Balneotherapy at Comano spa appears to be beneficial in children with mild to moderate AD.

same pathogenic pathway and some clinical manifestations, including chilblains and retinal vasculopathy. In addition, this type I IFN response produces microvascular injury, 6 which has already been reported to be related to COVID-19 infection, and it could explain both chilblains and retinal vasculitis. Also, Kawasaki disease can share some similarities with COVID-19 infection. Both cause acral skin lesions, vasculitis and show increased serum interleukin 6 (IL-6) related to the immune response to the disease. 7 Also, there are other viral infections associated with Kawasaki disease, including other species of human coronaviruses. 8 Other types of acral cutaneous lesions apart from chilblains have been reported in patients with COVID-19. This group includes cyanosis, blisters and gangrene in the feet and hands, primarily in adults. Nonetheless, these types of manifestations appear to be related to coagulation disorders in severe cases of COVID-19, and most carry poor prognosis. 9 Our analytical study was rigorously normal, with no poor prognostic data. In summary, special attention should be devoted to children, despite most remaining asymptomatic in the early stages of the infection. Currently, we do not know whether there will be any other complications in the late stages of the disease and what is the real meaning of the described features. However, these types of manifestations in children appear to occur in the convalescence phase of the infection. Further studies are needed to provide more specific preventive measures and to standardize the short-and middle-term follow-up of these patients.

DEAR EDITOR, The outbreak of chilblain-like lesions (CLL) coincidentally to the COVID-19 pandemic is a topic of great concern. [1][2][3][4][5][6] SARS-CoV-2 has been hypothesized as the aetiological agent of CLL, on the basis of the temporal correlation between the 'burst' of skin manifestations and the viral pandemic. However, the relationship between CLL and COVID-19 remains unclear, as researchers have failed to confirm the SARS-CoV-2 infection in these patients using real-time reverse-transcription polymerase chain reaction (RT-PCR) from nasopharyngeal swabs, which seldom tested positive. [1][2][3][4][5] Indeed, the most recent articles on the prevalence of the SARS-CoV-2 infection in CLL reported a positive swab test in only about one-fifth of these patients. 4,5 In a few cases, serological tests were used, but these initially available tests were largely unreliable, as they had been rapidly developed and placed on the market with limited validation on clinical samples.We collected data on 16 patients presenting with CLL, who were all negative to the nasopharyngeal swab. We then decided to recall our patients to perform a recently developed rapid chromatographic immunoassay (RCI) for the qualitative detection of specific antibodies to SARS-CoV-2, using the SD Biosensor COVID-19 IgM/IgG Duo assay (SD Biosensor Inc., Yeongtong-gu, South Korea). The SD Biosensor's package insert claims a sensitivity of 99Á10% and a specificity of 95Á09%, established in a retrospective, multicentre, randomized, single-blinded study on 504 specimens, if used more than 14 days after the onset of symptoms. In total, 12 of our patients agreed to undergo the RCI test; their characteristics are summarized in Table 1. All of them were tested at least 14 days after presentation of skin disease (mean value 51Á3 AE 25Á8), according to the manufacturer's instructions. In 11 of 12 the presence of IgM or IgG was not detected. The sole

No abstract

Thimerosal is an organic mercurial compound widely used as a preservative in vaccines, eyedrops, and contact lens cleaning and storage solutions. 5 infants, 2 female and 3 male, ranging in age from 7 to 28 months and affected by atopic dermatitis (AD) diagnosed according to the Hanifin and Rajka criteria, experienced an exacerbation of their clinical condition 2-10 days after mandatory vaccinations with vaccines containing thimerosal. Cutaneous lesions of nummular eczema appeared on the trunk, limbs and face. All patients were patch tested with serial dilutions of thimerosal in petrolatum. A positive patch test reaction to thimerosal 0.1% pet. was observed in all 5 children. 3 of them also showed a positive reaction at 0.01% and 0.05% pet. Despite their thimerosal-hypersensitivity, all children completed the entire series of mandatory vaccinations, care being taken to use different needles for injection and aspiration of the vaccine. The 2-year follow-up did not reveal other episodes of exacerbation of the AD after vaccination. The present study confirms the high frequency of sensitization to thimerosal in atopic children and suggests that vaccination can cause clinical symptoms in sensitized children. Nevertheless, sensitization to thimerosal does not prevent children from continuing with mandatory vaccinations.