ABSTRACT
Coronavirus could affect almost any part of the body including the skin. In this systematic review, the primary skin lesions resulting from the direct activity of the virus or the medications used for treatment and the changes in the behavior of the virus regarding the occurrence of these symptoms over time were assessed. PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, Cochrane Skin were searched for all published articles from February 19 to July 1, 2020, which met the inclusion criteria. Thirty-six related articles were extracted. Twenty-eight studies reported virus-related mucocutaneous eruptions and 8 articles, the drug-reactions. Data of 583 patients were included. Skin lesions of COVID-19 could be caused by both the virus itself or the influence of drugs used for the treatment. Morbilliform rashes, urticaria, and acral-vasculopathic cutaneous lesions were at the forefront of primary COVID-dependent skin lesions with no significant change during time, Also, Hydroxychloroquine, lopinavir/ritonavir, paracetamol, and antibiotics were reported as the main causes of drug-induced rashes. Since dermatologic manifestations may occur prior or simultaneously/after other COVID clinical symptoms, so they may helpful in patients’ early diagnosis or prediction of internal organ involvements via histopathologic evaluations of skin biopsies especially about vasculopathic and vasculitic, respectively.
ABSTRACT
Nowadays, the coronavirus disease 2019 (COVID-19) pandemic has become a global health problem and, given the high mortality and transmission rate of this infection and the lack of approved or specific treatments for it so far, the exploitation of the potentials of existing drugs is of paramount importance, hence, we aimed to investigate all possible COVID-19-related mechanisms of systemic retinoids. We systematically searched all related evidence in various data bases about the effect of retinoic acids on respiratory failure as the most important COVID-19-related complication and the other important potentials of this drug to affect COVID pathomechanism. Considering the various behaviors and presentations of this virus in different people, paying attention to the underlying diseases, physical conditions, genetics, and medications that cause these differences may be helpful in reducing the mortality and morbidity of the disease. In the field of dermatology, retinoids are a group of drugs that have controversial evidence regarding their effects when administered to patients with COVID-19. On one hand, these drugs offer immunomodulatory, immune-enhancing, antiviral, and antiangiogenesis activity, and can stimulate the differentiation and repair of epithelial cells. On the other hand, they can increase inflammation and cause the fragility of oral and nasal mucosae. When prescribe systemic retinoids, all of these aspects should be considered in all fields of the medicine and dermatology is not an exception.
ABSTRACT
The coronavirus disease 2019 (COVID-19) is currently the most important global health problem. Due to its pandemic state and high mortality rate, it is critical to find useful interventions that reduce the mortality rate and boost patient survival. Since there is no specific antiviral treatment for the disease and given the growing amount of data about the role of the inflammatory response and cytokine storm in increased disease severity, we evaluated the mechanisms and possible positive effects of some specific anti-inflammatory drugs on the disease course of COVID-19 and examined some suggested treatments in the form of a scoping review article. It is important to select patients who may benefit from these treatments without inflicting any serious adverse effects. In our view, in approaching COVID-19 patients, we should consider the severity of the body’s inflammatory response. Mild cases may not require additional anti-inflammatory treatment or at least should be treated with safer immunoregulatory drugs such as chloroquines, whereas in severe cases with an overactive immune response evidenced by high serum inflammatory marker levels (TNF, ESR, CRP, WBC count, LDH, ferritin) and severe lung involvement in chest images, stronger immunoregulatory drugs (targeted immunotherapy) such as TNF and kinase inhibitors may be considered as adjunctive treatments in combination with antiviral drugs. However, further precisely designed studies are needed to confirm the therapeutic effect and safety of each of these anti-inflammatory drugs in COVID-19 patients and to determine their optimal dose, route of administration, and possible side effects.
ABSTRACT
Nowadays, the coronavirus disease 2019 (COVID-19) pandemic has become a global health problem and, given the high mortality and transmission rate of this infection and the lack of approved or specific treatments for it so far, the exploitation of the potentials of existing drugs is of paramount importance, hence, we aimed to investigate all possible COVID-19-related mechanisms of systemic retinoids. We systematically searched all related evidence in various data bases about the effect of retinoic acids on respiratory failure as the most important COVID-19-related complication and the other important potentials of this drug to affect COVID pathomechanism. Considering the various behaviors and presentations of this virus in different people, paying attention to the underlying diseases, physical conditions, genetics, and medications that cause these differences may be helpful in reducing the mortality and morbidity of the disease. In the field of dermatology, retinoids are a group of drugs that have controversial evidence regarding their effects when administered to patients with COVID-19. On one hand, these drugs offer immunomodulatory, immune-enhancing, antiviral, and antiangiogenesis activity, and can stimulate the differentiation and repair of epithelial cells. On the other hand, they can increase inflammation and cause the fragility of oral and nasal mucosae. When prescribe systemic retinoids, all of these aspects should be considered in all fields of the medicine and dermatology is not an exception.