Persistent infection with high-risk human papillomavirus (HPV), particularly genotype 16, is the main driver of anogenital and oropharyngeal cancers. However, data on HPV16 genetic variability in anal and oral samples from people living with HIV are limited. In this study, we investigated the diversity of HPV16 E6 and E7 genes in anal and oral samples collected from HIV-positive men who have sex with men (MSM) according to different cytological outcomes and anatomical site. Among 53 MSM patients, we obtained 51 E6 and 52 E7 sequences. Lineage A predominated (96.1%), mainly represented by sublineages A1 (84.3%) and A2 (9.8%). The E6 region showed higher variability than E7: 31.4% were identical to the reference (K02718), 51.0% carried the L83V (T350G) mutation, while Q14H, D25N, and D25E were also observed. In E7, only one non-synonymous substitution was detected (N29S). No site-specific variants were detected between anal and oral samples. Overall, these findings confirm the predominance of European A1/A2 variants in Italian MSM and suggest that E6/E7 polymorphisms are not directly linked to lesion grade or anatomical localization.

Cutaneous tuberculosis (CTB) is an unusual manifestation of extrapulmonary tuberculosis, accounting for only 1.0

ABSTRACT This study investigates the prevalence of beta (β) and gamma (γ) human papillomavirus (HPV) types in cervical and anal samples from women living with HIV and examines their association with alpha (α) HPV and cytological lesions. Cervical and anal swabs were collected from 138 women. Detection of β‐ and γ‐HPV types were performed using bead‐based assays, and data analysis included only samples with adequate DNA quality, as confirmed by β‐globin amplification. The analysis revealed higher rates of β‐HPV in anal samples (51.7%) compared to cervical samples (30.3%), with β‐1 species being predominant in both sites. Furthermore, γ‐HPV types were more prevalent in anal samples (36.5%) than in cervical site (16.9%), with γ‐10 being the most frequently detected species. Concordance between cervical and anal samples for specific β‐HPV types (κ = 0.20, 95% CI: 0.03–0.36) and γ‐HPV types (κ = 0.17, 95% CI: 0.003–0.36) was poor. Co‐infections with both β‐ and γ‐HPV types in cervical samples was significantly associated with co‐infection at the anal site (OR 7.7; 95% CI: 1.44–38.25; p = 0.01). There was no statistically significant association ( p > 0.05) between β‐HPV positivity and neoplastic precancerous lesions (LSIL or HSIL) at either the cervical or anal site. Similarly, γ‐HPV positivity showed no significant association ( p > 0.05) with cytological abnormalities in cervical or anal samples. In conclusion, while the prevalence of β‐ and γ‐HPV types is higher in the anal region among HIV‐positive women, the absence of a strong association with neoplastic lesions underscores their limited oncogenic potential compared to high‐risk α‐HPV types.

Cutaneous pseudolymphomas are a wide group of diseases mimicking cutaneous lymphoma. They comprise several skin conditions with different etiopathogenesis, clinical-pathological features, and prognosis, which may occur in the absence of an identifiable trigger factor or after administration of medications or vaccinations, tattoos, infections, or arthropod bites. They present with different manifestations: from solitary to regionally clustered lesions, up to generalized distribution and, in rare cases, erythroderma. They persist variably, from weeks to years, and resolve spontaneously or after antibiotics, but may recur in some cases. CD30+ T-cell pseudolymphomas are characterized by the presence of large, activated lymphoid cells, generally in response to viral infections, arthropod assault reactions, and drug eruptions. Stenotrophomonas maltophilia is a ubiquitous Gram-negative bacillus responsible for opportunistic infections in immunocompromised patients. Infection of intact skin in immunocompetent patients is particularly rare. Here, we report a case of a man presenting an isolated nodule histopathologically mimicking a primary cutaneous CD30+ T-cell lymphoproliferative disorder.

