Pregnancy-associated changes in melanocytic nevi (MN), apart from size increase on the trunk, remain a topic of debate. We conducted the first prospective study to investigate dermoscopic changes in MN comparing pregnant with non-pregnant women on all body parts using a market-approved convolutional neural network (CNN). We included 25 pregnant and 25 non-pregnant women from Basel, Switzerland, who underwent standard skin cancer screenings and whose MN > 2 mm were digitally recorded and analysed by a CNN. Pregnant women were examined three times: in the first and third trimester and 8–12 weeks postpartum; non-pregnant women twice in an interval of 17–21 weeks. We analysed 2,799 MN. In pregnant women, diameter[p < 0.001], area[p < 0.001], number of colours [p = 0.009], shape asymmetry[p = 0.005] and border sharpness[p = 0.006] (inversely proportional value) increased while ellipseness [p < 0.001] decreased from first trimester to postpartum. Changes occurred mainly during the third trimester to postpartum. Compared to non-pregnant women (only first to third trimester) MN on the upper extremities of pregnant women increased in area[p = 0.011] and diameter[p = 0.025] and decreased in ellipseness[p = 0.037]. MN on the lower extremities increased in area[p = 0.044] and MN on the back increased in colour asymmetry[p = 0.022].

ZusammenfassungDer subakut kutane Lupus erythematodes (SCLE) ist ein Subtyp des kutanen Lupus erythematodes, der sich durch hohe Photosensitivität, Auftreten von anulären oder papulosquamösen Hautveränderungen im Bereich der UV-exponierten Körperregionen, serologischen Nachweis von Anti-Ro/SS-A-Antikörpern und milde systemische Beteiligung wie Arthralgien und Myalgien auszeichnet. Wie bei anderen Formen des kutanen Lupus erythematodes kann auch der SCLE durch bestimmte Triggerfaktoren wie UV-Exposition, Zigarettenrauchen oder Medikamente ausgelöst werden. Rheumatische Erkrankungen wie die Dermatomyositis sind seit Langem als paraneoplastische Syndrome bekannt. In den letzten Jahren wird zunehmend über die Assoziation von SCLE und Tumorerkrankungen publiziert. Wir berichten den Fall einer 78-jährigen Patientin, bei der zeitgleich mit der Entwicklung eines SCLE ein Magenkarzinom diagnostiziert wurde. Bei SCLE-Patienten höheren Alters, ausgedehntem Befall außerhalb der UV-exponierten Körperpartien oder neu aufgetretener B‑Symptomatik sollte das Vorliegen eines paraneoplastischen SCLE in Erwägung gezogen und entsprechende diagnostische Schritte zur Abklärung einer Tumorerkrankung sollten eingeleitet werden.

