Dermatological Symptoms Research Articles

Risk of Neurodegeneration in Patients with Morgellons Disease: A Focus on the Potential Risk of Developing Alzheimer’s

Morgellons disease is a distressing dermatologic condition that typically presents with multiple, non-healing skin lesions with filamentous protrusions. Initial presentation of the condition can often include various neurological symptoms with dermatologic symptoms. Common neurological symptoms include neuropathy, cognitive impairment, and dementia. Recent studies reveal that spirochetes are a causative agent of Morgellons disease. Chronic spirochete infection is strongly associated with neurodegeneration seen in dementia and Alzheimer’s disease. This paper will provide a brief overview of Morgellons and Alzheimer’s disease and will explore the possible risk of developing Alzheimer’s in Morgellons patients.

Effects of Two Chlorine Gas Attacks on Hospital Admission and Clinical Outcomes in Kafr Zita, Syria.

BackgroundIn 2014, Hama Governorate was exposed twice to chlorine gas, with 15 patients presenting to Kafr Zita Hospital in Northwest Syria. This study aimed to describe clinical manifestations of chlorine gas exposure to identify factors leading to facility admission and the need for ICU/intubation in conflict-affected areas with limited healthcare infrastructure.MethodsWe conducted a case-series study, using medical records of suspected chlorine-exposed patients presenting at Kafr Zita Hospital on either 11 April or 22 May 2014. Data on age, sex, initial clinical presentation, therapeutic management, and outcome were compared by hospital admission/non-admission and attack date. All patients provided verbal informed consent.ResultsFifteen patients with signs of chlorine gas exposure had detailed medical records. The mean age was 25.7 years (range 2-59), eight were male (53%), and three (20%) were under age 16.At initial presentation, all experienced respiratory distress, due to severe airway inflammation confirmed by nonspecific pulmonary infiltrates on chest x-ray, and similar intestinal, neurological, dermatological, ophthalmological, and psychological signs and symptoms. Acute management consisted of oxygen and bronchodilators for all patients, hydrocortisone (93%), antiemetics (80%), and dexamethasone (13%). Seven (47%) made a rapid symptomatic recovery and were discharged the same day and eight (53%) were admitted for a median of two days (range 1-6 days), one of whom required intubation and later died. The only significant associations found were higher mean pulse rate (i.e. 138 versus 124; p=0.043) and body temperature (37.0 versus 36.5; p=0.019) among admitted patients compared to non-admitted.ConclusionOur results demonstrated that even in low-resource humanitarian settings the survival rate for chlorine gas exposed patients is fair. Despite the small sample, this study provides insight into the clinical presentation, management, and outcomes of weaponized chlorine gas exposure, though further research is required to understand any chronic consequences.

Nails and COVID-19 - A comprehensive review of clinical findings and treatment.

The SARS‐CoV‐2 infection, responsible for COVID‐19, has raised the interest for infection‐associated muco‐cutaneous symptoms. While dermatologic symptoms in general gained an increasing awareness, affection of the nail organ has been mentioned only recently. We provide a narrative review on COVID‐19 manifestation on the nail organ and add symptoms induced by personal protective measures and SARS‐CoV‐2 vaccination. Available treatment options are discussed.

Health impact assessment of auto rickshaw and cab drivers due to exposure to vehicular pollution in Delhi: an integrated approach.

Vehicular emission is an important contributor to air pollution in the urban environment and impacts the health of commuters as well as drivers. The in-vehicle concentration of pollutants is known to be higher than the ambient environment and varies with the mode of transport. Thus, this study attempts to assess the health impacts of air pollution exposure on auto rickshaws and cab drivers. The study was conducted in Delhi using a triangular approach involving a health perception survey, lung function test and in-vehicle monitoring of particulate matter (PM1, PM2.5, PM10) concentration to assess the health impacts of air pollution on auto rickshaw and cab drivers. A total of 150 respondents (75 from each occupation) were surveyed, and spirometry was performed for 40 respondents (20 from each occupation). Binary logistic regression showed auto rickshaw drivers were exposed to significantly higher in-vehicle PM concentrations in summers and winters and, thus, had a significantly higher risk of developing respiratory, ophthalmic and dermatological health symptoms (p< 0.05 and relative risk >1). Pulmonary function test showed obstructive lung impairment was reported only among auto rickshaw drivers (6%) and restrictive lung impairment was also more prevalent among auto rickshaw drivers (48%) than cab drivers (33%), suggesting a greater vulnerability of auto rickshaw drivers to respiratory health issues. Lung function impairment was associated with age (p= 0.002). The health and well-being of individuals is a matter of global concern, also highlighted in sustainable development goal no. 3. However, it was observed that neither auto rickshaw drivers nor cab drivers used formal/standard protective measures mainly due to unawareness or unaffordability. The study suggests increasing awareness and formulating guidelines to highlight the use of proper protective measures by these vulnerable groups and specific policy measures to protect outdoor workers like auto rickshaw drivers.

