Vaccines for COVID-19 in patients with atopic dermatitis: three things every dermatologist should know

Almost 13 months have passed since the World Health Organization (WHO) declared the coronavirus disease 19 (COVID-19) pandemic, caused by the SARS-CoV-2, on March 11th, 2020. During this period, we have realized that the most effective weapon we have to prevent SARS-CoV-2 infection, or to make it less aggressive, is vaccines. Currently, according to the WHO document "Draft landscape of COVID-19 candidate vaccines," there are 275 vaccines in development against the virus, although at the moment there are four preparations in distribution in the United States and in Europe. The characteristics of these vaccines are quite different from each other and may even be unfamiliar in the medical field. In particular, among dermatologists, knowledge of vaccines is of fundamental importance, especially in atopic dermatitis. Atopic patients are aware of having a predisposition to develop allergies, and so they are asking dermatologists about the safety of the vaccines currently available against the SARS-CoV-2. This article provides an up-to-date overview of this topic by reviewing current literature and sharing our personal experience.

Severe systemic thrombosis in a young COVID-19 patient with a rare homozygous prothrombin G20210A mutation

COVID-19 patients may experience a hypercoagulable condition, leading to thrombotic events. We describe a patient with COVID-19, carrying a rare homozygous mutation of the prothrombin gene, who developed a severe systemic vein thrombosis. In COVID-19 patients with hypercoagulability disorders the most common inherited and acquired risk factors should be investigated.

Safety and Efficacy of Vaccines during COVID-19 Pandemic in Patients Treated with Biological Drugs in a Dermatological Setting

The BNT162b2 and mRNA-1273 vaccines, consisting of mRNA, have recently become available. The absolute novelty of these vaccines introduces questions about their safety and efficacy, especially in patients who are treated with biological drugs in dermatology. The aim of our review was to provide a broad overview of the current use of all available vaccinations in concomitance with biological therapy and to suggest indications for the new mRNA Covid-19 vaccines. We conducted a narrative review of the literature regarding the indications and safety of the various types of vaccines currently available in dermatological patients treated with biological therapy. The safety and efficacy of administering inactivated vaccines in patients undergoing biological therapy with inhibitors of TNF-alpha, IL-17, IL-12/23, and IL-4/13 was confirmed. Inactivated vaccines can be administered during therapy with inhibitors of IL-23 and IgE, taking into account that the level of evidence is lower due to the lack of specific studies. Live attenuated vaccines were contraindicated in concomitance with all biological therapies considered, except omalizumab. According to this evidence, we assume that there are currently no contraindications to the administration of the new Covid-19 BNT162b2 and mRNA-1273 vaccines during biological therapy with inhibitors of TNF-alpha, IL-17, IL-12/23, IL-23, and IL-4/13, since these vaccines are comparable to inactivated ones. For patients with chronic urticaria or allergic asthma treated with omalizumab, we currently recommend caution in using the mRNA Covid-19 vaccines (30 min observation). The only contraindications were a previous history of hypersensitivity to the Covid-19 vaccines themself or to their excipients. In conclusion, further randomized clinical trials are needed to evaluate the efficacy of the antibody response in these patients.

Two nasal swabs may not be enough to exclude SARS-CoV-2 infection in symptomatic patients.

Abstracts: The spread of COVID-19 (COronaVIrus Disease 2019), due to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2) has taken on dramatic pandemic proportions, affecting over 100 countries in a matter of weeks. Italy has had 237,828 confirmed cases according to the Istituto Superiore di Sanità as of May 13, and 34,448 deaths (1).

Tocilizumab in COVID-19 interstitial pneumonia.

BACKGROUND: Published reports on tocilizumab in COVID-19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. METHODS: This open-label trial, structured according to Simon's optimal design, aims to identify factors predicting which patients could benefit from anti-IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID-19 pneumonia needing of oxygen therapy to maintain SO2 > 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. RESULTS: Twenty-one patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. CONCLUSIONS: Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.

The activity of the 'gray Area' in the era of SARS-Cov2

Background and Aim of the study: The sensitivity of genomic testsfor the diagnosis of SARS CoV2, (RT-PCR) can be estimated ataround 60%, therefore it is inevitable to find negative subjects. Alot of patients, in the absence of a clear virological diagnosis, during an epidemic, were hospitalized in a 'gray area' to defined thereal negativity. A retrospective observational cohort study was conducted to analyze the clinical and laboratory characteristics of agroup of patients hospitalized in the gray area of F. Miulli Hospital(Acquaviva delle Fonti, BA)Materials and Methods: A cohort of 42 (23 M, 19 F, average age78.6 years) patients was studied retrospectively with respect toclinical and instrumental findings.Results: All patients had fever and in 14 of them also acute hypoxemic respiratory failure. The most represented comorbiditieswere: hypertension 14, ischemic heart disease 2, diabetes 4, ar rhythmias 4, renal failure 4,. The radiological pictures observedwere of: radiological alterations with areas of 'ground glass' in 14subjects;outbreak bronchopneumonia in 26;bronchiolitis ('treein bud') in 1 patient. Only one patient tested positive for SARSCoV2 virus infection detected by the third swab.Conclusions: Subjects hospitalized in 'gray area' were characterized by nonspecific elements, negative RT-PCR genomic test andradiological findings correlated with an intermediate probabilityfor SARS CoV2 virus infection (radiological pictures indeterminatebut suggestive). Most of the clinical and radiological pictures weretherefore related to other infections.

Effectiveness of three-month social distancing measuresto control the COVID-19 infection in Italy

Background and Aim of the study: After the outbreak in China,Italy was the first country facing COVID-19 pandemic. The earliestidentified cases in Lombardy at mid-February, 2020 have promptlygiven the idea of a dramatic infection. During the first decade ofMarch the Italian Government introduced drastic measures of social isolation to contain the spread of contagion, to prevent thecollapse of healthcare system, and to reduce deaths. We evaluatedthe geographic differences in COVID-19 cases, hospitalizations,and deaths as well as compared to the initial stage of diffusionacross Italian regions.Materials and Methods: We assessed data daily released by Italian Civil Protection Department since February to May, 2020. Wecompared six geographic repartitions of similar population sizeafter the first 1000 cases in each macro-area. Results: Out 227364 patients infected by COVID-19, 32330(14.2%) dead. Time to double infections was initially very short.The northern regions nearest to the epicenter showed the majorpercentage of cases, hospitalizations and fatal events. Conclusions: The COVID 19 infection represents an unexpectedhealth-care challenge. Although the spatial heterogeneity ofCOVID-19 diffusion through Italy, prompt containment measureshave produced positive results, in particular for southern regions.This aspect is due to holographic isolation, delay in spreading thevirus and social restrictions. The adopted strategies by the ItalianGovernment have been relevant to control the unpredictable andpotential fatal evolution of infection in our regions.