Importance The COVID-19 pandemic resulted in delayed access to medical care. Restrictions to health care specialists, staff shortages, and fear of SARS-CoV-2 infection led to interruptions in routine care, such as early melanoma detection; however, premature mortality and economic burden associated with this postponement have not been studied yet. Objective To determine the premature mortality and economic costs associated with suspended melanoma screenings during COVID-19 pandemic lockdowns by estimating the total burden of delayed melanoma diagnoses for Europe. Design, Setting, and Participants This multicenter economic evaluation used population-based data from patients aged at least 18 years with invasive primary cutaneous melanomas stages I to IV according to the American Joint Committee on Cancer (AJCC) seventh and eighth editions, including melanomas of unknown primary (T0). Data were collected from January 2017 to December 2021 in Switzerland and from January 2019 to December 2021 in Hungary. Data were used to develop an estimation of melanoma upstaging rates in AJCC stages, which was verified with peripandemic data. Years of life lost (YLL) were calculated and were, together with cost data, used for financial estimations. The total financial burden was assessed through direct and indirect treatment costs. Models were building using data from 50 072 patients aged 18 years and older with invasive primary cutaneous melanomas stages I to IV according to the AJCC seventh and eighth edition, including melanomas of unknown primary (T0) from 2 European tertiary centers. Data from European cancer registries included patient-based direct and indirect cost data, country-level economic indicators, melanoma incidence, and population rates per country. Data were analyzed from July 2021 to September 2022. ExposureCOVID-19 lockdown-related delay of melanoma detection and consecutive public health and economic burden. As lockdown restrictions varied by country, lockdown scenario was defined as elimination of routine medical examinations and severely restricted access to follow-up examinations for at least 4 weeks. Main Outcomes and Measures Primary outcomes were the total burden of a delay in melanoma diagnosis during COVID-19 lockdown periods, measured using the direct (in US$) and indirect (calculated as YLL plus years lost due to disability [YLD] and disability-adjusted life-years [DALYs]) costs for Europe. Secondary outcomes included estimation of upstaging rate, estimated YLD, YLL, and DALY for each European country, absolute direct and indirect treatment costs per European country, proportion of the relative direct and indirect treatment costs for the countries, and European health expenditure. Results There were an estimated 111 464 (range, 52 454-295 051) YLL due to pandemic-associated delay in melanoma diagnosis in Europe, and estimated total additional costs were $7.65 (range, $3.60 to $20.25) billion. Indirect treatment costs were the main cost driver, accounting for 94.5% of total costs. Estimates for YLD in Europe resulted in 15 360 years for the 17% upstaging model, ranging from 7228 years (8% upstaging model) to 40 660 years (45% upstaging model). Together, YLL and YLD constitute the overall disease burden, ranging from 59 682 DALYs (8% upstaging model) to 335 711 DALYs (45% upstaging model), with 126 824 DALYs for the real-world 17% scenario. Conclusions and Relevance This economic analysis emphasizes the importance of continuing secondary skin cancer prevention measures during pandemics. Beyond the personal outcomes of a delayed melanoma diagnosis, the additional economic and public health consequences are underscored, emphasizing the need to include indirect economic costs in future decision-making processes. These estimates on DALYs and the associated financial losses complement previous studies highlighting the cost-effectiveness of screening for melanoma.

The genesis of subacute cutaneous lupus erythematosus (SCLE) is multifactorial and includes idiopathic, drug-related and paraneoplastic etiologies. This article reports the case of a 70-year-old female patient with paraneoplastic SCLE in whom a lung adenocarcinoma was detected during the extended examination. A paraneoplastic SCLE should be considered when a patient with SCLE presents with lesions in regions of the skin not exposed to sunlight and beginning B symptoms.

As the most visible and vulnerable organ of the human organism, the skin can provide an impression of its state of health. Rare forms of diabetes and endocrinopathies are often diagnosed late or primarily misinterpreted due to their rarity. Skin peculiarities associated with these rare diseases may be indicative of the underlying endocrinopathy or form of diabetes. At the same time, rare skin changes in diabetes or endocrinopathies can also be a major challenge for dermatologists, diabetologists and endocrinologists in optimal patient and therapy management. Active collaboration between these different specialist groups can therefore lead to increased patient safety, better therapeutic success and more targeted diagnostics.

Objective:Little is known about specific cutaneous findings in children and adolescents with overweight and obesity. This study assessed the association of skin signs with pivotal auxological and endocrinological parameters and their influence on the quality of life (QoL) of young people with obesity. Study design:All patients initially recruited for a tertiary hospital's weight control program were offered participation in this interdisciplinary, single-center, cross-sectional study. All participants underwent a detailed dermatological examination, anthropometric measurements and laboratory examinations. QoL was assessed with validated questionnaires. Results:A total of 103 children and adolescents (age 11.6 ±2.5 years, 41% female, 25% prepubertal, BMI SDS 2.6 ± 0.5, homeostatic model assessment (HOMA) score 3.3 ± 4.2; mean ± s.d.) were recruited in a 12-month study period. Skin affections were linearly associated with increasing BMI and higher age. The most common skin findings were (%) striae distensae (71.0), keratosis pilaris (64.7), acanthosis nigricans (45.0), acne vulgaris (39.2), acrochordons (25.5) and plantar hyperkeratosis (17.6). The HOMA score was associated with acanthosis nigricans (P = 0.047), keratosis pilaris (P = 0.019) and acne vulgaris (P < 0.001). The general mean QoL(QoL) score, as assessed by the WHO-5, was 70 out of 100. A total of 38.9% of participants reported impaired dermatological QoL. Conclusions:This study shows the high prevalence of skin lesions in children and adolescents with obesity. The association between skin lesions and the HOMA score indicates that skin manifestations are a marker of insulin resistance. To prevent secondary diseases and improve QoL, thorough skin examinations and interdisciplinary cooperation are necessary.

