bar for SoMe consent, thereby protecting patient autonomy. [Extracted from the article]

Dear Editor, Coronavirus disease 2019 (COVID-19) has been associated with several cutaneous manifestations.1-3 A temporary field hospital was implemented during the pandemic peak in Madrid, Spain, to attend patients with COVID-19 who had mild-to-moderate pneumonia. Some patients recalled a burning sensation and redness or swelling of the hands or feet shortly after COVID-19 symptoms began. Firstly, we only included patients with mild-to-moderate COVID-19 pneumonia and cannot provide data on skin disease in asymptomatic patients or with more severe forms of COVID-19. [Extracted from the article]

Dear Editor, Since emerging in December 2019, coronavirus disease 2019 (COVID-19) has become a global pandemic with community transmission now reported in most World Health Organization regions.1 As the pandemic progresses, there have been a growing number of reports of cutaneous manifestations and discussions of how COVID-19 has impacted clinical practice.2-4 We hypothesized that many such dermatology publications may be authored from high-income countries, raising questions about case representation and the generalizability and comprehensiveness of COVID-19-related insights, discourse and guidance in our field. To address this question, we assessed authors' countries of professional affiliation in the published COVID-19 dermatology literature. Our analysis identified no COVID-19 dermatology publications listing authors from LICs. [Extracted from the article]