key: cord-0958707-htxa1aqt
authors: Rakita, U.; Kaundinya, T.; Guraya, A.; Nelson, K.; Maner, B.; Manjunath, J.; Schwartzman, G.; Lane, B.; Silverberg, J.I.
title: Lack of association between seborrheic dermatitis and SARS‐CoV‐2 outcomes
date: 2021-12-04
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.17825
sha: 18112e0dc6b9c8fd55d9962a4c35788eed3fc8a1
doc_id: 958707
cord_uid: htxa1aqt

Seborrheic dermatitis (SD) is a common form of dermatitis. Immune dysregulation is presumed to play a role in SD pathogenesis, with increased prevalence of SD in patients with older age, immunosuppression and neuropsychiatric disease.1,2 These characteristics have also been found to be associated with worse SARS-CoV-2 outcomes. Several pro-inflammatory cytokines associated with greater SARS-CoV-2 morbidity, e.g. interleukin-1, 6 and tumor necrosis factor-alpha, contribute to SD pathogenesis.1 A recent report of a severely ill SARS-CoV-2 patient developing SD suggests a possible associations between these two conditions.3 However, few studies examined potential associations between SD and SARS-CoV-2 outcomes. We investigated the relationship between SD and SARS-CoV-2 outcomes among adults with dermatologic disease.

To the Editor, Seborrheic dermatitis (SD) is a common form of dermatitis. Immune dysregulation is presumed to play a role in SD pathogenesis, with increased prevalence of SD in patients with older age, immunosuppression, and neuropsychiatric disease. 1,2 These characteristics have also been found to be associated with worse SARS-CoV-2 outcomes. Several pro-inflammatory cytokines associated with greater SARS-CoV-2 morbidity, e.g. interleukin-1, 6, and tumor necrosis factor-alpha, contribute to SD pathogenesis. 1 A recent report of a severely ill SARS-CoV-2 patient developing SD suggests possible associations between these two conditions. 3 However, few studies examined potential associations between SD and SARS-CoV-2 outcomes. We investigated the relationship between SD and SARS-CoV-2 outcomes among adults with dermatologic disease. The study was approved by the George Washington University institutional review board. We retrospectively analyzed medical records for patients treated at George Washington University Hospital and Medical Faculty Associates for SARS-CoV-2. Patients received standard-of-care dermatologic examination. Socio-demographics were compared between those with vs. without diagnosed SD and severe-critical vs. mild-moderate COVID-19 using chi-square and student's t-test for categorical and continuous variables, respectively. Binary logistic regression models were constructed with SARS-CoV-2 outcomes as dependent variables and SD as the binary independent variable. Multivariable models adjusted for socio-demographics and comorbidities. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. P-values were corrected using the approach of Benjamini-Hochberg.

Among 430 SARS-CoV-2 positive adults with skin disease, 39 (9.10%) had diagnosed SD, similar to the prevalence of SD in Turkish SARS-CoV-2 patients (11.8%). 4 Most (76.9%) SD patients were non-white. There were no significant differences between patients with vs. without SD with regard to sex, race, insurance status, history of smoking, cancer, immunosuppressant use, acquired immunodeficiency syndrome, diabetes mellitus (DM), congestive heart failure, obstructive lung disease, hypertension or chronic kidney disease (P ≥ 0.49 for all). SARS-CoV-2 severity was associated with older age (P < 0.0001) and DM (P < 0.0001).

In multivariable models adjusting for the abovementioned covariables, SD was not associated with hospitalization (adjusted odds ratio [95% Table 1) . Similar results were observed in bivariable models. Intubation, extracorporeal membrane oxygenation, and coagulation events were rare events with inadequate frequency to be modeled. Taken together, the results indicate that SD is not associated with poorer SARS-CoV-2 outcomes compared to other skin diseases, despite its underlying associations with immune dysregulation and use of immunosuppressants.

Study strengths include testing multiple COVID-19 outcomes and controlling for confounders in multivariable analyses. Limitations include that the cohort was derived from a single center, with racial homogeneity and no data on SD characteristics or SARS-CoV-2 variants. Nevertheless, SD was not associated with worse SARS-CoV-2 outcomes. P-values were corrected using the approach of Benjamini-Hochberg. Corrected P-values are presented. †Binary logistic regression models were constructed with seborrheic dermatitis diagnosis as the independent variable and COVID-19 outcomes as the dependent variables. Dependent variables included hospitalization (yes vs. no), visit type (inpatient vs. outpatient), oxygen therapy (yes vs. no), COVID-19 severity (severe-critical vs. asymptomatic-mild) and hospital duration (1-6 days vs. ≥7 days). ‡Multinomial logistic regression models were constructed with seborrheic dermatitis diagnosis as the independent variable (yes/no) and COVID-19 course as the dependent outcome variable (chronic complications or death vs recovered). Crude odds ratios (OR) and 95% confidence intervals (CI) were generated for unadjusted models. A 30-year-old Italian woman presented due to the sudden occurrence of papules and plaques on her face and upper back. The eruption started following a day spent outdoors, ten days after receiving the SARS-CoV-2 mRNA vaccine second dose (Pfizer, Cominarty). At the time of our consultation, we observed purplish, erythematous, and scaly papules and plaques on the upper back (Fig. 1a) , cheeks, temples, and forehead (Fig. 2a) . The rest of the skin was unaffected.

She reports that she has not changed her habits, has not introduced new drugs or suffered from new diseases in the last year. However, her past medical history was complex: she was born with biliary tract atresia, operated on with Kasai surgery. She developed portal hypertension and was treated with ursodeoxycholic acid for primary biliary cholangitis. Past 

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