Ziele Kinder und Jugendliche mit Übergewicht und Adipositas im Alter von 8 bis 17 Jahren können an einem ambulanten multidisziplinären Adipositas-Schulungsprogramm unserer Klinik teilnehmen.

ZusammenfassungEs werden zwei Patienten vorgestellt, die wegen eines streuenden allergischen Kontakt- bzw. Arzneimittelexanthems auf Budesonid bzw. Antibiotika abgeklärt wurden. Bei beiden trat innerhalb einiger Stunden nach Anlegen eines Epikutantests mit Budesonid bzw. Intradermaltests mit Amoxicillin eine stark positive Hauttestreaktion sowie ein Exanthem auf. Beim ersten Patienten lag eine Sensibilisierung auf die kreuzreagierenden Moleküle Budesonid und Amcinonid, bei der zweiten Patientin eine ausgeprägte Überempfindlichkeit auf Aminopenicilline vor. Aufflammphänomene (Flare-ups) sind v. a. aus der Kontaktallergologie bekannt, können aber auch bei der Abklärung von allergischen Arzneimittelexanthemen auftreten. Systemische Reaktionen vom verzögerten Typ auf Spättyp-Hauttests mit Medikamenten sind relativ selten, können aber eine erhebliche Morbidität bewirken. Verschiedene Formen von Aufflammphänomenen in der Allergologie werden diskutiert.

Two patients are presented, who were investigated because of a disseminated allergic contact or drug exanthema on budesonide and antibiotics, respectively. Both patients showed a strong positive skin test reaction and an exanthema within a few hours after a patch test with budesonide and an intradermal test with amoxicillin, respectively. The first patient had sensitization to the cross-reacting molecules budesonide and amcinonide , and the second patient had marked hypersensitivity to aminopenicillins. Flare-ups are known mainly from contact allergy but may also occur in the work-up of allergic drug exanthema. Delayed-type systemic reactions to delayed-type skin tests with drugs are relatively rare but can cause significant morbidity. Various forms of flare-up phenomena in allergology are discussed.

Hand dermatitis is a widespread problem among cleaners. In most cases, it is caused by a combination of wet work and contact with irritants, which can result in irritant (toxic) contact dermatitis. In some cases, the irritant contact eczema then evolves into allergic contact dermatitis, although not all cases of allergic contact dermatitis are preceded by irritant contact dermatitis. This mini-review proposes a two-step diagnostic algorithm based on patch testing, which can be used if allergic contact dermatitis is suspected in cleaning workers. As a first step, we recommend performing the DKG standard series (German Contact allergy research group, DKG), the DKG rubber series, both DKG "further fragrances" series as well as the DKG preservative and disinfectant series. If there are clear hints of an occupational contact dermatitis, the first step can also involve testing patients' own products alongside the standardized tests. In a second step (at the latest), if standardized tests do not suffice to identify the culprit allergen and there is well-founded suspicion, we recommend testing the patients' own products. If necessary, the second step can also include testing the individual contact allergens contained in the screening mixes that are part of the standard series.

ZusammenfassungHandekzeme sind ein häufiges Problem in der Berufsgruppe der Reinigungsfachkräfte. Ursächlich dafür ist meistens eine Kombination aus Feuchtarbeit und Kontakt mit Irritanzien, die in einer irritativ‐toxischen Kontaktdermatitis resultieren kann. Sekundär oder auch primär treten allergische Kontaktekzeme auf. Dieser Mini‐Review stellt einen zweistufigen Abklärungsalgorithmus unter Anwendung des Epikutantests vor, der bei Verdacht auf ein allergisches Kontaktekzem bei Reinigungsfachkräften empfohlen wird. Dieser sieht im ersten Schritt eine Testung der DKG‐Standardreihe (Deutsche Kontaktallergie‐Gruppe, DKG), der DKG‐Gummireihe, der beiden erweiterten DKG‐Duftstoffreihen und der DKG‐Konservierungs‐ sowie Desinfektionsmittelreihe vor. Bei deutlichen Hinweisen auf einen berufsspezifischen Auslöser kann zudem schon hier eine Eigensubstanz‐Testung erwogen werden. Findet sich mittels standardisierter Testreihen kein auslösendes Allergen, raten wir (spätestens) im zweiten Schritt bei begründetem Verdacht zur Testung von eigenen Substanzen. Im zweiten Schritt können zudem positive Indikator‐Mixe aus dem ersten Schritt aufgeschlüsselt werden.

