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Reply to: Introducing special cutaneous “sign” tribute to healthcare workers managing new coronavirus disease (Covid -19)

      To the Editor,
      Since our initial publication on coronavirus disease 2019 (COVID-19) infection and the skin, the pandemic has evolved with nearly 1,600,000 new cases and more than 93,000 deaths since the beginning of April 2020,
      • World Health Organization
      Coronavirus disease (COVID-19) situation dashboard.
      with these numbers increasing daily. In China, 3300 health care workers have been infected with the virus, and the number in Italy has escalated to 2600 as of this writing.

      Medical personnel at risk

      Medical personnel are at high risk for acquiring the infection due to intense exposure, lack of protective equipment, and ineffective prophylaxis. In the memory of those medics who have committed their lives to fighting the pandemic, we propose a new skin sign: “COVID-19 MS sign” (MS stands for medical staff), reflecting those facial cutaneous manifestations due to protective medical devices and personal equipment.
      • Kannangara K.
      Introducing special cutaneous “sign” tribute to healthcare workers managing new coronavirus disease (Covid -19).
      We support this proposal with the clarification that facial skin changes similar to those in health care workers have been reported elsewhere in the population, also created by the extensive use of protective equipment.
      Subsequent to our initial publication, specific skin manifestations of the COVID-19 infection have been reported, including maculopapular eruptions, urticaria, and vesicular lesions, along with livedo-like and petechial lesions.
      • Recalcati S.
      Cutaneous manifestations in COVID-19: a first perspective.
      ,
      • Joob B.
      • Wiwanitkit V.
      COVID-19 can present with a rash and be mistaken for Dengue.
      We would like to remind the readership that COVID-19 is not detected in skin specimens taken from infected patients.
      • Yao X.H.
      • Li T.Y.
      • He Z.C.
      • et al.
      A pathological report of three COVID-19 cases by minimally invasive autopsies.
      The structure of the skin and accessories is basically normal, with a sparse lymphocytic infiltrate surrounding the superficial small blood vessels of the dermis.
      The direct effect of the virus on the skin is not evident. We attribute our cutaneous observations to hyperergic manifestations and hypersensitivity reactions to the infection.
      • Knopfel N.
      • Noguera-Morel L.
      • Latour I.
      • et al.
      Viral exanthems in children: a great imitator.

      Conclusions

      We underline the role of skin preventive measures, including the use of emollients, barrier creams, and moisturizers, to assist in preventing skin complications aggravated by preventive measures during the pandemic.

      References

        • World Health Organization
        Coronavirus disease (COVID-19) situation dashboard.
        • Kannangara K.
        Introducing special cutaneous “sign” tribute to healthcare workers managing new coronavirus disease (Covid -19).
        Clin Dermatol. 2020; (accepted)
        • Recalcati S.
        Cutaneous manifestations in COVID-19: a first perspective.
        J Eur Acad Dermatol Venereol. 2020; 34: e212-e213
        • Joob B.
        • Wiwanitkit V.
        COVID-19 can present with a rash and be mistaken for Dengue.
        J Amer Acad Dermatol. 2020; 82e177
        • Yao X.H.
        • Li T.Y.
        • He Z.C.
        • et al.
        A pathological report of three COVID-19 cases by minimally invasive autopsies.
        Zhonghua Bing Li Xue Za Zhi. 2020; 49E009
        • Knopfel N.
        • Noguera-Morel L.
        • Latour I.
        • et al.
        Viral exanthems in children: a great imitator.
        Clin Dermatol. 2019; 37: 213-226