In the context of COVID-19 pandemic, teledermatology is being favoured over in-person consultation in order to avoid the possibility of virus transmission. 1 In France, COVID-19 was not known to cause cutaneous manifestations before 6 April 2020, when an alert about possible associated skin symptoms was raised to the general public and the professional social network. 2-4 We aimed to assess the impact of alerting about COVID-associated lesions on the activity of urgent teledermatology (TD) and the activity of dermatologic emergencies unit (DEU) of two university hospitals during this pandemic. This study was conducted between 30 March and 10 April 2020. These two institutions provide urgent consultations via a DEU and a store-and-forward teledermatology, between dermatologists and other healthcare professionals, with rapid responses. All consultations in the DEU and urgent TD were retrieved, and the number of consultations for suspicious COVID-associated lesions and non-COVID lesions was collected Figure 1 Number of patients with suspicious COVID-associated lesions and non-COVID lesions in teledermatology consultations.

Angiotensin-converting enzyme 2 (ACE 2) is expressed by several cells in the body, like the epithelial cells of the lungs and the blood vessels. It is a host receptor for severe acute respiratory syndrome coronavirus [SARS-CoV] and SARSCoV-2. 1 ACE inhibitors and angiotensin II type I receptor blockers (ARBs) cause an upregulation of ACE2. 2 Patients with hypertension and diabetes are at increased risk of COVID-19 infection. 2 This can possibly be because they are frequently treated with ACE inhibitors and ARBs, which increase the host receptor of the virus. 2 Carvedilol is a drug with vasodilating properties, initially designed for managing hypertension and coronary artery disease. Unlike ACE inhibitors that increase the expression of ACE 2, carvedilol decreases its expression. 3 This is why, ACE inhibitors or ARBs prescribed for hypertensive patients can be replaced by carvedilol during this pandemic. Moreover, not only patients on ACE inhibitors or ARBs can benefit from carvedilol. Since carvedilol decreases the expression of ACE, which is the COVID-19 host receptor, it can be useful for all COVID-19 patients.On the other hand, carvedilol can fight COVID-19 by another mechanism. Carvedilol has interleukin 6 (IL-6) suppressing properties. 4 Detectable serum SARS-CoV-2 viral load is closely associated with drastically elevated IL-6 level in critically ill COVID-19 patients. 5 So, carvedilol can be used to target IL-6, which plays a major role in the inflammatory cascade of COVID-19.In conclusion, we hypothesize that by downregulating ACE and by having anti-IL-6 properties, carvedilol has the potential to block 2 pathogenic pathways of COVID-19.

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DLBCL was made. The patient complained of diplopia and left eyelid ptosis 8 days after the biopsy. Magnetic resonance imaging detected a small tumour, a suspicious DLBCL lesion, in the left cavernous sinus (Fig. 2f). The dose-attenuated CHOP regimen with standard dose of rituximab was initiated. Besides, radiotherapy (40 Gy) targeting the brain nodule was performed. Through combined modality therapy, the nodules in the left axilla and left cavernous sinus disappeared. This is the first case report of DLBCL developed shortly after BNT162b2 vaccination, although the recurrence of remitted Tcell lymphoma cases has been reported. 1,2 Reactive lymphadenopathy after COVID-19 vaccination has been repeatedly reported; hence, both cases were initially suspected as temporal LN swelling. The influence of vaccination on the development of DLBCL is uncertain. BNT162b2 vaccines have been reported to induce a cytokine signature featuring IL-15, IFN-c, CXCL10 and IL-6. 3 On the contrary, the elevation of these cytokines was observed in the sera of patients with pretreated DLBCL, 4 suggesting some roles of these cytokines in the growth or survival of DLBCL. Thus, it might be conceivable that pre-existing or subclinical DLBCL may rapidly grow in a specific condition induced by BNT162b2 vaccination. Nevertheless, the precise mechanism regulating the induction of DLBCL by this vaccination must await further investigations, including interaction between lymphoma cells and tumour microenvironment, genetic instability and so on. 5,6 In conclusion, DLBCL may rapidly grow after BNT162b2 vaccination. Dermatologists should pay attention to enlarging LNs or mass near the injection site of BNT162b2 vaccine. This case report might become an emergent alert for the candidates receiving anti-COVID-19 vaccination.

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Editor Teledermatology (TD) was previously described as an efficient substitute for in-person visits for COVID-19-associated lesions. 1 During the first COVID-19 wave, chilblain-like lesions (CLLs) were the most reported dermatological manifestation. [2][3][4] Although SARS-CoV-2 infection polymerase chain reaction and serology testing were negative for most cases, this unexpected outbreak of chilblains like lesions remained remarkable. 5 To date, it is unclear whether CLL outbreak reported during the first COVID-19 pandemic is related to media release of this particular sign right after the wave or whether observed CLLs are truly associated with COVID-19 disease. 6 Therefore, we aimed

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