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.