Urticarial vasculitis in a COVID-19 recovered patient Dear Editor, Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms, but the clinical spectrum appears to be wide. 1 Skin is rarely involved in the course of COVID-19, but its involvement may be underreported. 2 Herein, we report a case of COVID-19 who developed urticarial vasculitis after recovery. On March 24, 2020, a 64-year-old woman presented to the emergency room with fever, dry cough, dyspnea, nausea, and anorexia. The past medical history was significant for diabetes mellitus and hypertension. She was screened for COVID-19 with a low-dose chest CT scan that showed patchy parenchymal ground-glass opacities with peripheral distribution typical for COVID-19 infection. Her lab tests showed a normal WBC count without lymphopenia and elevated levels of both lactate dehydrogenase (LDH: 554 U/L) and C-reactive protein (CRP: 61 mg/l; Positive > 10). Nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR) was positive for SARS-CoV-2. She was treated with hydroxychloroquine (200 mg BD) and azithromycin 250 mg/day for 5 days with advice to keep home quarantine, which led to a gradual improvement of the symptoms. On April 22, 2020, she presented again with weakness, malaise, anorexia recurring for the previous 1 week, and newonset generalized skin lesions. Skin lesions had appeared abruptly 48 hours before the presentation. Cutaneous examination revealed prominent periorbital

Vitiligo is an autoimmune disorder of melanocyte characterized by macular and depigmented patches. There are several treatment modalities for this disease, including the use of corticosteroids, calcineurin inhibitors, vitamin D analogous and topical phenytoin. Combination therapy utilizing fractional CO 2 laser with different topical agents has been used to enhance treatment response with promising results. In this study, we aimed to evaluate the effect of fractional CO 2 laser in combination with topical phenytoin. In this study, 25 patients (11 females and 14 males) with age of 18-59 (mean age of 31.12) with nonsegmental stable vitiligo were recruited with insufficient response to at least 1-year treatment with a monotherapy using topical corticosteroids, calcineurin inhibitors, and/or NB-UVB phototherapy. Patients were treated with a combination of fractional CO 2 laser (10,600 nm, pulse energy 30-50 mJ, MIXEL, South Korea, Rating: 220VAC, 3A, 50/60 Hz) with monthly intervals for six sessions and application of phenytoin 1% cream twice daily. Photography was done before and after treatment with Wood's lamp. The severity of disease using VASI score was calculated and compared before and after treatment. The mean VASI score before treatment was 0.55, and sixth month after treatment increased to 1.97 (p-value < 0.001). Patients were divided into three groups based on the vitiligo subtype: acral, upper extremities, and trunk. VASI score was measured in each group: VASI score before and after treatment was 0.50 and 1.48 in acral areas, 0.45 and 2.04 in upper extremities and 0.79 and 3.39 in trunk, respectively. This study revealed that combination therapy with phenytoin and fractional CO 2 laser is effective in treatment of vitiligo not only in the upper extremities and trunk, but also interestingly in the acral areas.fractional CO 2 laser, phenytoin cream 1%, treatment, VASI, vitiligo | INTRODUCTIONVitiligo is an acquired autoimmune disorder of pigmentation targeting epidermal melanocytes that affecting 0.5% of the general population worldwide, regardless of age or race. This disorder is generally classified into two categories: nonsegmental and segmental types. 1,2 Different treatment options with variable response have been used such as medical treatment with topical corticosteroids,