ZusammenfassungHaarkosmetikprodukte wie Shampoos, Färbe‐, Bleich‐ oder Glättmittel enthalten häufige Kontaktallergene. Diese können insbesondere bei Friseuren, aber auch bei ihren Kunden und bei Selbstanwendern, zu allergischen Kontaktekzemen führen. Während sich Kontaktekzeme bei Friseuren in der Regel als Handekzem manifestieren, sind bei Kunden und Selbstanwendern vor allem Kopf, Hals und Gesicht betroffen. Wir schlagen einen zweistufigen Algorithmus zur strukturierten allergologischen Abklärung mittels Epikutantestung bei Verdacht auf ein haarproduktbedingtes allergisches Kontaktekzem vor. Als ersten Schritt empfehlen wir die Testung der Deutsche Kontaktallergie‐Gruppe (DKG)‐Standardreihe, DKG‐Externareihe, DKG‐Konservierungsmittelreihe, DKG‐Friseurreihe, DKG‐Duftstoffreihen sowie (vor allem bei Friseuren) der DKG‐Gummireihe. Wird mittels der standardisierten Testreihen kein auslösendes Allergen identifiziert, sollte spätestens in einem zweiten Schritt – bei entsprechendem Verdacht – eine personalisierte Testung mit Eigensubstanzen, wie Shampoos, Haarsprays und Färbemitteln, durchgeführt werden.

Hair cosmetics such as shampoos, hair dyes, bleaching agents or hair straightening creams contain frequent contact allergens. These can lead to allergic contact dermatitis especially in hairdressers, but also in their customers and in others who use hair products at home. While hairdressers suffer mainly from hand dermatitis, in customers and home-users, dermatitis primarily affects the head, neck and face. In this mini-review, we propose a diagnostic algorithm in two steps, based on patch testing, that can be used for the assessment of suspected hair product-induced contact dermatitis. In a first step, we recommend testing the German Contact Allergy Group (DKG) standard series, DKG ointment series, DKG preservative series, DKG hairdresser series, DKG fragrance series as well as (especially in hairdressers) the DKG rubber series. In a second step, if the culprit allergen cannot be identified with the help of the standardized test series and there is a well-founded suspicion, testing the patient's own products, such as shampoos, hair sprays and hair dyes, is recommended.

