We describe the cases of two immunocompetent children who developed mucositis with oral, ocular, and genital involvement during acute COVID-19 illness. The pattern of mucosal involvement with no other cutaneous involvement was consistent with reactive infectious mucocutaneous eruption (RIME). No other intercurrent infections or new medications were identified, suggesting that COVID-19 was causative. Both patients noted improvement with systemic corticosteroid therapy.

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The term ‘topical steroid withdrawal’ (TSW) describes an adverse effect that generally occurs with inappropriate prolonged use of high‐potency topical corticosteroids (TCS). The presence of user‐generated content relating to TSW on social media (SoMe) has not been well‐defined to date. We aimed to explore content relating to topical steroid withdrawal on SoMe. Using a data analytics platform, we retrospectively analysed the hashtag #topicalsteroidwithdrawal on SoMe over a 5‐year period from 8 February 2016 until 8 February 2021. We assessed interactions, performance, shares, likes, mentions, language and country of origin using descriptive statistics. Across all SoMe platforms, there was a 274% increase in mentions of the hashtag #topicalsteroidwithdrawal in the year 2020 (n = 7992) compared with the year 2016 (n = 2138). The top associated hashtags included #TSW, #eczema and #topicalsteroidaddiction. On Instagram, we found a 288% increase in number of mentions and a 592% increase in performance of #topicalsteroidwithdrawal in 2020 (n = 618 354) compared with 2016 (n = 89 390). Our results confirm an increase in the presence of user‐generated content relating to TSW on SoMe and also highlight its extent. Large numbers of patients are exposed to this content, which could influence their engagement with TCS.

Lan et al recently highlighted the under-representation of older adults in clinical trials of systemic therapies for atopic dermatitis (AD). Late-onset AD is increasingly recognized in older adults. Spontaneous remission is uncommon with this phenotype. Existing drug treatments such as corticosteroids, methotrexate, ciclosporin, and azathioprine are complicated by adverse effects including increased malignancy risk, immunosuppression in the context of immunosenescence, and drug interactions in the setting of polypharmacy. A case series is presented of seven patients over 50 years of age with AD who were prescribed dupilumab or tofacitinib or upadacitinib for at least 6 months. All patients were clear or almost clear (investigator global assessment score 0/1) after 1 month of therapy. No significant adverse events were seen. This case series provides preliminary evidence about the safety and efficacy of these novel drugs for AD in older adults. Further studies with higher numbers of participants are needed to obtain realworld evidence for these drugs in older adults, given the limited data in clinical trials.

Dupilumab as treatment for atopic dermatitis in a pediatric heart transplant patient: a case report. Dermatol Ther 2020; 33: e14018.