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2.
Front Med (Lausanne) ; 9: 996288, 2022.
Article in English | MEDLINE | ID: covidwho-2022787

ABSTRACT

Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.

3.
Int J Dermatol ; 61(10): 1187-1204, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2019306

ABSTRACT

To date, over 250 million people have been reportedly infected by COVID-19 disease, which has spread across the globe and led to approximately 5.1 million fatalities. To prevent both COVID-19 and viral transmission, DNA-based/RNA-based vaccines, non-replicating viral vector vaccines, and inactivated vaccines have been recently developed. However, a precise clinical and histological characterization of SARS-CoV-2 vaccine-related dermatological manifestations is still lacking. A systematic review of 229 articles was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in order to provide an extensive overview of SARS-CoV-2 vaccine-related skin manifestations. Data on demographics, number of reported cases with cutaneous involvement, vaccine, and rash type (morphology) were extracted from articles and summarized. A total of 5941 SARS-CoV-2 vaccine-related dermatological manifestations were gathered. Local injection-site reactions were the most frequently observed, followed by rash/unspecified cutaneous eruption, urticarial rashes, angioedema, herpes zoster, morbilliform/maculopapular/erythematous macular eruption, pityriasis rosea and pityriasis rosea-like eruptions, and other less common dermatological manifestations. Flares of pre-existing dermatological conditions were also reported. Cutaneous adverse reactions following SARS-CoV-2 vaccine administration seem to be heterogeneous, rather infrequent, and not life-threatening. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.


Subject(s)
COVID-19 Vaccines , COVID-19 , Exanthema , Pityriasis Rosea , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Exanthema/etiology , Humans , SARS-CoV-2
4.
J Immunother Cancer ; 10(6)2022 06.
Article in English | MEDLINE | ID: covidwho-2009227

ABSTRACT

Merkel cell carcinoma (MCC) is a rare and highly aggressive cutaneous neuroendocrine carcinoma. The MCC incidence rate has rapidly grown over the last years, with Italy showing the highest increase among European countries. This malignancy has been the focus of active scientific research over the last years, focusing mainly on pathogenesis, new therapeutic trials and diagnosis. A national expert board developed 28 consensus statements that delineated the evolution of disease management and highlighted the paradigm shift towards the use of immunological strategies, which were then presented to a national MCC specialists panel for review. Sixty-five panelists answered both rounds of the questionnaire. The statements were divided into five areas: a high level of agreement was reached in the area of guidelines and multidisciplinary management, even if in real life the multidisciplinary team was not always represented by all the specialists. In the diagnostic pathway area, imaging played a crucial role in diagnosis and initial staging, planning for surgery or radiation therapy, assessment of treatment response and surveillance of recurrence and metastases. Concerning diagnosis, the usefulness of Merkel cell polyomavirus is recognized, but the agreement and consensus regarding the need for cytokeratin evaluation appears greater. Regarding the areas of clinical management and follow-up, patients with MCC require customized treatment. There was a wide dispersion of results and the suggestion to increase awareness about the adjuvant radiation therapy. The panelists unanimously agreed that the information concerning avelumab provided by the JAVELIN Merkel 200 study is adequate and reliable and that the expanded access program data could have concrete clinical implications. An immunocompromised patient with advanced MCC can be treated with immunotherapy after multidisciplinary risk/benefit assessment, as evidenced by real-world analysis and highlighted in the guidelines. A very high consensus regarding the addition of radiotherapy to treat the ongoing focal progression of immunotherapy was observed. This paper emphasizes the importance of collaboration and communication among the interprofessional team members and encourages managing patients with MCC within dedicated multidisciplinary teams. New insights in the treatment of this challenging cancer needs the contribution of many and different experts.