Bullous pemphigoid (BP), although a rare disease, is the most frequent subepidermal autoimmune disorder. Treatment with gliptins, used for type 2 diabetes, was reported as associated with BP onset. To identify HLA alleles that may reflect a higher susceptibility to BP in the Italian population, we analysed 30 patients affected by idiopathic bullous pemphigoid (IBP) and 86 gliptin-associated BP (GABP) patients. A significant association between HLA-DQB1*03:01 allele and IBP and GABP patients was found. Of note, both IBP and GABP were significantly associated with one of the following haplotypes: DRB1*11:01, DRB3*02:02, DQA1*05:05, DQB1*03:01 or DRB1*11:04, DRB3*02:02, DQA1*05:05 and DQB1*03:01. These data identify, for the first time, potential markers of susceptibility to BP in the Italian population, especially when associated with gliptin intake.

Background: Human papillomavirus (HPV) infection is linked to several cancers, including anal and oral cancers. The incidence of anal cancer is particularly high among HIV-positive men who have sex with men (MSM). DNA methylation markers have shown promise as biomarkers for identifying precancerous lesions and cancer in HPV-infected individuals. The aim of this study was to investigate the correlation of DNA methylation with HPV infection in oral samples and the correlation of DNA methylation with lesion degree in the anal samples of HIV-positive MSM. Methods: This study investigated DNA methylation in oral and anal samples from HIV-positive MSM at the National Institute for Infectious Diseases (INMI) in Rome, Italy. Exfoliated oral epithelial cells and anal samples were collected and analyzed for 28 HPV genotypes using the Allplex 28 HPV assay. DNA methylation was assessed with the PrecursorM+ kit for oral samples and the AnoGyn kit for anal samples, focusing on the promoter regions of specific genes. Results: The study included 63 participants, with a median age of 49 and a median CD4+ count of 705 cells/µL. The oral samples showed HPV16 as the most common type, with 22% testing positive for DNA methylation. The anal samples exhibited HPV-related methylation changes linked to cytological lesions, with a 30% increase in the observed ddCt ratio. Significant differences were found in both ASCL1 and ZNF582 genes, particularly for HSILvsNILM and HSILvsLSIL lesions. Of the samples with an increased ddCt ratio, 80% were from patients over 35 years old, and multiple HPV infections were common. Conclusions: DNA methylation markers could be valuable in identifying high-risk HPV infections in oral samples and detecting potential precancerous lesions in anal samples. These markers may enhance the early detection and prevention strategies for HPV-related cancers in high-risk populations, with follow-up data indicating potential for monitoring lesion progression.

Journal of the European Academy of Dermatology and VenereologyVolume 37, Issue 2 p. e143-e146 COVID-19 SPECIAL FORUM - LETTER TO THE EDITOR Female genital mucosal lesions associated with COVID-19 vaccination: A brief review of the literature Antonella Tammaro, Corresponding Author Antonella Tammaro [email protected] orcid.org/0000-0002-4230-100X NESMOS Department of Dermatology, Sapienza University of Rome, Rome, Italy Correspondence Antonella Tammaro, NESMOS Department of Dermatology, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Email: [email protected]Search for more papers by this authorKarolina Anna Kulakowska, Karolina Anna Kulakowska NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorCarmen Cantisani, Carmen Cantisani NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorFrancesca Romana Parisella, Francesca Romana Parisella Department of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorAlessandra Scarabello, Alessandra Scarabello NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorGaniyat Adenike Ralitsa Adebanjo, Ganiyat Adenike Ralitsa Adebanjo orcid.org/0000-0001-8850-3072 NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this author Antonella Tammaro, Corresponding Author Antonella Tammaro [email protected] orcid.org/0000-0002-4230-100X NESMOS Department of Dermatology, Sapienza University of Rome, Rome, Italy Correspondence Antonella Tammaro, NESMOS Department of Dermatology, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy. Email: [email protected]Search for more papers by this authorKarolina Anna Kulakowska, Karolina Anna Kulakowska NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorCarmen Cantisani, Carmen Cantisani NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorFrancesca Romana Parisella, Francesca Romana Parisella Department of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaSearch for more papers by this authorAlessandra Scarabello, Alessandra Scarabello NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorGaniyat Adenike Ralitsa Adebanjo, Ganiyat Adenike Ralitsa Adebanjo orcid.org/0000-0001-8850-3072 NESMOS Department of Dermatology, Sapienza University of Rome, Rome, ItalySearch for more papers by this author First published: 30 October 2022 https://doi.org/10.1111/jdv.18711Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume37, Issue2February 2023Pages e143-e146 This article also appears in:JEADV COVID-19 articles RelatedInformation

