key: cord-297532-ktiwfcop
authors: De Fata Salvatores, Gaia; Villani, Alessia; Fabbrocini, Gabriella; Di Guida, Adriana
title: Patients with bullous disorders during COVID‐19 period: management and adherence to treatment
date: 2020-05-26
journal: Dermatol Ther
DOI: 10.1111/dth.13697
sha: 
doc_id: 297532
cord_uid: ktiwfcop

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Dear Editor, Pemphigoid is included in the group of rare autoimmune bullous disorders affecting the skin and the mucous membrane. It mainly occurs in elderly patients that usually present other comorbidities such as cardiovascular and respiratory problems. This bullous disorder is characterized by an alteration of T-cell immune response, leading to the production of pathogenetic autoantibodies directed against different proteins of the desmosome, and by the release of pro-inflammatory cytokines. This immune alteration clinically manifests with vescicles and erosions on the epithelium of the mucous membrane and of the skin, exposing patients to a higher risk of comorbidities and secondary infections 1 . SARS-CoV2 infection has now spread all over the world and higher mortality rates have been reported among elderly and comorbid (diabetes, cardiovascular disease, immunosuppression) patients. In this scenario, patients with bullous pemphigoid are part of the high-risk population and preventive measures in order to minimize the risk of infection must be implemented.

We want to share our experience about the management of patients with bullous disorders, in particular pemphigoid disease in our outpatient clinic during COVID-19 pandemic.

Since the beginning of March 2020, in our Dermatological clinic, outpatient visits have been suspended with the postposition of all non-urgent visits, except for oncological dermatology and emergencies. 10 patients (6 women and 4 men) with a median age of 68.5 years, affected by bullous pemphigoid, all histologically confirmed, were already followed in our Day-Hospital service before the COVID-19 pandemic spread. 7/10 (70%) patients had a mild-moderate grade of the disease, This article is protected by copyright. All rights reserved. It has been widely recognized that the use of immunosuppressive agents, such as oral CCS is associated with an increased mortality in patients with coronavirus pneumonia 2 , but, on the other hand, there are no evidences suggesting the preventive discontinuation of CCS in patients on longterm treatment with these drugs, especially for the risk of acute adrenal insufficiency 3 . Weekly telephonic consultations were performed in order to control patients adherence to treatment and to avoid the risk of COVID-19 infection. Patients received information about the importance of home isolation and the early identification of COVID-19-related symptoms. Video-call visits were performed and CCS dosages were tapered in case of adverse events and according to the reported skin condition, showing good results and without discontinuing their treatment. In literature, several articles suggesting the use of teledermatology services, such as video-call visits, e-mail and mobile applications as useful tool to take care of patients during this pandemic period have already been

Bullous pemphigoid

The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis

Corticosteroid treatment of patients with coronavirus disease

COVID-19)

Teledermatology: a useful tool to fight COVID-19

Teledermatology in the Wake of COVID-19: Advantages and Challenges to Continued Care in a Time of Disarray

This article is protected by copyright. All rights reserved.reported 4, 5 . This tele-service resulted to be effective also in the follow-up of our patients with rare autoimmune disorders; nevertheless reports on larger sample size are needed.