Subject(s)
Carcinoma, Merkel Cell , Merkel cell polyomavirus , Skin Neoplasms , Carcinoma, Merkel Cell/diagnosis , Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/therapy , Humans , Immunotherapy/methods , Italy , Skin Neoplasms/drug therapy , Skin Neoplasms/therapy
5.
Ital J Dermatol Venerol ; 157(3): 282-283, 2022 06.
Article in English | MEDLINE | ID: covidwho-1904113

Subject(s)
Acne Vulgaris , COVID-19 , Humans
6.
Clin Exp Vaccine Res ; 11(1): 129-132, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1716133

ABSTRACT

The coronavirus disease 2019 (COVID-19) vaccines are authorized for use in numerous countries worldwide. Several cutaneous findings are reported after severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) vaccination. Here, we report the case of a patient with a rapid onset of alopecia areata immediately after receiving the second dose of the COVID-19 vaccine. Alopecia areata is a common autoimmune disease leading to non-scarring hair loss. Among the many cutaneous adverse effects reported after the anti-SARS-COV2 vaccination, no episodes of alopecia areata have been described to date. In this paper, we report the first case of alopecia areata after COVID-19 vaccination described in the literature with a revision of cases of alopecia areata reported after other types of vaccination. Although the significance of these skin reactions is not yet known, further studies will certainly clarify whether the development of alopecia areata or other forms of immune-mediated reactions could represent a positive prognostic factor regarding immune protection from SARS-CoV-2.

7.
Cancers (Basel) ; 13(23)2021 Dec 02.
Article in English | MEDLINE | ID: covidwho-1551565

ABSTRACT

BACKGROUND: The current COVID-19 pandemic has influenced the modus operandi of all fields of medicine, significantly impacting patients with oncological diseases and multiple comorbidities. Thus, in recent months, the establishment of melanoma management during the emergency has become a major area of interest. In addition to original articles, case reports and specific guidelines for the period have been developed. PURPOSE: This article aims to evaluate whether melanoma management has been changed by the outbreak of COVID-19, and if so, what the consequences are. We summarized the main issues concerning the screening of suspicious lesions, the diagnosis of primary melanoma, and the management of early-stage and advanced melanomas during the pandemic. Additionally, we report on the experience of our dermatological clinic in northern Italy. METHODS: We performed a literature review evaluating articles on melanomas and COVID-19 published in the last two years on PubMed, as well as considering publications by major healthcare organizations. Concerning oncological practice in our center, we collected data on surgical and therapeutic procedures in patients with a melanoma performed during the first months of the pandemic. CONCLUSIONS: During the emergency period, the evaluation of suspicious skin lesions was ensured as much as possible. However, the reduced level of access to medical care led to a documented delay in the diagnosis of new melanomas. When detected, the management of early-stage and advanced melanomas was fully guaranteed, whereas the follow-up visits of disease-free patients have been postponed or replaced with a teleconsultation when possible.

9.
European Journal of Cancer ; 156:S53-S54, 2021.
Article in English | Academic Search Complete | ID: covidwho-1461895

ABSTRACT

Patients with advanced CTCL disease ((stage IIB–IVB) mycosis fungoides (MF) or Sézary syndrome (SS)) have a poor prognosis and suffer from profound symptom burden. These patients require systemic treatment. However, it is still a key challenge to achieve durable remissions with the available treatment options. CTCL is characterized by the presence of malignant clonal T-cells in the skin and/or blood, lymph nodes or visceral organs. Epigenetic alterations in malignant T cells are known to play a key role in the pathogenesis of the disease. Resminostat is an orally available HDAC-inhibitor, which induces changes in gene expression resulting in growth inhibition, modified cell differentiation and enhanced tumor immunogenicity. The purpose of the RESMAIN study is to investigate resminostat as maintenance treatment for patients with advanced stage mycosis fungoides (MF) or Sézary syndrome (SS) that have achieved disease control with systemic therapy. The RESMAIN study is a multicenter, double blind randomized, placebo controlled, prospective efficacy trial. Patients are randomized 1:1 to the resminostat and the placebo arm. Furthermore, patients are stratified according to their remission status and their disease stage immediately prior to the last systemic therapy. Patients will be treated until disease progression. Patients of the placebo arm have the option to receive resminostat treatment. In addition, exploratory biomarker analyses will be performed. The study is conducted in 11 European countries at 51 sites and at 5 sites in Japan. The first patient was enrolled in January 2017. Recruitment was impacted by the COVID-19 pandemic but continued slowly in 2020 and is now in its final stage. The independent data safety monitoring committee (DSMB) recommended continuation of the ongoing RESMAIN study without modification after a pre-specified review of cumulative safety data of the first 50, 100, ,150 and 175 patients which had completed at least one treatment cycle. The poster will present an actual status update of the RESMAIN study. The primary objective is to determine if maintenance treatment with resminostat increases progression free survival (PFS) compared to placebo. As a key secondary end point the effect of resminostat on time to symptom worsening (TTSW) of pruritus compared to placebo will be assessed. Further secondary endpoints are TTP, TTNT, ORR, OS and HrQoL among others. To our knowledge, this is the first randomized study that investigates the potential of an HDAC inhibitor as maintenance therapy in advanced CTCL. [ABSTRACT FROM AUTHOR] Copyright of European Journal of Cancer is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