A 59-year-old treatment-naive patient with advanced HIV infection presented with a severe and protracted course of mpox (formerly known as monkeypox) that did not respond to the current mpox treatment options. The patient worsened clinically, and developed new mucocutaneous lesions and necrotic evolution of pre-existing ones, along with multiple bilateral lung nodules and the appearance of a tracheal necrotic lesion. Although severe forms of mpox have been observed in people with severe immune system deficiency, including those with advanced HIV presentation, the immunological mechanisms underlying this observation have not yet been fully explained. To our knowledge, this is the first account of a necrotising mpox in a person living with HIV, with viral shedding for more than 11 months and a comprehensive immunological description. Moreover, we documented the virus' persistence by detecting mpox virus DNA from multiple sites and quantified anti-monkeypox virus IgA, IgM, IgG, and neutralising antibodies in serum samples. The severe HIV-driven immune depression and the presence of other co-infections might skew and impair immune responses, thus contributing to the persistence of monkeypox virus infection. Further investigations of immune responses to monkeypox virus infection in people with severe immunosuppression are required to improve management and prevention.

International Journal of DermatologyEarly View Correspondence Mpox lesions in two patients with multiple comorbidities Alessandra Scarabello MD, PhD, Alessandra Scarabello MD, PhD Department of Dermatology, INMI Lazzaro Spallanzani, Rome, ItalySearch for more papers by this authorGaniyat A. R. Adebanjo MD, Ganiyat A. R. Adebanjo MD orcid.org/0000-0001-8850-3072 NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorSalvatore Volpe MD, Salvatore Volpe MD orcid.org/0000-0002-6367-2344 NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorFrancesca R. Parisella MD, Francesca R. Parisella MD Department of Medicine, The Univesity of Queensland, Brisbane, AustraliaSearch for more papers by this authorMaria E. Greco MD, Maria E. Greco MD NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorCharalampos G. Balampanos MD, Charalampos G. Balampanos MD NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorAntonella Tammaro MD, PhD, Corresponding Author Antonella Tammaro MD, PhD [email protected] orcid.org/0000-0002-4230-100X NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this author Alessandra Scarabello MD, PhD, Alessandra Scarabello MD, PhD Department of Dermatology, INMI Lazzaro Spallanzani, Rome, ItalySearch for more papers by this authorGaniyat A. R. Adebanjo MD, Ganiyat A. R. Adebanjo MD orcid.org/0000-0001-8850-3072 NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorSalvatore Volpe MD, Salvatore Volpe MD orcid.org/0000-0002-6367-2344 NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorFrancesca R. Parisella MD, Francesca R. Parisella MD Department of Medicine, The Univesity of Queensland, Brisbane, AustraliaSearch for more papers by this authorMaria E. Greco MD, Maria E. Greco MD NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorCharalampos G. Balampanos MD, Charalampos G. Balampanos MD NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorAntonella Tammaro MD, PhD, Corresponding Author Antonella Tammaro MD, PhD [email protected] orcid.org/0000-0002-4230-100X NESMOS Department, Sapienza University of Rome, Rome, ItalySearch for more papers by this author First published: 22 August 2023 https://doi.org/10.1111/ijd.16805 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Moore MJ, Rathish B, Zahra F. Mpox (Monkeypox). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK574519/. Accessed February 2, 2023 2Maronese CA, Beretta A, Avallone G, Boggio FL, Marletta DA, Murgia G, et al. Clinical, dermoscopic and histopathological findings in localized human monkeypox: a case from northern Italy. Br J Dermatol. 2022; 187(5): 822–823. https://doi.org/10.1111/bjd.21773 3Maronese CA, Errichetti E, Avallone G, Beretta A, Marzano AV. Dermoscopy as a supportive diagnostic tool in human monkeypox. J Eur Acad Dermatol Venereol. 2022; 24: e412–e414. https://doi.org/10.1111/jdv.18597 4Rodríguez-Cuadrado FJ, Castaño-Fernández JL, Elosua-González M, Roustan-Gullón G, Alfageme-Roldán F. Sonography of monkeypox cutaneous lesions. J Ultrasound. 2023; 26: 307–311. https://doi.org/10.1007/s40477-022-00771-3 5Messina MD, Wolf EL, Kanmaniraja D, Alpert PL, Ricci ZJ. Imaging features of anorectal proctitis in monkeypox infection. Clin Imaging. 2022; 92: 109–111. https://doi.org/10.1016/j.clinimag.2022.10.008 Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

