Introduction
COVID-19, caused by SARS-CoV-2 infection has spread rapidly worldwide becoming pandemic, as defined by the World Health Organization on March 11th 2020.1 Most patients exhibit mild-to-moderate symptoms and recover without sequelae, though hospitalization, generally due to pneumonia, and more severe respiratory involvement such as acute respiratory distress syndrome, septic shock, and/or multiple organ failure, associated with high mortality, may occur.1
Italy has faced the first wave of SARS-CoV-2 infection out of China before the rapid worldwide pandemic spreading. To face the virus spreading, a nationwide lockdown period (phase I) limiting all kind of activities including health care services, was decided on March 10th and lasted until May 4th, when a phase II was planned with a gradual re-opening of hospital dermatology services. During these two initial phases, medical visits were restricted to urgent cases, and the use of teledermatology was implemented in many dermatological services. On June 15th, 2020, a phase III was established recovering almost all activities with sanitary restrictions, and health care services were restored based on the decision of local sanitary authorities.
Thereby, COVID-19 pandemic led to the sudden need of increasing the use of web- and phone-consulting, and defining practical guidelines for the management of immune-mediated dermatologic conditions, such as AD that in moderate-to-severe cases are commonly treated with systemic immunomodulant/immunosuppressive compounds or phototherapy. The effect of immunomodulant/immunosuppressive compounds on the clinical course of COVID-19 is currently unclear and there is concern of an increased risk of infection in AD patients treated with systemic compounds, though the continuation of therapy during pandemic was recommended by national and international scientific societies.2-7 Nevertheless, immunomodulant/immunosuppressive agents, such as methotrexate, mycophenolate, azathioprine, and cyclosporine were suggested to be tapered to the lowest effective dose, likely avoiding disease flare, and to consider drug discontinuation in patients when viral symptoms are present.2,5 Similarly, caution was recommended in prescribing systemic corticosteroids given their broad immunosuppressive effects.2,5 Furthermore, some authors recommended halting office-based phototherapy to minimize potential exposure to SARS-CoV-2 virus and instead encourage exposure of affected areas to natural sunlight, bleach baths, and wet wraps.5However, current recommendations are based on limited knowledge regarding the risk of systemic immunomodulant/immunosuppressive compound use, and few data related to AD patients treated during COVID-19 pandemic.
We designed a national registry, the DA-COVID-19 registry, aimed to evaluate the impact of the pandemic on the therapeutic management and clinical course of AD in patients treated with any systemic immunomodulant/immunosuppressive compound or phototherapy. This observational study analyzed clinical and demographic characteristics of moderate-to-severe AD patients, who were managed with telemedicine and eventually by regular ambulatory visits during the COVID-19 pandemic.