10.
European Journal of Cancer ; 156:S32-S33, 2021.
Article in English | Academic Search Complete | ID: covidwho-1461892

ABSTRACT

At the onset of the COVID-19 pandemic, the United States Cutaneous Lymphoma Consortium (USCLC) and the European Organisation for Research and Treatment of Cancer Cutaneous Lymphoma Task Force (EORTC-CLTF) developed emergency guidelines for the management of patients with cutaneous lymphomas (CLs) during the pandemic. These emergency protocols were intended to ensure patient safety and called for dose modifications, treatment delays and treatment interruptions as necessary to minimize exposure risks to COVID-19. Because there are no established maintenance protocols for CLs, the impact of such delays or interruptions on disease outcomes was not known. The ISCL created an International Cutaneous Lymphomas Pandemic Section (ICLYPS) to collect data from the institutions around the world to assess the impact of these changes on patients' outcomes and to determine if these measures were effective in preventing infection. We summarize the outcomes from a preliminary cohort of patients from Brazil, Greece, Italy, Spain, Switzerland, the UK and the US. Actively managed patients with an established diagnosis of CL from March to October 2020 were included according to the Institutional Protection of Human Subjects guidelines at the respective centers. We included 149 patients in this retrospective review. The average age was 61.88 years (range: 22–95). 2 patients (1.3%) had diagnoses of CD30+ lymphoproliferative disorders (LyP and pcALCL), 112 (75.2%) had mycosis fungoides (MF), and 35 (23.5%) had Sézary syndrome (SS). 77 patients (68.7%) had stages IA–IIA MF, 23 (20.5%) had Stage IIB MF, 6 (5.4%) had stage III MF, and 41 (27.5%) had Stage IV disease, of which 6 had Stage IV MF (5.4%) and 35 had SS (23.5%). Treatment was delayed for more than half (53.0%) of the patients for a mean of 3.2 months (range: 10 days to 10 months). Treatment delay was associated with a significant risk of disease relapse or progression across all stages (65.8% vs 32.9%, p<0.00001). During follow up, 6 patients (4%) died due to disease progression, including 3 patients with Stage IIB MF, one with Stage IVB MF, and two with SS. Twenty-eight patients (18.8%) had a confirmed COVID-19 infection during the capture period. Two of these cases were definitive hospital-acquired infections following prolonged hospital admission, while the remaining contracted the virus through community exposures. There were no outpatient office-acquired infections. Three of the 26 patients who contracted COVID-19 died of the infection (2 SS and 1 LyP, mean age: 80, range: 66–89). The ICLYPS analysis has revealed that treatment interruptions and delays during the COVID-19 pandemic resulted in significantly worse outcomes in patients with CLs as compared to those who did not experience treatment interruptions. No outpatient office-acquired infections were reported in this extensive review, and patients with CLs who developed COVID-19 did not do worse than expected according to their risk factors. Effective safety measures and protocols can prevent transmission of COVID-19 at physicians' offices. Interruption of therapy leads to negative clinical outcomes and should be avoided, especially in the setting of advanced disease, as the risk of contracting COVID-19 in the outpatient setting did not outweigh the risk of morbidity and mortality due to disease progression. Ensuring continuity of treatment and maintenance therapy appears to be critical to avoiding life-threatening disease progression. [ABSTRACT FROM AUTHOR] Copyright of European Journal of Cancer is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