SARS-COV-2 Pandemic in Syria: Symptoms and Treatments

ABSTRACT SARS-CoV-2 has caused global pandemic that resulted in a dramatic loss of human life worldwide. The first human case was reported in December 2019 in China, and while the first case in Syria was confirmed on March 2020. By July 1st, 2021, 25551 cases were reported in Syria with 1879 deaths. The most common symptoms of covid-19 are fever, dry cough, and shortness of breath. Some patients may endure from musculoskeletal, gastrointestinal and dermatologic symptoms. Many drugs (including antibiotics, corticosteroids, antiviral and Immunomodulatory drugs) have been evaluated and recommended to be used in COVID-19 treatment, resulting in clinical recovery. Keywords: SARS-CoV-2, Syria, pandemic, remdesivir, corticosteroids, antiviral Keyword : SARS-CoV-2, Syria, pandemic, remdesivir, corticosteroids, antiviral

A critical analysis of surgery for occult tethered cord syndrome.

Tethered cord syndrome (TCS) is an amalgamation of neurological, urological, orthopedic, and dermatologic signs and symptoms with radiographic evidence of a thickened filum and low-lying conus. Surgical sectioning of the filum and disconnection of any tethering entities such as dermal sinus tracts or lipomas has been shown to improve outcomes. The manifestation of TCS symptoms in the absence of a low-lying conus has been referred to as occult tethered cord syndrome (OTCS) and is much less well reviewed in the literature. To date, there has only been one randomized controlled trial examining the effect of intervention in OTCS; therefore, contemporary data is often elicited from limited cohorts. To perform a comprehensive literature review of management in OTCS and evaluate treatment response rates to sectioning of the filum terminale. Seventeen papers met inclusion criteria for our review. Sample sizes ranged from 8 to 60 children, and results were mixed, often dependent on study design, definition of typical OTCS symptoms, and follow-up intervals. Symptomatic improvement was observed in > 50% of patients for all but one study; however, the recurrence rates were highly variable. The data regarding the efficacy of surgical treatment in OTCS is mixed and merits more rigorous scientific examination with strict and clear parameters regarding symptomatic operationalization and follow-up time points to monitor for TCS recurrence.

Cutaneous hyperalgesia in the setting of COVID-19 infection: reporting 2 cases from North India

&lt;p&gt;COVID-19 (Coronavirus disease) infection can manifest with a variety of dermatological and neurological symptoms which might have similar underlying patho-mechanisms. Here we report 2 cases of rt-PCR (Real time PCR) positive COVID infection who developed cutaneous hyperalgesia during the illness and review the case reports, case series, and other literature available on this symptom. We found that out of the total 13 reported cases (including the two cases reported here), most common onset of this symptom was within the first 3 days of illness (median duration ten days). Common sites of involvement included abdomen and back, but chest, arms and legs could also be involved. Warm baths, gabapentin and pregabalin showed good efficacy in relieving the symptom. The exact pathogenesis remains unclear but is hypothesised to be due to the neurotrophic properties of the virus and/or the inflammatory cytokines released during the illness. Further studies are necessary to expand the scope of knowledge in this regard.&lt;/p&gt;

Longitudinal association between polypharmacy and development of pruritus: a Nationwide Cohort Study in a Japanese Population.

