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Naltrexone is more effective than placebo in the treatment of pruritus in patient with eczema. Naltrexone might be considered as an adjunct treatment in the treatment of pruritus. However, further studies in this aspect are highly fostered.

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

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To the Editor-Healthcare workers (HCWs) are encouraged to wear gloves by the WHO in the direct care of the patients during the COVID-19 pandemic. Medical gloves are made of different polymers, including latex, nitrile rubber, polyvinyl chloride, polyurethane, and neoprene. Nitrile and latex gloves are preferred during the COVID-19 pandemic due to better durability. 1 Latex gloves are flexible, fit well, are sensitive to touch, and provide moderate protection. 2 Vinyl gloves provide moderate protection, are sensitive to touch, but are not as durable. 2 However, nitrile gloves are chemical-and puncture-resistant and provide the highest level of protection and durability. 2 Many adverse skin reactions, including irritant contact dermatitis, allergic contact dermatitis, and contact urticaria have been reported with the use of all types of gloves. 3 Latex gloves are frequently used among HCWs. Hypersensitivity to natural rubber latex (NRL) has been increasingly reported, with an incidence of 2.8% to 17% among HCWs. 3 HCWs are highly at risk of developing allergic reactions to NRL, especially operating room personnel, dental assistants, laboratory personnel, hospital housekeeping personnel, and ambulance attendants. 4 Atopic background, history of hand dermatitis, allergy to certain foods, female gender, and multiple exposures are among the risk factors for developing hypersensitivity to NRL. 3 Hypersensitivity reaction to bananas, avocados, chestnuts, kiwis, and other fruits have been reported among these patients. 5 Skin reactions include localized pruritus, burning, stinging, contact and generalized urticaria. The most frequently observed reaction is irritant contact dermatitis presenting as dry, crusted, fissuring

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