12.
Clin Dermatol ; 39(5): 911-919, 2021.
Article in English | MEDLINE | ID: covidwho-1244719

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has led to lockdowns for much of the world. In Italy, all health procedures not directly related to COVID-19 were reduced or suspended, thus limiting patient access to hospitals. Any delay in cancer treatment presents the additional risk of tumors progressing from being curable to incurable. Specifically, melanoma survival rate strictly depends on tumor thickness, which, in turn, is a function of time. To estimate the impact on melanoma progression caused by the reduction in dermatologic services during the COVID-19 lockdown, a retrospective observational cohort study was conducted. This study was designed to compare the clinical and histologic characteristics of the primary melanomas removed in the first 2 months after the end of the lockdown (May-July 2020) in 12 Italian centers characterized by different COVID-19 case frequencies. The control group was represented by the melanomas removed during the same period in the previous 3 years. Overall, 1,124 melanomas were considered: 237 as part of the study group and 887 from the control group (average, 295), with a 20% reduction. Breslow thickness, as well as high-risk histotypes and melanomas with vertical growth, increased for all melanomas. Ulcerated and high mitotic index melanomas increased, particularly in northern Italy. In Italy, the lockdown led to a significant worsening of melanoma severity, causing a staging jump, with a consequent worsening of outcomes.


Subject(s)
COVID-19 , Melanoma , Skin Neoplasms , Communicable Disease Control , Humans , Italy/epidemiology , Melanoma/diagnosis , Melanoma/epidemiology , Retrospective Studies , SARS-CoV-2 , Skin Neoplasms/diagnosis , Skin Neoplasms/epidemiology
13.
J Am Acad Dermatol ; 84(5): 1356-1363, 2021 05.
Article in English | MEDLINE | ID: covidwho-1131418

ABSTRACT

BACKGROUND: COVID-19 is associated with a wide range of skin manifestations. OBJECTIVE: To describe the clinical characteristics of COVID-19-associated skin manifestations and explore the relationships among the 6 main cutaneous phenotypes and systemic findings. METHODS: Twenty-one Italian Dermatology Units were asked to collect the demographic, clinical, and histopathologic data of 200 patients with COVID-19-associated skin manifestations. The severity of COVID-19 was classified as asymptomatic, mild, moderate, or severe. RESULTS: A chilblain-like acral pattern was significantly associated with a younger age (P < .0001) and, after adjusting for age, significantly associated with less severe COVID-19 (P = .0009). However, the median duration of chilblain-like lesions was significantly longer than that of the other cutaneous manifestations taken together (P < .0001). Patients with moderate/severe COVID-19 were more represented than those with asymptomatic/mild COVID-19 among the patients with cutaneous manifestations other than chilblain-like lesions, but only the confluent erythematous/maculo-papular/morbilliform phenotype was significantly associated with more severe COVID-19 (P = .015), and this significance disappeared after adjustment for age. LIMITATIONS: Laboratory confirmation of COVID-19 was not possible in all cases. CONCLUSIONS: After adjustment for age, there was no clear-cut spectrum of COVID-19 severity in patients with COVID-19-related skin manifestations, although chilblain-like acral lesions were more frequent in younger patients with asymptomatic/pauci-symptomatic COVID-19.


Subject(s)
COVID-19/diagnosis , Skin Diseases, Viral/diagnosis , Adult , Age of Onset , Aged , Chilblains/virology , Humans , Italy , Male , Middle Aged , SARS-CoV-2 , Severity of Illness Index , Skin Diseases, Viral/pathology
17.
Expert Opin Biol Ther ; 21(2): 271-277, 2021 02.
Article in English | MEDLINE | ID: covidwho-939506

ABSTRACT

Background: The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown. Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection. Methods: Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered. Results: A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study. In this cohort 26 patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died. Conclusion: The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen 'cytokine storm' of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.