There is a desperate need to identify effective treatments for coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1Sanders J.M. Monogue M.L. Jodlowski T.Z. Cutrell J.B. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review.JAMA. 2020; 323: 1824-1836PubMed Google Scholar Most drugs currently explored in this pandemic are repurposed antiviral and immunomodulatory drugs. Adverse drug reactions (ADRs), when encountered, add an additional level of complexity to the management of patients with COVID-19. Given these are repurposed drugs, there is already an experience base in dealing with their ADRs. In this review, we aim to offer guidance from an allergy and pharmacology perspective on ADRs, including drug hypersensitivity reactions (DHRs), caused by drugs currently used for the treatment of COVID-19. The clinical spectrum of a SARS-CoV-2 infection can range from mild flu-like symptoms to acute respiratory distress syndrome and multiple organ dysfunction compounded by an excessive proinflammatory host response ("cytokine storm"). Drugs repurposed for the treatment of COVID-19 are aimed at either modulating virus-host interaction or disrupting the viral life cycle.1Sanders J.M. Monogue M.L. Jodlowski T.Z. Cutrell J.B. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review.JAMA. 2020; 323: 1824-1836PubMed Google Scholar Drugs designed to block receptor-mediated endocytosis and thereby viral cell entry include the influenza drug umifenovir. The antimalarial drugs chloroquine and hydroxychloroquine were initially considered to provide additional therapeutic benefit due to their immunomodulatory properties, but given the lack of efficacy and concerns about safety, the US Food and Drug Administration withdrew them from use in COVID-19 in June 2020. Promising drugs that block virus synthesis by interfering with RNA-dependent RNA polymerase are nucleoside analogues such as remdesivir and favipiravir. Agents that disrupt the viral life cycle by stalling the release of new virus particles from infected cells include protease inhibitors such as lopinavir and ritonavir. Host-targeted treatments for COVID-19 intended to modify the detrimental effects of various proinflammatory cytokines include TNF-α inhibitors such as infliximab, IL-6 and IL-6 receptor inhibitors such as tocilizumab and sarilumab, IL-1 inhibitors such as anakinra and canakinumab, IFN-γ inhibitors such as emapalumab, and Janus kinase inihibitors such as ruxolitinib, tofacitinib, baricitinib, and upadacitinib.1Sanders J.M. Monogue M.L. Jodlowski T.Z. Cutrell J.B. Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review.JAMA. 2020; 323: 1824-1836PubMed Google Scholar ADRs are classified into type A, dose-dependent reproducible side effects and type B, immunologically or nonimmunologically triggered DHRs/drug allergy reactions. Most DHRs are categorized by the suspected underlying pathomechanism into either immediate-type (IgE- or non–IgE-mediated) or delayed-type (T-cell–mediated or p-i concept [pharmacologic interaction with immune receptors]) reactions.2Pichler W.J. Immune pathomechanism and classification of drug hypersensitivity.Allergy. 2019; 74: 1457-1471Crossref PubMed Scopus (125) Google Scholar ADRs to biologicals have to be distinguished from infusion reactions and are classified into 4 hypersensitivity reaction patterns, namely, type I–like, cytokine release, mixed (type I/cytokine release), and type IV reactions, and are described for all biologicals used in COVID-19. Any organ system, but also multiple organs simultaneously, can be affected by ADRs from drugs used in COVID-19 (Fig 1). In multiple organ dysfunction associated with COVID-19, ADR are an important differential diagnosis. Cutaneous manifestations are common with DHRs and are therefore considered in detail in Fig 2.3https://vigilyze.who-umc.org/Date accessed: May 9, 2020Google Scholar Immediate-type DHRs appear within minutes after drug intake, and the viral entry inhibitor umifenovir as well as the biologicals are common culprits with symptoms such as urticaria, angioedema, and anaphylaxis. Delayed-type DHRs present in various clinical manifestations, and are differentiated primarily by their morphology and organ involvement (Fig 2). Parainfectious exanthems are an important differential diagnosis of DHRs. Some viruses, mainly of the herpes group, Coxsackie A or ECHO viruses, commonly elicit parainfectious exanthems, whereas coronaviruses, in particular SARS-CoV-2, do not seem to do so as frequently. In general indicative, but not conclusive, for a viral trigger of exanthems are distal lesions with a proximal spread toward the trunk. A Spanish publication has categorized cutaneous manifestations of COVID-19 into 5 clinical patterns: acral areas of erythema with vesicles or pustules (pseudo-chilblain), other vesicular eruptions, urticarial lesions, maculopapular lesions, and livedo or necrosis.4Galván Casas C. Català A. Carretero Hernández G. Rodríguez-Jiménez P. Fernández Nieto D. Rodríguez-Villa Lario A. et al.Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.Br J Dermatol. 2020; 183: 71-77Crossref PubMed Scopus (958) Google Scholar An association with "receiving drugs" was more frequent in those with maculopapular, livedoid, and urticarial lesions, compared with those with pseudo-chilblain or vesicular lesions.4Galván Casas C. Català A. Carretero Hernández G. Rodríguez-Jiménez P. Fernández Nieto D. Rodríguez-Villa Lario A. et al.Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.Br J Dermatol. 2020; 183: 71-77Crossref PubMed Scopus (958) Google Scholar Recalcati reported uncomplicated cutaneous manifestations in approximately 20% of 88 patients, mainly erythematous rash, urticaria, and chickenpox-like vesicles.5Recalcati S. Cutaneous manifestations in COVID-19: a first perspective.J Eur Acad Dermatol Venereol. 2020; 34: e212-e213Crossref PubMed Scopus (922) Google Scholar Hedou et al responded with a prospective study on skin manifestations of SARS-CoV-2–positive patients, identifying 1 case of urticaria in the prodromal phase, 2 erythematous rashes and 1 case of urticaria as well as 1 reactivation of oral herpes simplex during the infection in a total of 103 patients.6Hedou M. Carsuzaa F. Chary E. Hainaut E. Cazenave-Roblot F. Masson Regnault M. Comment on "Cutaneous manifestations in COVID-19: a first perspective" by Recalcati S.J Eur Acad Dermatol Venereol. 