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INTRODUCTION
This topic will discuss issues related to dermatologic care during the COVID-19
pandemic.
Case series from around the world have identified a range of potential
dermatologic manifestations of COVID-19 [2,3]. The frequency (ranging from
0.2 to 20.4 percent of cases) and timing of cutaneous manifestations of COVID-
19 are difficult to ascertain [4-6]. Also unclear is the association of certain skin
manifestations with the illness severity [7]. Moreover, it cannot be excluded that
in some patients the observed skin findings may represent cutaneous reactions
to the numerous treatments used for COVID-19 [7,8].
Some infants born to mothers with COVID-19 at birth have had transient rash.
In a review of nine small case series from China that included a total of 65
pregnant women who were infected with SARS-CoV-2 during pregnancy and 67
newborns, two newborns presented with a rash [37]. The rash has been
described in one infant as a diffuse, maculopapular eruption that resolved in
one day with desquamation and in another as a diffuse, red, miliaria-like
eruption that disappeared in 10 days without treatment [38].
In support of the theory that risks of continuing biologic therapy for skin disease
may be low, one retrospective study of 5206 patients in northern Italy treated
with biologic agents for plaque psoriasis between February 20 and April 1,
2020, found no COVID-19-related deaths and only four COVID-19-related
hospitalizations [57]. In addition, a case control study performed in the
Lombardy region of Italy that involved assessment of 1193 patients with
psoriasis treated with biologic or small molecule therapy and approximately 10
million controls between February 21 and April 9, 2020, found higher risks for
testing positive for COVID-19, being self-quarantined at home due to COVID-
19, or being hospitalized due to COVID-19 among psoriasis patients receiving
biologic therapy compared with controls but did not find statistically significant
increases in risk for intensive care unit admission or dying in this population
[58].
Although the potential for a beneficial effect of biologic inhibitors tumor necrosis
factor (TNF)-alpha or interleukin (IL) 17 in COVID-19 has been proposed based
upon the theory that some immunosuppressive drugs might have inhibitory
effects on damaging immune response that is thought to contribute to organ
damage in COVID-19, this has not been proven [63-66]. Data on IL-6 pathway
inhibitors is reviewed separately. (See "Coronavirus disease 2019 (COVID-19):
Epidemiology, virology, and prevention" and "Coronavirus disease 2019
(COVID-19): Management in hospitalized adults", section on 'IL-6 pathway
inhibitors'.)
Skin cancer — Many full body skin examinations, biopsies, and skin cancer
excisions are being postponed due to the COVID-19 pandemic, which may lead
to delays in diagnosis and treatment. Triage and management strategies during
the COVID-19 pandemic for melanoma, advanced squamous cell carcinoma,
and advanced basal cell carcinoma have been developed by several groups,
including the National Comprehensive Cancer Network, the European Society
for Medical Oncology, and the American College of Mohs Surgery, with
deferment of surgery or prompt surgery dependent upon the type of lesion and
reason for the visit [76-78]. The United States Cutaneous Lymphoma
Consortium has published recommendations for the treatment of cutaneous
lymphomas during the COVID-19 pandemic [79].
For patients with advanced melanoma and nonmelanoma skin cancers who are
under treatment, there are no recommendations to cease skin cancer-related
systemic therapies [80,81]. However, the decision regarding the continuation or
initiation of systemic targeted therapies or immunotherapies must be made on a
case-by-case basis, after careful evaluation of benefits versus risks.
General and specific issues related to the care of cancer patients during the
pandemic are discussed elsewhere. (See "Coronavirus disease 2019 (COVID-
19): Cancer care during the pandemic".)
Concerns have been raised over privacy and security of telemedicine [88,89].
The platform selected should be compliant with local privacy regulations. Due to
the COVID-19 pandemic, some regulatory bodies have relaxed or waived rules
to allow more flexibility in telemedicine [90].