Systemic Medications of Dermatological Importance in COVID-19

September 2020 | Volume 19 | Issue 9 | Original Article | 889 | Copyright © September 2020


Published online August 21, 2020

Robert A. Schwartz , Aseem Sharma , Jacek C. Szepietowski , Sunmeet Sandhu , Mohamad Goldust

aRutgers New Jersey Medical School, Newark, NJ bSkin Saga Centre for Dermatology, Mumbai, India cUniversity of Studies Guglielmo Marconi, Rome, Italy dWroclaw Medical University, Wroclaw, Poland eArmed Forces Medical College, Pune, India fUniversity Hospital Basel, Basel, Switzerland

Abstract
Early December 2019 witnessed an international outbreak of a novel coronavirus (COVID 19) designated severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Since then, a number of therapeutic molecules have been explored to have potential efficacy against the SARS-Cov-2 per se or its sequelae. There are no Food and Drug Administration specific therapies approved so far; however, numerous drugs based on varying levels of evidence, in vitro studies and compassionate drug trials are being established as therapeutic agents, especially drugs approved for previous emergence of the severe acute respiratory syndrome (SARS-CoV-1) and Middle east respiratory syndrome coronavirus (MERS-Cov). Numerous active clinical trials for COVID-19 with more than 150 drugs and products are under study. Needless to say, many dermatological drugs are being employed to mitigate this pandemic threat. We aim to review drugs with potential against SARS-Cov-2 widely used in dermatology practice. Additionally, rampant and overzealous use of these drugs as well as introduction of new molecules might lead to emergence of adverse effects associated with these agents. Dermatologists must be on lookout for any cutaneous adverse effects of these drugs.
J Drugs Dermatol. 2020;19(9):889-892. doi:10.36849/JDD.2020.5323

INTRODUCTION

In light of the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection being declared a pandemic by World Health Organization (WHO), the International Clinical Trials Registry Platform of WHO has recorded more than 1000 clinical trials to study and develop therapies for the COVID‑19 infection.1-3 The Solidarity Trial by WHO aims to reduce the time taken for clinical trial by 80% and includes four treatment options (remdesivir, lopinavir/ritonavir, lopinavir/ritonavir with interferon beta-1a and chloroquine or hydroxychloroquine) against standard care, to assess effectiveness against COVID-19.4 Additionally, numerous clinical trials, including drugs used in dermatology, are under study against SARS-Cov-2 infection. We highlight these dermatological drugs and review the adverse effects associated with other drugs being studied.5-8

Dermatological drugs with efficacy against SARS-Cov-2
Antimalarials
In view of clinical studies and their in vitro effects, hydroxychloroquine (HCQ) and chloroquine (CQ) have been recommended as prophylactic agents in COVID-19 and included in the (HCQ) Chinese guidelines for COVID-19 management. The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) to allow the emergency use of HCQ.9 These antimalarials possess antiviral activity owing to inhibition of viral entry into the cell via pH dependant endocytosis, inhibition of glycosyl-transferases, and viral post-translational modifications. Wang et al10 proved in vitro suppression of viral infection at both entry and at post-entry stages of the 2019-nCoV infection in Vero E6 cells by CQ in combination with remdesivir. CQ might have additional antiviral action by inhibition of quinone reductase-2, an enzyme involved in sialic acid biosynthesis, as sialic acid is present on SARS angiotensin-converting enzyme 2 receptors.11 These also have immunomodulatory functions by guarding against the cytokine storm associated with disease severity of SARS-CoV-2.HCQ was shown to be a more potent agent than chloroquine in inhibiting SARS-CoV-2 in vitro.12 HCQ successfully lead to negative viral RNA in nasopharyngeal samples after 6 days. Viral clearance was seen in 12.5% of patients who did not receive HCQ, in 70% of those treated with HCQ alone, and in 100% of those treated with HCQ combined with azithromycin.13

HCQ has been associated with severe cutaneous adverse drug reaction (generalized pustular figurate erythema, toxic epidermal