key: cord-1021949-tn6mwpt4
authors: Türsen, Ümit; Türsen, Belma; Lotti, Torello
title: Coronavirus‐days ın dermatology
date: 2020-04-29
journal: Dermatol Ther
DOI: 10.1111/dth.13438
sha: b5f665631b3a3c56ac68aa9b1e17666051e47031
doc_id: 1021949
cord_uid: tn6mwpt4

Severe acute respiratory syndrome‐corona virus‐2, which causes coronavirus disease 2019 (COVID‐19), is highly contagious and a particularly popular problem in all around the World and also in all departments of every hospital. In order to protect the well‐being of health care providers while providing a sufficient workforce to respond to the COVID‐19 are vital for pandemic planning. In this article, we will discuss this problem from a dermatological aspect.

everybody against COVID-19 is done by frequently cleaning the hands. By doing this; we eliminate the viruses that may be on our hands and avoid infection that could occur by then touching our eyes, mouth, and nose. Some antiseptics such as alcohol or chlorine can try to kill the viruses that have already entered our body. But these substances can be harmful to clothes or mucosal surfaces including eyes and mouth. Soap works better than alcohol and disinfectants at destroying the structure of viruses. Soap dissolves the fat membrane, and the virus falls apart like a house of cards and "dies," or rather, it becomes inactive as viruses are not really alive. Viruses can be active outside the body for hours, even days. Disinfectants, or liquids, wipes, gels, and creams containing alcohol have a similar effect but are not as good as regular soap. Apart from alcohol and soap, antibacterial agents in those products do not affect the virus structure much. Consequently, many antibacterial products are just an expensive version of soap for virus killing. Soap is the best, but alcohol wipes are good when soap is not practical or handy, for example, in office reception areas. Soap contains fat-like substances known as amphiphiles, structurally similar to the lipids in the virus membrane. The soap molecules "compete" with the lipids in the virus membrane. That is more or less how soap also removes the normal dirt of the skin. The soap molecules also compete with a lot of other non-covalent bonds that help the proteins, RNA and the lipids to stick together. The soap is effectively "dissolving" the glue that holds the virus together. When you add to that all the water it is even better. The soap also outcompetes the interactions between the virus and the skin surface. Soon the virus gets detached and falls apart like a house of cards due to the combined action of the soap and the water. 2 Alcohol-based products include all "disinfectants" and "antibacterial" products that contain a high share of alcohol solution, typically 60% to 80% ethanol, sometimes with a bit of isopropanol, water, and a bit of soap. Ethanol and other types of alcohol do not only readily form hydrogen bonds with the virus material but, as a solvent, are more lipophilic than water. Hence, alcohol does dissolve the lipid membrane and tions in Mersin University like in all other dermatology departments.

We discharged all hospital inpatients who are medically fit to leave and in these days we have only four inpatients in our department. We also minimized all nonessential outpatient appointments and we accept only serious and emergent cases now. We are trying to use telemedicine, WhatsApp, e-mail, or phone for simple skin issues in our city.

There is a very limited evidence base to formulate a specific advice for dermatology patients on immunomodulators with regards to COVID-19. The following is based on expert opinion, taking into account the known risks of other RNA viruses. There are complex interactions between coronaviruses' replication and host immune response in COVID-19. Since there are limited studies, we need more information on the risk of immunosuppression in patients exposed to this virus. 9 We can propose that mono-immunosuppressive therapy, target therapies, immunomodulatory agents such as intravenous immunoglobulin, acitretin, etc. in the presence of significant comorbidities including diabetes mellitus, hypertension, and obesity. We should do a patient-by-patient evaluation about ongoing treatments in patients with psoriasis, lupus erythematosus, lichen planus etc.

In our university, standard medicine student education was canceled due to COVID-19 outbreak. All universities created e-learning pro- 

We use hydroxychloroquine for the treatment of discoid lupus erythematosus and understand its relative safety. Hydroxychloroquine and chloroquine have antiviral activity against COVID-19 in vitro and in small uncontrolled clinical studies with limited and inconclusive results. In COVID-19, a small non-randomized study from France indicated some benefits with serious methodological flaws, and a followup study still lacked a control group. However, another very small, randomized study from China in patients with mild to moderate COVID-19 found no difference in recovery rates. Sadly, reports of adverse events have increased, with several countries reporting sideeffects including ventricular arrhythmias, QT prolongation, other cardiac toxicities, ocular toxicity, and even death. We should know that these drugs may pose particular risk to critically ill persons. Due to the remarkable pharmacokinetics and efficacy, azithromycin with immunomodulatory and anti-inflammatory properties, is well established as a potent treatment for some skin diseases such as rosacea, psoriasis, and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Combining hydroxychloroquine with the antibiotic azithromycin has also been associated with positive patient outcomes according to low-powered France study. 10 Whether this results in better clinical outcomes-that is, if patients recover more quickly-is still being debated.

Colchicine has been used to treat various dermatologic diseases, some of which are quite seldom, which include Behçet's disease, epidermolysis bullosa acquisita, recurrent oral aphthosis, cutaneous vasculitis, chronic urticaria, and Sweet syndrome for its antineutrophilic immunomodulatory effect. In the last clinical trial called COLCORONA (Colchicine COVID-19 Trial), colchicine is being used to reduce the inflammatory reaction caused by COVID-19 that can lead to pulmonary involvement, organ failure, and death. It will be used for its anti-inflammatory and anti-cytokine storm effects when treating COVID-19. 11 A variety of repurposed drugs and investigational drugs have been identified for COVID19 treatment. However, evaluation of investigational agents requires adequately powered, randomized, controlled trials with realistic eligibility criteria, and appropriate stratification of the patients.

These are globally uncertain and testing times. We can prefer webinar and online education models, online examinations, and online patient examination until the COVID-19 pandemic is over. But the most important thing is that we have to work together as a professional community to support one another, therefore upcoming challenges that are important in human development. 12, 13 Questions remain regarding that COVID-19 pandemia is whether or not a major driver of human evolution.

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