19: a multicentric case series Dear Editor, The constantly evolving COVID-19 pandemic, caused by SARS-CoV-2 virus, has affected millions of people worldwide. The most commonly reported symptoms include fever, cough, dyspnea, muscle pain, headaches, dysgeusia, and anosmia. The currently available evidence shows a vast cutaneous involvement in pediatric and adult patients affected by the disease. Most recently there have been reports of novel dermatological manifestations involving the oral mucosa, still regarded as a fairly new concept. Our study reports the clinical data of a cohort of adult and pediatric COVID-19 patients with oral and genital mucosa manifestations from the National Institute for Infectious Diseases Lazzaro Spallanzani in Rome (Italy), Sant’ Andrea Hospital in Rome (Italy), as well as the Pediatric Department of the University Hospital of Sulaimani (Iraq). Thirteen patients with COVID-19 and mucosal manifestations (male:female ratio = 7:6; mean age = [28.76 17.18] years; three patients younger than 18 years old) were identified between October 2021 and July 2022. The lesions involved the oral mucosa in 10 patients and the genital mucosa in three patients. The reported oral manifestations included painful, burning erythematous lesions (one 46-year-old female, location: soft palate), vesicular lesions (five patients, location: labial frenulum and lips), ulcers (Figure 1a) (two patients, location: soft and hard palate), and fissures (two patients, location: tongue and lips). For what concerns the genital mucosa, the lesions of our patients included vulvar and perineal ulcers (one patient, age: 28 years old) (Figure 1b), penile vesicular lesions (one patient, 22 years old), and penile erosions and swelling (one patient, 26 years old) (Figure 2). The mean latency time between the COVID-19 diagnosis, which was performed via reverse transcriptase polymerase chain reaction, and the onset of the dermatological lesions was (4.1 2.46) days for the patients who developed oral lesions. On the other hand, the latency between COVID-19 diagnosis and the onset of genital mucosa lesions was 15 days, 9 days, and unclear, respectively. For oral lesions, the mean recovery time was (13.8 7.15) days. Because no other causative agent could be identified (other viral infections were ruled out via laboratory exams), our patients’ oral and mucosal lesions were attributed to the compound effect of the SARS-CoV-2 infection and to the immunosuppressive state induced by COVID-19. A systematic review from 2021 by Bhujel et al. stated that COVID-19 may manifest as oral mucosa lesions, however, discerning whether such lesions are to be attributed to the virus only or to the treatment may be a challenging task. Moreover, although the literature evidence supporting the association between COVID-19 and oral lesions is starting to become conspicuous, large prospective studies investigating this topic are still missing. The oral mucosa lesions that have been reported to occur in association with COVID-19 include but are not limited to ulcerative lesions, tongue changes, gingival lesions, candida lesions, oral lichenoid lesions, oral enanthema, pigmentation, and mucositis. No sexual predilection was observed. According to Fakhruddin et al., COVID-19-associated oral mucosa lesions appear to be more common on the dorsum of the tongue, the palate, lips, buccal mucosa, gums, and tonsillar area. Notably, both the recovery time and the latency time between the diagnosis of COVID-19 and the onset of the lesions are quite variable. Many viral agents like cytomegalovirus and herpes simplex virus are known to be the etiological factors that lead to oral lesions. Moreover, the fact that the ACE2 receptors of the novel coronavirus are well represented in the mouth, providing the virus with direct access to the oral mucosa cells is an established concept. Thus, the association between COVID-19 and oral lesions is not surprising.