Subject(s)
Biological Products/therapeutic use , Biological Therapy/methods , COVID-19/epidemiology , Psoriasis/drug therapy , Adult , Aged , Aged, 80 and over , Biological Products/pharmacology , COVID-19/diagnosis , Chronic Disease , Cohort Studies , Female , Humans , Incidence , Interleukin-17/antagonists & inhibitors , Italy/epidemiology , Male , Middle Aged , Pandemics , Psoriasis/diagnosis , Psoriasis/epidemiology , Receptors, Interleukin/antagonists & inhibitors , Risk Assessment/methods , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Young Adult
18.
Ther Adv Med Oncol ; 12: 1758835920977002, 2020.
Article in English | MEDLINE | ID: covidwho-937033

ABSTRACT

Since the end of 2019, global healthcare systems have been dealing with the COVID-19 pandemic. In oncology, the biggest questions concern interaction of COVID-19 with pre-existing cancer disease and with systemic anticancer treatments. With regards to immunotherapy, there is uncertainty about its effect in the context of COVID-19 in terms of probability and course of viral infection. Herein, we retrospectively report data of patients with advanced cutaneous squamous cell carcinoma (cSCC) treated with immunotherapy at five Italian referral cancer centers during the pandemic. cSCC is a disease poorly represented in the literature, typically affecting fragile, elderly patients, with multiple comorbidities and often immunosuppressed. Overall, 54 patients were identified, most of them coming from Lombardy and Piedmont, the two regions hit hardest by COVID in Italy. In most cases, our choice was to continue treatment, reserving temporary interruptions only to patients considered particularly at risk for age and comorbidity. A total of 9% of patients developed new-onset symptoms or had chest radiological assessment potentially related to COVID-19. Nasopharyngeal swabs were collected in all suspicious cases and two hospitalized patients were found to be positive. In conclusion, the outbreak of COVID-19 is a major worldwide health concern. Our data indicate that COVID-19 mortality in patients with cancer may be principally driven by advancing age, the presence of other comorbidities, and other cancer-related conditions (i.e. hospitalization). Our data further suggests the safety of continued use of PD-1 blockade during the COVID-19 pandemic (obviously implementing all the safety measures in the hospital environment) also considering the possible negative effects of a prolonged suspension on the course of the tumor evolution. We think it is useful to collect and report case studies coming from reference centers, because they can represent helpful examples for the scientific community of clinical management of patients affected by cancer in this difficult period and guide further research.

19.
Semin Oncol ; 47(5): 302-304, 2020 10.
Article in English | MEDLINE | ID: covidwho-696421

ABSTRACT

BACKGROUND: Patients with cancer are presumed to have a higher risk to contract SARS-CoV-2 infection, because of their immunosuppressed status. The impact and course of COVID-19 infection in cancer patients receiving immunotherapy remains unknown. OBJECTIVES: To evaluate the safety of the management of patients with advanced melanoma treated with immunotherapy in 2 Cancer Centers located in areas of Italy with a high incidence of COVID-19 infections. METHODS: We retrospectively analyzed data from January 1 to April 30, 2020 on patients with locally advanced and metastatic melanoma receiving immunotherapy at either Istituto Europeo di Oncologia or Città della Salute e della Scienza University Hospital. RESULTS: One-hundred and sixty-nine patients with stage III and IV melanoma were treated with an immunotherapy regimen at either Istituto Europeo di Oncologia or Città della Salute e della Scienza University Hospital. One-hundred and four patients continued treatment without interruption or delay, while 49 patients had a treatment delay. The main reasons for treatment delay were older age (median age of the group of patients with or without treatment-delay, respectively 60 and 69 years, P value <0.001) and/or presence of comorbidities (percentage of patients with at least one comorbidity respectively 81% and 62%, in patients with or without treatment delay, P value = 0.001). One-hundred and twelve patients had at least 1 thoracic CT scan performed and radiological findings suspicious for COVID-19 were observed in only 7 cases (4%). Fifteen patients (9%) developed symptoms potentially related to COVID-19; nasopharyngeal swabs were collected in 9 patients and only 1 was positive for SARS-CoV-2. CONCLUSIONS: The incidence of symptomatic COVID-19 infection observed in our cohort of patients with advanced malignant melanoma treated with immunotherapy appears meaningfully lower as compared with that reported in the overall population in Italy as well as in patients affected by solid tumors. We conclude that in patients with locally advanced and metastatic melanoma, immunotherapy can be safely continued without delay in the majority of cases, reserving precautionary delay only for the most frail patients.


Subject(s)
COVID-19/diagnosis , Immunotherapy/methods , Melanoma/therapy , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Female , Humans , Incidence , Italy/epidemiology , Male , Melanoma/epidemiology , Melanoma/immunology , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2/physiology , Young Adult
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