2020; 34: e299-e300Crossref PubMed Scopus (84) Google Scholar Furthermore, polymorphic rash and erythema of the palms and soles appear to be typical for the newly described Kawasaki-like disease in COVID-19–affected children, which is currently suspected to develop as a consequence of SARS-CoV-2–induced cytokine storm/macrophage activation syndrome.7Verdoni L. Mazza A. Gervasoni A. Martelli L. Ruggeri M. Ciuffreda M. et al.An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study.Lancet. 2020; 395: 1771-1778Abstract Full Text Full Text PDF PubMed Scopus (1703) Google Scholar The evolving knowledge of frequent COVID-19–induced coagulopathies and thrombophilic and hyperviscous states may help to understand the occurrence of petechiae, chilblain-like lesions and livedo reticularis as a consequence of cytokine-induced inflammation and microthrombus formation facilitated by viral binding to angiotensin-converting enzyme 2.8Fernandez-Nieto D. Jimenez-Cauhe J. Suarez-Valle A. Moreno-Arrones O.M. Saceda-Corralo D. Arana-Raja A. et al.Characterization of acute acral skin lesions in nonhospitalized patients: a case series of 132 patients during the COVID-19 outbreak.J Am Acad Dermatol. 2020; 83: e61-e63Abstract Full Text Full Text PDF PubMed Scopus (169) Google Scholar In the ongoing COVID-19 pandemic, classical presentations of ADRs are increasingly reported: acute generalized exanthematous pustulosis mainly to chloroquine/hydroxychloroquine (before they were withdrawn as recommended medications for COVID-19), recently also to cefditoren; symmetrical drug-related intertriginous and flexural exanthema in a COVID-19–positive patient without a clearly identifiable elicitor; and 1 case of potential Stevens-Johnson syndrome/toxic epidermal necrosis overlap with an unclear elicitor (potentially virus-induced).9Torres-Navarro I, Abril-Pérez C, Roca-Ginés J, Sánchez-Arráez J, Botella-Estrada R. A case of cefditoren-induced acute generalized exanthematous pustulosis during COVID-19 pandemics: severe cutaneous adverse reactions (SCARs) are an issue [published online ahead of print May 26, 2020]. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16664.Google Scholar,10Lagziel T. Quiroga L. Ramos M. Hultman C.S. Asif M. Two false negative test results in a symptomatic patient with a confirmed case of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and suspected Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).Cureus. 2020; 12e8198PubMed Google Scholar There are no reports of drug reaction with eosinophilia and systemic symptoms or fixed drug eruption in the COVID-19 context so far. An initial assessment of the chronology of drug exposure and symptom onset is required to identify the suspected offending agents. Notably, treatment durations of the repurposed drugs for COVID-19 are considerably shorter compared with the usual indication in chronic diseases. Sometimes, switching within a drug group is possible (eg, switching from anakinra to canakinumab). Otherwise, avoidance of the most likely culprit drug would be recommended. Irrespective of the offending drug, treatment of suspected DHRs should be symptom-guided (eg, antihistamines for pruritus), and in anaphylaxis according to guidelines. In general, drug exanthems are treated with topical and, if necessary, systemic corticosteroids, but other immunomodulators and immunosuppressants might play a role in patients with COVID-19 with severe cutaneous adverse reactions and concurrent cytokine storm. Occasionally, a further increase in symptoms occurs over subsequent days despite discontinuation of the triggering agent, which may suggest an additional DHR to a substitute medication, an overhang of the initial ADR momentum, or, in the case of patients with COVID-19, a cytokine storm. For certain phenotypes of DHRs, drug desensitization is a theoretical option if the culprit drug is clearly needed and adequate therapeutic alternatives are not available. Drug desensitization is not an option, however, for infusion reactions in patients with COVID-19. Although desensitization in specialized centers has been shown to be safe in cancer and chronic disease, in the context of highly inflammatory processes such as COVID-19, there are considerable risks for breakthrough reactions, and there are no published cases of attempts to desensitize in patients with COVID-19. A specialist allergy assessment is mandatory between 6 weeks and 6 months later, with the aim to confirm the suspected DHR or consequently delabel the patient. This avoids misleading results from an overhanging nonspecific immune activation, causing false positives, and optimizes diagnostic yield, avoiding false negatives. For immediate-type DHRs, testing should include skin tests and, if available, serological testing. In vitro functional assays such as basophil activation tests can be considered. In delayed-type DHRs, the main diagnostic measures are intradermal tests with late reading after 48 hours or patch testing. In vitro lymphocyte transformation test can be of added value. COVID-19 is a complex immunologic interplay between the virus and the host. ADRs to COVID-19 treatments can pose an additional challenge and need to be distinguished from the inflammatory COVID-19 clinical picture. Several agents being given together make attribution to a single agent challenging. Immediate management following ADRs is avoidance of that drug, identification of a suitable alternative, and symptom-guided treatment of the ADR. For DHRs, detailed documentation aids in subsequent allergological workup. Further studies are needed to help differentiate clinical symptoms attributable to COVID-19 from symptoms associated with ADRs. As the amount of data available from randomized controlled trials and pharmacovigilance studies will increase over the coming months, the picture of ADRs in the COVID-19 context will become clearer.