A 56-year-old woman presented to the emergency to be department with diarrhea, asthenia, cough, and dysgeusia. The patient had chronic obstructive pulmonary disease (COPD) and was found infected with coronavirus disease 2019 (COVID-19). On physical examination, a small basal cell carcinoma (BCC) lesion was identified on her scalp; however, following the administration of noninvasive ventilation, the appearance of both macroscopic and microscopic BCC worsened dramatically. Our findings point to positive pressure noninvasive ventilation used to treat COVID-19 associated with COPD as a possible causative agent for the progression of cutaneous BCC. (SKINmed. 2022;20:463-465).

•Topical photodynamic therapy (PDT) with 5-aminolevulinic acid could be used to control the disease.•Topical photodynamic therapy with 5-aminolevulinic acid can guarantee the patients’ skin integrity.•Better results are observed in patients undergoing PDT within a few days from the onset of the lesions.

Background Surveillance of human leishmaniasis in Europe is mostly limited to country-specific information from autochthonous infections in the southern part. As at the end of 2021, no integrated analysis has been performed for cases seen across centres in different European countries. Aim To provide a broad perspective on autochthonous and imported leishmaniasis cases in endemic and non-endemic countries in Europe. Methods We retrospectively collected records from cutaneous, mucosal and visceral leishmaniasis cases diagnosed in 15 centres between 2014 and 2019. Centres were located in 11 countries: Belgium, France, Germany, Italy, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the United Kingdom. Data on country of infection, reason for travelling, infecting species, age and sex were analysed. Results We obtained diagnostic files from 1,142 cases, of which 76%, 21% and 3% had cutaneous, visceral, and mucosal disease, respectively. Of these, 68% were men, and 32% women, with the median age of 37 years (range: 0–90) at diagnosis. Visceral leishmaniasis was mainly acquired in Europe (88%; 167/190), while cutaneous leishmaniasis was primarily imported from outside Europe (77%; 575/749). Sixty-two percent of cutaneous leishmaniasis cases from outside Europe were from the Old World, and 38% from the New World. Geographic species distribution largely confirmed known epidemiology, with notable exceptions. Conclusions Our study confirms previous reports regarding geographic origin, species, and traveller subgroups importing leishmaniasis into Europe. We demonstrate the importance of pooling species typing data from many centres, even from areas where the aetiology is presumably known, to monitor changing epidemiology.

Background: Recently, several case-control studies demonstrated an association between gliptins and bullous pemphigoid (BP) occurrence. However, data on the clinical and immunologic features of gliptinassociated bullous pemphigoid (GABP) are controversial.Objective: This study aimed to clinically and immunologically characterize a large cohort of GABP patients to get an insight into the pathophysiology of this emerging drug-induced variant of BP.Methods: Seventy-four GABP patients were prospectively enrolled and characterized from 9 different Italian dermatology units between 2013 and 2020.Results: Our findings demonstrated the following in the GABP patients: (1) a noninflammatory phenotype, which is characterized by low amounts of circulating and skin-infiltrating eosinophils, is frequently found; (2) immunoglobulin (Ig)G, IgE, and IgA humoral responses to BP180 and BP230 antigens are reduced in frequency and titers compared with those in patients with idiopathic BP; (3) IgG reactivity targets multiple BP180 epitopes other than noncollagenous region 16A.Limitations: A limitation of the study is that the control group did not comprise only type 2 diabetes mellitus patients with BP.Conclusion: GABP patients show peculiar features of anti-BP180 and-BP230 humoral responses, laying the foundation for diagnostic improvements and getting novel insights into understanding the mechanism of BP onset. ( J Am Acad Dermatol 2022;87:56-63.)