Although polypharmacy is known to cause side-effects due to drug-drug interactions, dermatological symptoms triggered by polypharmacy are not fully addressed. To investigate whether polypharmacy is associated with the risk of pruritus. A cohort study was performed to examine cross-sectional and longitudinal relationships between polypharmacy and pruritus in a general population. Data were collected from the Norm Study conducted in 2016 and 2017, which is a nationwide survey based on a self-administered questionnaire with Japanese representative participants aged 16-84years. Presence of polypharmacy which was defined as concurrent use of ≥5 prescribed drugs. Primary outcomes were the presence of severe pruritus at baseline for the cross-sectional analysis and the development of severe pruritus after one year for the longitudinal analysis. Multivariable modified Poisson regression analyses were performed to estimate risk ratios (RRs) and 95% confidence intervals (95%CIs) with adjustment for potential confounders (age, gender, smoking habits, drinking habits, depressive symptoms, moderate activities based on IPAQ score and presence of 11 comorbid conditions including skin disease). The study included 3126 participants (mean age, 48.7years); nearly half (49.8%) were male. In all, 332 participants (10.3%) had polypharmacy in the cross-sectional analysis. Participants with polypharmacy were more likely to present with severe pruritus at baseline than those who were not using drugs (adjusted RR=1.52 [95%CI 1.15-2.01, P=0.003]). The longitudinal analysis (n=1803) was limited to those without severe pruritus at baseline; participants with polypharmacy at baseline were more likely to develop severe pruritus after a one-year follow-up period than those not using drugs (adjusted RR=1.46 [95%CI 1.14-1.87, P=0.002]). Polypharmacy was associated with the presence of pruritus at baseline and may predict the future risk of developing pruritus.

Clinical and Immunological Biomarkers for Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is characterized by immune system dysfunction and is clinically heterogeneous, exhibiting renal, dermatological, neuropsychiatric, and cardiovascular symptoms. Clinical and physiological assessment is usually inadequate for diagnosing and assessing pathophysiological processes in SLE. Clinical and immunological biomarkers could play a critical role in improving diagnosis, assessment, and ultimately, control of SLE. This article reviews clinical and immunological biomarkers that could diagnose and monitor disease activity in SLE, with and without organ-specific injury. In addition, novel SLE biomarkers that have been discovered through “omics” research are also reviewed.

A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States

Children and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatric COVID-19 patients. We conducted a retrospective cross-sectional analysis of pediatric patients diagnosed with COVID-19 from healthcare organizations in the United States. The study outcomes (hospitalization, mechanical ventilation, critical care) were assessed using logistic regression. The subgroups of sex and race were compared after propensity score matching. Among 12,306 children with lab-confirmed COVID-19, 16.5% presented with respiratory symptoms (cough, dyspnea), 13.9% had gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), 8.1% had dermatological symptoms (rash), 4.8% had neurological (headache), and 18.8% had other non-specific symptoms (fever, malaise, myalgia, arthralgia and disturbances of smell or taste). In the study cohort, the hospitalization frequency was 5.3%, with 17.6% needing critical care services and 4.1% requiring mechanical ventilation. Following propensity score matching, the risk of all outcomes was similar between males and females. Following propensity score matching, the risk of hospitalization was greater in non-Hispanic Black (RR 1.97 [95% CI 1.49–2.61]) and Hispanic children (RR 1.31 [95% CI 1.03–1.78]) compared with non-Hispanic Whites. In the pediatric population infected with COVID-19, a substantial proportion were hospitalized due to the illness and developed adverse clinical outcomes.

Bőrgyógyászati tüneteket okozó felnőttkori szisztémás vírusinfekciók szemelvények

Viral infections are increasingly a global health problem, but not only because of the current COVID pandemic and acute diseases, but also because of the long-term consequences. The authors shortly describe the main characteristics of hepatitis B and C and tropical viral diseases (dengue, Zika, chikungunya), focusing on dermatological symptoms and also provide a brief current literature review, as well as national aspects related to each pathogen.

Escitalopram in patients with psoriasis

Introduction Psoriasis is a chronic skin disease, affecting up to 2-4% of population. The majority of investigations agree that this disease appears to be a result of confluence of genetic, allergenic and emotional factors. There is usually more than one trigger that leads to the manifestation or exacerbation of symptoms. Psychogenic factors are clearly in a pattern here. Some personality traits may lead to instability of the emotional sphere that can act alternately as a cause, then as an aftereffect of exacerbation of the chronic process, forming a so called “vicious circle” of psychosomatic disease.ObjectivesTo discover the impact of escitalopram on the symptoms of psoriasis.Methods 14 patients were diagnosed with psoriasis. All patients underwent psychiatric interviewing and psychological testing (STAI and HADS). The results revealed increased trait anxiety levels among 8 of them with moderate severity of the process according to SCORAD index. 3 cases demonstrated symptoms of clinically expressed and 4 subclinical levels of depression. Escitalopram (10 to 20 mg. daily) was administered along with common dermatologic therapy in these patients.ResultsPatients treated with escitalopram showed a reduction of anxiety and depression tests scores as well as the values some dermatological symptoms such as pruritus.Conclusions These preliminary results of 3 months study gives us a hope of successful psychopharmacological treatment of psoriasis in cooperation with dermatologists. Finding intercommunications in pathogenesis of skin and emotional disorders could optimize the treatment and improve patient’s quality of life. The publication was prepared with the support of the “RUDN University Program 5-100”.

