key: cord-0717156-fzj3ciif
authors: Vezzoli, Pamela; Di Mercurio, Marco; Carugno, Andrea; Gambini, Daniele Mario; Robustelli Test, Elisa; Imberti, Gianlorenzo; Castagna, Angelo Francesco; Sena, Paolo
title: Cutaneous lupus erythematosus patients in a high‐epidemic COVID‐19 area, Bergamo, Italy
date: 2020-06-07
journal: Dermatol Ther
DOI: 10.1111/dth.13776
sha: 633cee77d073dc6abe3b844b168b682891418ea5
doc_id: 717156
cord_uid: fzj3ciif

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Dear editor, the current pandemic of coronavirus disease 2019 (COVID-19) has raised the interest in reporting the management's experience with systemic lupus erythematosus (SLE) patients under long-term treatment with immunosuppressor drugs or hydroxychloroquine (HCQ). SLE patients could have a higher potential risk of a severe COVID-19 course 1-2 due to underlying immune dysregulation, the potential presence of organ damage associated with the disease and comorbidities. 3, 4 Indeed, infections remain a leading cause of mortality in lupus patients. 5 Recently, some authors reported the importance to maintain disease remission in lupus patients, especially in high-epidemic areas, avoiding unnecessary emergency room visits and hospitalization. Therefore, it has been suggested not to discontinue current therapy in such patients. 5, 6 However, no data about the management of risk infection in cutaneous lupus erythematosus (CLE) during the current pandemic are present in the literature to date.

Our hospital is located in a high-epidemic area of Lombardy: we decided to advice patients affected by SLE with cutaneous manifestations and CLE, to scrupulously comply with hygiene rules and protective devices use, to maintain social distancing, not to spontaneously suspend ongoing therapy and to inform the dermatologist in case of the onset of symptoms, as suggested This article is protected by copyright. All rights reserved.

by the Italian Society of Dermatologists (SIDeMaST) 7 and several papers. 5 Observation of these data shows that lupus patients with cutaneous manifestations could have susceptibility to COVID-19 independently of contact with known or suspected COVID-19 patient. In particular a higher risk factor to experience SARS-CoV-2 infection can be observed in SLE patients as reported in the literature. [4] [5] [6] [7] Fortunately, all the 4 COVID-19 suspected This article is protected by copyright. All rights reserved.

patients experienced mild symptoms without severe respiratory complications. Furthermore, none of our patients showed a recurrence of the underlying disease.

The role of HCQ on COVID-19 is still debated 12 and our data do not allow us to draw conclusions on the matter. Therefore, we think it is important to create a communication channel with patients to reduce in-person follow-up visits, to give human support and help in managing therapies. We observed that it is essential to advise and empower LE patients on activities to limit the risk of infection (hand hygiene, social distancing, use of protective devices), not only in the systemic form but also in the cutaneous form.

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