Emerging literature evidence shows that the manifestations of the coronavirus disease 2019 (COVID‐19), which is the disease caused by SARS‐CoV‐2, encompass alterations of the pulmonary, cardiovascular, gastrointestinal, and neurological system. Moreover, hematologic and dermatologic manifestations have been documented.

We observed three cases, one man and two women, with chronic familial benign pemphigus or Hailey-Hailey disease with the presence of erythematous areas and various district erosions: groin, armpits, inframammary sulcus. In two cases, a man, and a woman, with St. Aureus superinfection. The treatment assigned was based on systemic cortisone (prednisone 25 mg), antioxidants (lactoferrin or polydatin), PEG gel (polyoxyethylene glycol + allantoin) and in cases of systemic antibiotic superinfection (azithromycin and in the other case Clarithromycin). A new type of advanced dressing was recommended at home (3 × patients): gauzes with a porous membrane of polycaprolactone with maltodextrin, collagen, chitosan, and colloidal silver. In the third week of treatment in two cases there was a marked decrease in erythematous areas and erosions in the absence of symptoms (itching, burning, pain and bad odor). In the other case, the objective result showed a less decisive but clear improvement. Therefore, these dressings in combination with traditional therapy protocols could be extended to a greater number of cases for better evaluation.

It is not yet entirely clear what is the relevance of skin symptoms and what clinical implications are related to their appearance in COVID-19 patients. We describe two cases of COVID-19-associated pneumonia, which presented skin manifestations in advanced stage of illness, when nasopharyngeal swabs became negative for SARS-CoV-2. The first case presented erythematous, maculopapular lesions; the second developed petechial, vesicular and blood-encrusted lesions on the limbs. Histopathology documented perivascular lymphocytic infiltrates, with prevalent CD4+ T-cells in both patients. The research of SARS-CoV-2 in tissues with real time RT-PCR was negative. Basal keratinocytes displayed C4d deposits in one case, who developed laboratory signs indicative of a procoagulative condition at the same time as the skin rash. Skin manifestations during SARS-CoV-2 infection seem to be clinically relevant and further studies are necessary to assess if they are linked to systemic complications, lack of viral clearance or cascades of immune responses induced by the virus, even in patients affected by mild pneumonia.

In severe COVID-19, which is characterized by blood clots and neutrophil-platelet aggregates in the circulating blood and different tissues, an increased incidence of cardiovascular complications and venous thrombotic events has been reported. The inflammatory storm that characterizes severe infections may act as a driver capable of profoundly disrupting the complex interplay between platelets, endothelium, and leukocytes, thus contributing to the definition of COVID-19-associated coagulopathy. In this frame, P-selectin represents a key molecule expressed on endothelial cells and on activated platelets, and contributes to endothelial activation, leucocyte recruitment, rolling, and tissue migration. Briefly, we describe the current state of knowledge about P-selectin involvement in COVID-19 pathogenesis, its possible use as a severity marker and as a target for host-directed therapeutic intervention.

Immune recovery folliculitis (IRF) is defined as the development of an inflammatory disorder of the facial pilo-sebaceous unit due to the immune reconstitution inflammatory syndrome (IRIS). Skin lesions can be related to an immune response against skin saprophyte bacteria (e.g. Demodex folliculorum, Cutibacterium acnes). The rapid reconstitution of T lymphocyte, with a CD8+ predominance, is considered a key pathogenic factor for this phenomenon. IRF is clinically similar to acne vulgaris and can be challenging to treat. Patients with facial pustules can experience social discomfort. Here we report two cases of IRF diagnosed at the human immunodeficiency virus (HIV) clinic of the National Institute of Infectious Diseases L. Spallanzani, in Rome, Italy. The first case occurred in an antiretroviral therapy (ART)-experienced patient, after a treatment simplification; the second one was registered in an ART-naïve patient, diagnosed with acute HIV infection shortly, after ART initiation. To date, an IRF secondary to an ART switch, has not been described yet. IRF should be ruled out and considered in differential diagnosis from antiretroviral drug-related skin effects.