Medical, neurobiological, and psychobehavioral perspectives of mastocytosis: a case report

BackgroundCutaneous mastocytosis is a rare pathology characterized by an abnormal proliferation and degranulation of mast cells, affecting the skin. Here we present the case of a patient suffering from chronic resistant mastocytosis. An original integrative method of evaluation was tested in this patient, to improve therapeutic management. It integrated the interactions between stressful life events and medical history as well as psychobehavioral components and neurobiological factors.Case presentationThe patient was a 65-year-old Caucasian woman. The cutaneous symptoms of mastocytosis had progressively evolved over the past 36 years, increasingly affecting the patient’s quality of life. At the time of the evaluation, psoralen and ultraviolet A therapy had reduced pruritus, but very unsightly brown-red maculopapules persisted on the chest, back, and arms. We proposed an integrative diagnosis that combined a semistructured interview, a psychometric assessment with the Millon Behavioral Medicine Diagnostic tool, and the collection of medical data. The medical data were compared with the analysis of the significant events in the patient’s life, to determine the threshold of tolerance to stress beyond which the skin symptoms led to profuse thrusts of pruritus. At the same time, the psychobehavioral profile of the patient was determined; this highlighted how social isolation, the denigrated coping style, and problematic compliance could influence the extension of dermatological symptoms. The effects of stressors on the infiltration and degranulation of skin mast cells have been discussed in light of the neurobiological processes currently known. At the end of the evaluation, a new therapeutic strategy was proposed.ConclusionThis case report reveals the mind–body relationship of a patient suffering from mastocytosis. It highlights the points of vulnerability and the adaptative strategies specific to each patient to be considered in therapeutic management of other resistant chronic diseases.

Pellagra in South Africa from 1897 to 2019: a scoping review.

Pellagra is a nutritional deficiency disease associated with niacin (vitamin B3) deficiency. The history of pellagra is well documented for Europe and the USA, but less is known about the prevalence in sub-Saharan African countries. This study documents the history of pellagra in South Africa, as diagnosed based on dermatological symptoms. Scoping review of information from scientific databases, library archives, other archives and record services and from Statistics South Africa. South Africa, 1897-2019. South African. Pellagra was first officially recorded in South Africa in 1906, but there are earlier indications of the disease. The prevalence of pellagra peaked after it was all but eradicated in the USA and Europe. Pellagra was never as prevalent in South Africa as in Europe, the USA and Egypt, where special hospitals for pellagrins were established. However, studies on urinary excretion of metabolites conducted in 1960s and 1970s suggested a high prevalence of subclinical (sub-pellagra) niacin deficiency, especially in previously disadvantaged Black populations. As in Europe and the USA, pellagra was associated with poverty and an overdependence on maize as staple food. Malnutrition was the main cause of the disease, but alcohol abuse might have been a contributing factor. In South Africa, reports of pellagra had declined by the late 1980s/early 1990s and hardly any cases were reported by the year 2000. Although pellagra, diagnosed based on dermatological symptoms, appears to be largely eradicated in South Africa, it does not rule out the potential for subclinical niacin deficiency.

Dermatological findings in patients admitting to dermatology clinic after using face masks during Covid-19 pandemia: A new health problem.

In the present study, the purpose was to evaluate the presence of dermatological symptoms and the effects of mask use on existing dermatological diseases associated with face in patients admitting with any dermatological disease. The present study consisted of 150 patients, including 91 volunteering women and 59 men, admitting to our dermatology clinic with any dermatological symptoms. The presence of symptoms, such as itching, rash, drying and peeling, discomfort, redness, burning, pain, swelling, acne, oily skin symptoms because of mask use, and previous history of facial dermatological disease, whether this disease increased with the use of mask, were questioned. The diagnosis made after dermatological examination and the dermatological examination findings were evaluated with the results of the survey. The most common finding in all patients after mask use was itching with a rate of 64.7%. Similar rates were detected for other symptoms. A significant increase was detected in the severity of acneiform and inflammatory dermatosis after the use of masks (P < .05). Our study showed that long‐term mask use caused primary skin symptoms, such as itching, redness, rash, dryness and peeling, burning, oily skin, and acne formation in individuals who have dermatological diseases, and also increased the existing dermatological facial diseases. Therefore, it should be recommended to use water‐based moisturizers as it may have a barrier effect on the faces of individuals who use a face mask and have any facial dermatosis, and patients should be closely monitored for skin diseases on the face.

