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Bullous pemphigoid (BP) and pemphigus vulgaris (PV) are blistering disorders associated with barrier disruption, immune dysregulation and use of immunosuppressing systemic therapy. Patients with BP and PV have higher potential risk factors for infections secondary to skin alterations, comorbidity and chronic treatment with immunosuppressing agents.

The antimalarials, Chloroquine and Hydroxychloroquine (HCQ), and the antivirals Lopinavir/Ritonavir have been recently recorded as having anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) effects.1 In particular, regarding Italy, one of the countries most affected by the pandemic, the Italian Society of Infectious and Tropical disease (Lombardy section) has recommended the use of HCQ for treatment of coronavirus disease 2019 (COVID‐19).

The antimalarials, Chloroquine and Hydroxychloroquine (HCQ), and the antivirals Lopinavir/Ritonavir have been recently recorded as having anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) effects.1 In particular, regarding Italy, one of the countries most affected by the pandemic, the Italian Society of Infectious and Tropical disease (Lombardy section) has recommended the use of HCQ for treatment of coronavirus disease 2019 (COVID‐19).

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of chilblain-like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS-CoV-2 infection has not been unequivocally established. Methods: In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1 June 2020. Results: The mean age was 14.2 years, and 21 patients (78%) experienced mild systemic symptoms a median of 28 days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients – 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT-PCR for SARS-CoV-2 showing only 1 positive. Histopathological examinations of 7 skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS-CoV-2 RNA in skin biopsies, both with real-time polymerase chain reaction (RT-PCR) and RNAscope in situ hybridization (ISH). Limitations: Limited number of cases, unavailability of laboratory confirmation of COVID-19 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset. Conclusions: These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN-I or complement-mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease. Patients with AD have increased infection risk, including skin infections and systemic infections. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin‐4 (IL‐4) and IL‐13. Dupilumab is approved for inadequately controlled moderate‐to‐severe AD.1

Bullous pemphigoid (BP) and pemphigus vulgaris (PV) are blistering disorders associated with barrier disruption, immune dysregulation and use of immunosuppressing systemic therapy. Patients with BP and PV have higher potential risk factors for infections secondary to skin alterations, comorbidity and chronic treatment with immunosuppressing agents.

Since the beginning of the pandemic of Coronavirus disease (COVID‐19) an increasing number of skin manifestations have been reported.1,2 Most reports concern adult patients and describe various patterns of skin eruptions, in most of cases with low specificity and no univocal temporal association with the onset of systemic symptoms of COVID‐19.1‐3

Bowen's disease is a cutaneous squamous cell carcinoma (SCC) in situ with a potential risk of progression to invasive SCC. Despite the high number of approved treatments, elderly patients with extensive lesions of critical sites may represent a therapeutical challenge, especially in cases of treatment failure or recalcitrant disease. Here, we report the successfully use of topical Imiquimod 3.75% to treat an extensive Bowen's disease of the cheek in an elderly.