During the lockdown period most planned visits have been postponed and the number of accesses to Emergency Department (ED) has dramatically reduced. The aim of our study is to analyze the impact of the lockdown on the number, type and severity of Dermatological ED diagnosis. We performed a retrospective review of all dermatological consultations in the ED of IRCSS San Matteo during the lockdown period in Italy (February 22nd ‐ May third 2020) and compared them with those from the same period in 2019. We noticed a sharply reduction in the number of dermatological consultations requested in the ED: from 164 patients in 2019 to 33 in 2020. Some diagnostic categories showed a significant difference with a higher incidence of vasculopathic lesions (0.6% vs 12.1%, P < 0.0001), urticarial rashes (8.5% vs 21.2%, P = 0.03) and scabies (3% vs 12.1%, P = 0.023). We observed an increase in the proportion of patients starting medications, before coming to the ED 26.2% in 2019 vs 66.7% in 2020 ( P < 0.001). Furthermore, we noticed a significant increase in the average complexity of cases presenting to the ED in 2020, as proven by the increased need for biopsies and systemic therapy. This article is protected by copyright. All rights reserved.

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there has been an open debate on the impact of biological drugs used in the treatment of psoriasis. To define whether patients under treatment with biologics suffer from increased morbidity and mortality from COVID-19, compared to psoriatic patients treated only with topical drugs, we designed an observational monocentric prevalence study recording the personal and clinical data of psoriatic patients, with focus on the presentation of signs and symptoms related to COVID-19 in the period of time ranging from 1 January 2020 to 31 May 2020. A total of 180 patients were enrolled into two groups: 100 patients in the topical therapy group and 80 patients in the biological therapy group. No statistically significant difference was found between the groups regarding the prevalence of COVID-19 infection and symptoms at a bivariable analysis with adjustment for confounders. In conclusion, psoriatic patients under treatment with biologics do not seem to be more susceptible to COVID-19 compared to other psoriatic patients and we suggest not interrupting treatment with biological drugs, even in areas suffering from active outbreaks of the disease.

regarding patients who attended Accident and Emergency (A&E) after developing herpes zoster (HZ) infection after COVID-19 vaccination, to assess clinical features and timing of VZV infection after COVID-19 vaccines.From 1 st of January 2021 until 15 th of July 2021, 11 patients attended A&E Department at the University Hospital of Heraklion in Heraklion, Crete, Greece, who developed HZ viral (VZV) viral infection after COVID-19 vaccination. There were six (6/ 11, 54.5%) females and five (5/11, 45.5%) males. The mean age of the patients was 67 years (SD AE 7.899). Eight patients developed VZV after the second dose of Pfizer vaccine, one patient developed VZV after the second dose of AstraZeneca vaccine (Fig. 1), and two patients developed VZV after the first dose of Pfizer vaccine. Both of these patients who developed VZV after the first dose of Pfizer vaccine had after three weeks the second dose of Pfizer vaccine with no further complications. The mean latency period till symptoms' onset was 7. Ninety-one days (SD AE 4.86) and the mean latency period until vesicular eruptions onset was 11.09 days (SD AE 5.41). None of the patients was immunosuppressed and all of them received treatment with oral antiviral for seven days with good response.Here, we have reported a case series of VZV reactivation after AZD1222 and BNT162b2 COVID-19 mRNA vaccines. In our case series, two patients developed VZV after the first dose of Pfizer vaccine and both were proceeded to the second dose of vaccine without any complications. Limitations of this study consist that this case series was from a single centre in Greece during a short period of time. In the literature, there are only few reports of VZV reactions after COVID-19 vaccines. [4][5][6][7][8][9][10] In a study from Spain, VZV and herpes simplex virus (HSV) reactivations accounted for 13.8% of reactions. 1 The exact pathophysiology underlying cutaneous effects after AZD1222 and BNT162b2 COVID-19 mRNA vaccines have still to be elucidated, and further prospective larger studies are needed. Nevertheless, even though VZV reactivation is rare, medical professionals should pay close attention to the possible adverse effects of the COVID-19 vaccines.