Histamine 4 receptor is a Potential Target for COVID-19 Treatment

COVID-19 pandemic started in December 2019, and is a worldwide health disaster today, pulmonary fibrosis and cytokine storm are two major complications in COVID-19 patients which can decrease life quality after recovery, and cause death. Histamine effects on the immune system through 4 histamine receptors. The function pattern of histamine 4 receptor has many similarities to COVID-19 pathogenesis pattern.H4R antagonists prevent lung fibrosis in bleomycine-induced lung fibrosis murine models, it can reduce TNF-α and IL-6 secretion in several immunemediated diseases such as asthma, colitis and dermatitis.H4R stimulation also decreases IL-12 which is not detected to be high in COVID-19 patients.TH- 17 acts as an important inflammatory effector in COVID-19 pathogenesis, through IL-17 secretion which results in TNF-α and IL-6 secretion, and also IL-17 promotes tissue remodeling and fibrosis via matrix metalloproteinase induction.TH-17 expresses H4R which can be stimulated by H4R antagonist and results in IL-17 production, this process can explain the relation between H4R and COVID-19 pathogenesis. The other content supporting this theory is the compatibility of gastrointestinal, neurologic, and dermatologic signs and symptoms of COVID-19 with the H4R function pattern.in addition to the previous evidences, clusters of Kawasaki-like disease are reported recently, these patients were highly infected with SARS- COV2, and this can be explained by the important role of IL-17 in Kawasaki disease and the stimulatory effect of H4R on TH-17. According to the above content the author hypothesis that H4R stimulation by SARS-COV2 results in IL-17 expression which is associated with cytokine release, and H4R is a potential target point for COVID-19 treatment. This hypothesis can be evaluated by a clinical trial study of the therapeutic and preventive effect of H4R antagonists in COVID-19 patient’s complication, severity progression, and mortality

Evaluation of a New Histoplasma spp. Quantitative RT-PCR Assay

Laboratory diagnosis of histoplasmosis is based on various methods, including microscopy, culture, antigen, and DNA detection of Histoplasma capsulatum var. capsulatum or Histoplasma capsulatum var. duboisii. To improve sensitivity of existing real-time quantitative PCR (qPCR) assays, we developed a new RT-qPCR assay that allows amplification of whole nucleic acids of Histoplasma spp. validated on suspected cases. The limit of detection was 20 copies, and the specificity against 114 fungal isolates/species was restricted to Histoplasma spp. Whole nucleic acids of 1319 prospectively collected consecutive samples from 907 patients suspected of having histoplasmosis were tested routinely between May 2015 and May 2019 in parallel with standard diagnostic procedures performed in parallel. Forty-four had proven histoplasmosis attributable to H. capsulatum var. capsulatum (n = 40) or H.capsulatum var. duboisii (n = 4) infections. The results of RT-qPCR were positive in 43 of 44 patients (97.7% sensitivity) in at least one specimen. Nine of 863 cases (99% specificity) were RT-qPCR positive and therefore classified as possible cases. RT-qPCR was positive in 13 of 30 (43.3%) blood samples tested in proven cases. A positive RT-qPCR result in blood was significantly associated with H. capsulatum var. capsulatum progressively disseminated histoplasmosis with a positive RT-qPCR result in 92.3% of the immunocompromised patients with disseminated disease. This new Histoplasma RT-qPCR assay enabling amplification of H. capsulatum var. capsulatum and H. capsulatum var. duboisii is highly sensitive and allows the diagnosis of histoplasmosis advantageously from blood and bronchoalveolar lavage fluid.

Public interest in dermatologic symptoms, conditions, treatments, and procedures during the COVID-19 pandemic: Insights from Google Trends.

Coronavirus disease 2019 (COVID‐19) pandemic had substantial effect both on daily life and medical practice. Internet data have been used to analyze the trends in public interest in various medical conditions and treatments. The aim of this study is to analyze the public interest in dermatologic symptoms, conditions, treatments, and procedures during the COVID‐19 pandemic. Google Trends was queried for a total of 120 dermatological search queries. Three periods of 2020 ([March 15‐May 9], [May 10‐July 4], and [July 5‐October 31]) were compared with the previous 4 years (2016‐2019). A significantly decreased interest in skin cancers and certain dermatologic conditions (eg, pityriasis rosea and scabies) was observed throughout the study period. Whereas a significant increase of interest in dry skin, hair shedding, oily hair, atopic dermatitis, and hand eczema was detected during the study. An initial decrease in interest was followed by a significant increase for acne, comedones, melasma, rosacea, botox, dermaroller, and peeling. The study demonstrated a significant impact of the COVID‐19 pandemic on the public interest in dermatology. The present results would help to create healthcare policies and information sources, which can meet the public demand. The reasons for the observed trends and their effect on patient outcomes might be of interest for future studies.

