Summary COVID‐19 is an infectious disease caused by severe acute respiratory coronavirus 2 (SARS‐CoV‐2). Vesicular skin rashes have been reported as associated with COVID‐19, but there is little information about this cutaneous manifestation. We designed a prospective observational study of patients diagnosed with COVID‐19 who had vesicular lesions. Clinical characterization of skin findings was conducted by dermatologists. When possible, histological analysis and detection of SARS‐CoV‐2 in the content of the vesicles was performed. In total, 24 patients were included. A disseminated pattern was found in 18 patients (75%), and a localized pattern was found in 6 (25%). Median duration of the skin rash was 10 days. Of the 24 patients, 19 (79.2%) developed the skin rash after the onset of COVID‐19 symptoms. Histological examination in two patients was consistent with viral infection, SARS‐CoV‐2 was not detected in four patients. This single‐centre study shows the clinical characteristics of vesicular skin rashes in patients with COVID‐19.

Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings

investigate further. First, the analysis did not include patients with similar clinical symptoms, i.e. cough or fever, but were tested negative. Since COVID-19 negative patients, likely with other viral infections, may also have similar skin manifestation as COVID-19 positive patients do, the difference in the prevalence and morphology of skin rash between COVID-19 positive and negative patients warrants comparisons. This would address whether the skin rashes of the three patterns described in the study (erythematous, urticarial and varicelliform) are specific to the COVID-10. Second, it is crucial to measure the viral load in different time points before, during and after the skin rashes in future studies. Viraemia and the skin exanthem may have different time kinetics in different viral infections. For example, viraemia of the measles peaks at the onset of skin rash, 7 whereas viraemia of the parvovirus B19 ends before the onset of skin rash. 8 Hence, the dynamic viral load and its reference to skin rash can become a vital clinical clue for the clinicians to determine the optimal timing (before, during or after the skin rash) to collect the samples for molecular identification. As we have observed the heavy burden of triage and shortage of essential medical goods posed by the outspread of COVID-19, the introduction of an easy clinical assessment tool like classic COVID-19 skin manifestation is a novel path to cope with the challenge that we are facing during the pandemic. However, this will take more studies to build up the validity and reliability. Dermatology's outlook in the COVID-19 is multidimensional, starting from the pathogenesis, public health issues to applying new technologies in clinical practice, the opportunities are infinite. Most importantly, we dermatologists as part of the medical community should contribute our unique perspective in the battle against this formidable pandemic.

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Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Fig 1. Purpuric skin rash in a patient with COVID-19 bilateral pneumonia, revealing purpuric, coalescing macules on (A) left and (B) right periaxillary regions.

Figure 1). Their HAP scores gradually increased, and the hypotrichosis in the patient with TRPS1 did not improve (Figure 2A). Hair shaft diameters were increased in every participant with LIPH pathogenic variants (Figure 2B and C). There were no serious adverse events, but some mild adverse events were reported (dry skin on the scalp, trichiasis, and mild hypertrichosis on the entire body). Discussion | Lysophosphatidic acids bind the P2Y5 receptor in the hair follicle epithelium and activate hair growth. 5 In ARWH due to LIPH pathogenic variants, loss-of-function variants in LIPH lead to a deficiency of lysophosphatidic acids and insufficient activation of P2Y5. The present prospective interventional study suggests that minoxidil could be associated with improvements in hypotrichosis in ARWH owing to LIPH pathogenic variants. There appears to be a binary response to minoxidil, with one group responding better than the other. The data on causative pathogenic variants suggest that it is unrelated to the LIPH pathogenic variants. Among the 8 patients with ARWH due to LIPH pathogenic variants, 5 patients were unrelated, and the other 3 were from 1 family. All 3 members of the family were in the group responding better. Thus, we cannot exclude the possibility that the family had an unknown genetic modifying factor affecting the efficacy of minoxidil. We need to know more about the follicular pathology to understand the pharmacologic response to minoxidil.

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low dose oral minoxidil (OM) is an increasingly used treatment for androgenetic alopecia and other types of hair loss. to analyze available data of patients treated with OM, focusing on safety and adverse effects. a search in PubMed and EMBASE was performed for studies reporting the treatment of alopecia with OM. Individual patient data available for pooled-analysis were sex, dose of OM, presence of hypertrichosis and lower limb edema. 14 studies including 442 patients were analyzed. OM was used at doses between 0.25 and 5 mg, for eight different types of alopecia. Hypertrichosis was observed in 24% of patients. All doses had an increased odds ratio of hypertrichosis, compared to 0.25 to 0.5 mg (P < .001). Pedal edema was observed in 2% and was also associated with higher doses of OM (P = .009). Postural hypotension and heart rate alterations occurred only in 1.1% and 1.3% of the patients, respectively. Efficacy of OM could not be analyzed due to heterogeneous studies. However, four studies using OM for androgenetic alopecia reported a clinical response in 70% to 100% of the patients. Low dose OM is a safe and well-tolerated treatment for hair loss, presenting a lower adverse effect rate than standard doses.