Introduction The COVID‐19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim To understand how CU patients are affected by the COVID‐19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID‐19. Materials and Methods Our cross‐sectional, international, questionnaire‐based, multicenter UCARE COVID‐CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results The COVID‐19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID‐19 patient care, which negatively impacted on the care of urticaria patients. The rate of face‐to‐face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID‐19, but COVID‐19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID‐19. Conclusions The COVID‐19 pandemic brings major changes and challenges for CU patients and their physicians. The long‐term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.

BackgroundPsoriasis is a chronic and inflammatory disease that impairs quality of life and causes psychological symptoms. Despite the high prevalence of psoriasis in pediatric patients, studies investigating the impact of psoriasis in the quality of life of children, adolescents and families are sparse.ObjectiveTo investigate the impact of psoriasis in the quality of life of children and adolescents with psoriasis and their families and to determine depression and anxiety levels of the patients.MethodsA total of 58 patients with psoriasis aged 7-18 years (median age: 11) and a family member of each patient were included in the study. Children's Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), Children's Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIC) were used in the study.ResultsThe median PASI score of the patients included in the study was 1.8. The median CDLQI and FDLQI scores in the study groups were 5 and 10, respectively. The median CDI score, STAIC-state and STAIC-trait scores of the patients were 6, 28 and 32.5, respectively.Study limitationsLack of a control group and patient assessment of disease severity. Relatively mild disease severity of the subjects.ConclusionsPsoriasis has a negative impact in the quality of life of children, adolescents and their families, even in the presence of mild disease. Considering that impairment in quality of life may be associated with psychosocial morbidity, a combined approach with medical therapy, family counseling and quality of life assessment may be beneficial in this patient group.

Vitiligo and acne patients had higher levels of social anxiety, anxiety, and depression compared with healthy control subjects. Considering that increased psychosocial morbidity was regardless of age, sex, and disease severity and was correlated with quality of life impairment, evaluation of the psychosocial morbidity, in particular social anxiety, may be valuable in all vitiligo and acne patients.

[Epub ahead of print]. 8. Van Gasse AL, Ebo DG, Chiriac AM, et al. The limited value of prolonged drug challenges in nonimmediate amoxicillin (clavulanic acid) hypersensitivity.

The data on long-term efficacy, safety and drug survival rates of conventional systemic therapeutics in pediatric psoriasis is lacking. The primary aim of this study is to investigate acitretin, methotrexate, cyclosporin efficacy, safety and drug survival rates in pediatric patients as well as predictors of drug survival. This is a multicenter study including 289 pediatric cases being treated with acitretin, methotrexate and cyclosporin in four academic referral centers. Efficacy, adverse events, reasons for discontinuation, 1, 2- and 3-year drug survival rates, and determinants of drug survival were analyzed. A 75% reduction of Psoriasis Area and Severity Index score or better response rate was obtained in 47.5%, 34.1% and 40% of the patients who were treated with acitretin, methotrexate and cyclosporin, respectively. One-year drug survival rates for acitretin, methotrexate and cyclosporin were 36.3%, 21.1% and 15.1%, respectively. The most significant determinant of drug survival, which diminished over time, was treatment response whereas arthritis, body mass index and sex had no influence. Although all three medications are effective and relatively safe in children, drug survival rates are low due to safety concerns at this age group. Effective disease control through their rational use can be expected to improve survival rates.

Netherton syndrome (NS) is an orphan disease characterized by congenital ichthyosis, hair abnormalities, and atopy, with limited treatment options. We achieved temporary improvement only during the initial 6 weeks of treatment with dupilumab, which differs from the sustained improvement observed in 2 other recently published cases. Although the clinical presentation of atopy and increased pre-allergic cytokines in NS patients suggest that dupilumab may be beneficial, larger studies are required.

Funding informationNone K E Y W O R D S : contact allergy, methylchloroisothiazolinone, methylisothiazolinone, Turkey Isothiazolinones, that is, methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI), are widely used preservatives in cosmetic, industrial and household products, owing to their strong biocidal effects. 1 Following an epidemic of contact allergy to MCI/MI (Kathon CG) and subsequent regulatory measures regarding the use of MCI/MI, the use of MI as a monopreservative has increased. The reports of contact allergy to MI during the mid-2000s led to further limitations on the use of MI in cosmetic products, and MI was added to the European baseline series in 2015. 2-5 Despite the vast amount of data from different countries, there are still, to our knowledge, no data on MCI and MI contact allergy in Turkey. Thus, the aim of the present study was to investigate the frequency, and demographic and clinical features, of MCI/MI and MI contact allergy in a tertiary dermatology centre in Turkey. PATIENTS AND METHODSA retrospective study was performed. Medical records of all patients who had been tested with the European baseline series in our contact dermatitis outpatient clinic between January 2016 and June 2018were reviewed. Patients were tested with allergens (MCI/MI 0.02% aq. and MI 0.2% aq.) and IQ Ultra chambers obtained from Chemotechnique Diagnostics (Vellinge, Sweden). Readings were performed on day (D) 2 and D4, according to ESCD guidelines. 6 The study protocol was reviewed and approved by our institution's ethics committee. RESULTSA total of 324 patients were patch tested during the study period. Of them, 29 (8.9%) had positive reactions to MCI/MI and/or MI. The rate of positive reactions to MCI/MI and MI showed a decrease during the TABLE 1 The frequency of methylchloroisothiazolinone (MCI)/ methylisothiazolinone (MI) and MI contact allergy and the change over the years Years 2016 n (%) 2017 n (%) 2018 n (%) Total n (%) Total number of patients 128 108 89 324 MCI/MI positive 8 (6.25) 7 (6.48) 5 (5.61) 20 (6.17) MI positive 12 (9.37) 9 (8.33) 5 (5.61) 26 (8.02) Both positive 7 (5.46) 6 (5.55) 4 (4.49) 17 (5.24) MCI/MI and/or MI positive 13 (10.15) 10 (9.25) 6 (6.74) 29 (8.95) SALMAN 193

Although it is not associated with disease severity and course, increased bodyweight may be a health problem for psoriatic children.