Pharmacogenomic Profile and Adverse Drug Reactions in a Prospective Therapeutic Cohort of Chagas Disease Patients Treated with Benznidazole.

Chagas disease remains a major social and public health problem in Latin America. Benznidazole (BZN) is the main drug with activity against Trypanosoma cruzi. Due to the high number of adverse drug reactions (ADRs), BZN is underprescribed. The goal of this study was to evaluate the genetic and transcriptional basis of BZN adverse reactions. Methods: A prospective cohort with 102 Chagas disease patients who underwent BZN treatment was established to identify ADRs and understand their genetic basis. The patients were classified into two groups: those with at least one ADR (n = 73), and those without ADRs (n = 29). Genomic analyses were performed comparing single nucleotide polymorphisms between groups. Transcriptome data were obtained comparing groups before and after treatment, and signaling pathways related to the main ADRs were evaluated. Results: A total of 73 subjects (71.5%) experienced ADRs. Dermatological symptoms were most frequent (45.1%). One region of chromosome 16, at the gene LOC102724084 (rs1518601, rs11861761, and rs34091595), was associated with ADRs (p = 5.652 × 10−8). Transcriptomic data revealed three significantly enriched signaling pathways related to BZN ADRs. Conclusions: These data suggest that part of adverse BZN reactions might be genetically determined and may facilitate patient risk stratification prior to starting BZN treatment.

Covid-19 Hastalığında Dermatolojik Lezyonlar

Although the etio-pathogenesis of skin lesions in COVID-19 is yet not clear, several theories have been proposed. One of them is cytokine storm causing thrombophilic arteritis in COVID-19 patients due to activation of endothelial cells and macrophages. Furthermore, involvement of activated keratinocytes and/or Langerhans cells of the skin may cause various clinical spectrum According to another theory, livedo reticularis-like lesions may be result of decreased blood flow to cutaneous micro-vascular system by accumulation of micro-thromboses derived from other organs. From SARS-CoV-2 infected 148 patients, hospital records of 18 patients clinically showed skin involvement. 8 out of 18 patients showed the symptoms at the onset of COVID-19 and remained after hospitalization. Erythematous rash was observed in 14 patients, widespread urticaria in 3 patients, and chickenpox-like vesicles in 1 patient. Generally, affected area was trunk with low itching, but skin lesions healed in a few days. The authors emphasized skin manifestations are similar to cutaneous involvement occurring during common viral infections.1 Castelnovo et al reported skin involvement of two young COVID-19 patients. First patient presented widespread urticaria in the thigh and peri-malleolar area spontaneously improving in a few days.2 Second patient had vasculitic purpura, then evolving to erythematous rash. The patient was recovered after a short time with corticosteroid. In another study, a woman with COVID-19 was admitted with odynophagia. She later developed arthralgia and pruritic disseminated erythematous plaques involving face and acral areas. The authors suggested skin symptoms as an indicator for SARS-CoV-2 infection. 3 The skin manifestations in 130 COVID-19 patients of two hospitals from Rome and Barcelona were examined. Vesicles surrounded by erythematous halos with mild pruritus were observed in only 2 patients of Rome. In Barcelona, only 1 patient had numerous isolated vesicular lesions in the back. The authors stated that skin lesions seen in COVID-19 are similar to dermatological manifestations seen in typical viral infection of Herpesviridae family.4 Fernandez-Nieto et al conducted a retrospective analysis of 132 patients with SARS-CoV-2 infection. The mean duration of skin lesions was 8.7 days.5 In 95 patients, there were acute acro-ischemic (chilblain-like pattern) lesions in the form of red to violet macules, plaques, and nodules, usually at the distal aspects of toes and fingers. Rounded erythematous macules and vesicles in erythema multiforme-like pattern tending to coalesce were observed in 37 patients. In conclusion; as of today, there are limited studies and reports available on dermatological manifestations in COVID-19 patients. Dermatological symptoms can start before or after SARS-CoV-2 infection. The region of involvement and healing time of symptoms varies. Some symptoms are the same as occurring during classical viral infections.