Understanding the disease course and prevalence of COVID-19 is important not only for medical, but also for socioeconomic reasons. So far, COVID-19 has been understood as a multisystem disease, mainly affecting the lungs, kidneys, and heart.1 In the past few months, different cutaneous manifestations, such as chilblain-like, vasculitis-like, or urticaria-like lesions, have been described in patients with COVID-19.2 Colmenero and colleagues3 detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in endothelial cells of cutaneous chilblain lesions via immunohistochemistry methods in seven paediatric patients with negative nasopharyngeal swabs.

Contact DermatitisVolume 83, Issue 3 p. 233-234 CONTACT POINT Multilocular bullous fixed drug eruption elicited by paracetamol and migraine attacks, but not by paracetamol alone Dagmar Jamiolkowski, Corresponding Author dagmar.jamiolkowski@usb.ch orcid.org/0000-0003-0567-0647 Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, Switzerland Correspondence Dagmar Jamiolkowski, Division of Allergy, Department of Dermatology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. Email: dagmar.jamiolkowski@usb.chSearch for more papers by this authorEsther Steveling-Klein, Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, SwitzerlandSearch for more papers by this authorKathrin Scherer Hofmeier, Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, SwitzerlandSearch for more papers by this authorKarin Hartmann, Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, SwitzerlandSearch for more papers by this author Dagmar Jamiolkowski, Corresponding Author dagmar.jamiolkowski@usb.ch orcid.org/0000-0003-0567-0647 Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, Switzerland Correspondence Dagmar Jamiolkowski, Division of Allergy, Department of Dermatology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. Email: dagmar.jamiolkowski@usb.chSearch for more papers by this authorEsther Steveling-Klein, Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, SwitzerlandSearch for more papers by this authorKathrin Scherer Hofmeier, Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, SwitzerlandSearch for more papers by this authorKarin Hartmann, Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland Department of Biomedicine, University of Basel, Basel, SwitzerlandSearch for more papers by this author First published: 20 April 2020 https://doi.org/10.1111/cod.13567Citations: 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 Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume83, Issue3September 2020Pages 233-234 RelatedInformation