Morbilliform to maculopapular rashes, seborrheic dermatitis, erythema nodosum, purpura, petechiae, exfoliative erythroderma, EM, TEN, and drug reaction with eosinophilia and systemic symptoms have been reported.30
Drugs explored/ being studied in SARS-Cov-2 infection with cutaneous adverse effects
Various drugs such as remdesivir, ribavirin, interferon gamma, favipavir, arbidol hydrochloride, imatinib are being studied for their potential activity against SARS-Cov-2 infection.31 Table 1 highlights the probable mechanism of antiviral action and reported cutaneous adverse effect of these drugs.
CONCLUSION
With current existing limited clinical evidence of the majority of drugs proposed against SARS-Cov-2, a number of therapeutic agents are being explored globally against this catastrophic viral pandemic.32 Reinforcement of a few commonly utilized dermatological drugs with efficacy against this viral infection in mitigating active infection and its sequelae can further add to the novel treatment strategies. Dermatologist all across the world need to be aware of the potential adverse reactions of the known as well as these new drugs in light of their potentially overzealous use.
DISCLOSURES
The authors have no conflict of interest to declare.
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10. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019- nCoV) in vitro. Cell Res. 2020;30(3):269–71.
11. Savarino A, Di Trani L, Donatelli I, Cauda R, Cassone A. New insights into the antiviral effects of chloroquine. Lancet Infect Dis. 2006;6(2):67–9.
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13. Gautret P, Lagier J-C, Parola P, Meddeb L, Mailhe M, Doudier B, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;105949.
14. Schwartz RA, Janniger CK: Generalized pustular figurate erythema. a newly delineated severe cutaneous drug reaction linked with hydroxychloroquine. Dermatol Ther. 2020; 33(3):e13380. doi: 10.1111/dth.13380. PMID: 32253799.
15. Coulombe J, Boccara O. Hydroxychloroquine-related skin discoloration. Can Med Assoc J. 2017;189(5):E212.
16. Nutho B, Mahalapbutr P, Hengphasatporn K, Pattaranggoon NC, Simanon N, Shigeta Y, et al. Why are lopinavir and ritonavir effective against the newly emerged Coronavirus 2019?: Atomistic insights into the inhibitory mechanisms. Biochemistry. 2020. doi:10.1021/acs.biochem.0c00160. [Epub ahead of print] PubMed PMID: 32293875.
17. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020.
18. Borras-Blasco J, Navarro-Ruiz A, Borras C, Castera E. Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection. J Antimicrob Chemother. 2008;62(5):879–88.
19. Ghosn J, Duvivier C, Tubiana R, Katlama C, Caumes E. Acute generalized exanthematous pustulosis induced by HIV postexposure prophylaxis with lopinavir-ritonavir. Clin Infect Dis. 2005;41(9):1360–1.
20. Zha L, Li S, Pan L, Tefsen B, Li Y, French N, et al. Corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19). Med J Aust. 2020. doi: 10.5694/mja2.50577. [Epub ahead of print] PubMed PMID: 32266987.
21. Organization WH. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. World Health Organization; 2020.
22. Zhao JP, Hu Y, Du RH, Chen ZS, Jin Y, Zhou M, et al. Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia. Chinese J Tuberc Respir Dis. 2020;43(3):183–4.
2. Rudnicka L, Gupta M, Kassir M, et al. Priorities for global health community in COVID-19 pandemic. Dermatol Ther. 2020 Apr 1:e13361. doi: 10.1111/ dth.13361.
3. Sharma A, Fölster-Holst R, Kassir M, et al. The Effect of quarantine and isolation for COVID-19 in general population and dermatologic treatments. Dermatol Ther. 2020 Apr 10:e13398. doi: 10.1111/dth.13398.
4. Solidarity clinical trial for COVID-19 treatments [Internet]. [cited 2020 Apr 25]. Available from: https://www.who.int/emergencies/diseases/novelcoronavirus- 2019/global-research-on-novel-coronavirus-2019-ncov/solidarityclinical- trial-for-covid-19-treatments.
5. Abdelmaksoud A, Vestita M, El-Amawy HS, et al. Systemic isotretinoin therapy in the era of COVID-19. Dermatol Ther. 2020 May 1:e13482. doi: 10.1111/dth.13482.
6. Rudnicka L, Goldust M, Glowacka P, et al. Cyclosporine therapy during the COVID-19 Pandemic is not a reason for concern. J Am Acad Dermatol. 2020 May 3:S0190-9622(20)30775-1.
7. Goldust M, Kroumpouzos G, Murrell DF, et al. Update on COVID-19 effects in dermatology specialty. Dermatol Ther. 2020 May 7. doi: 10.1111/dth.13523.
8. Murrell DF, Arora G, Rudnicka L, et al. A dermatologist's perspective of the COVID-19 outbreak. Dermatol Ther. 2020 May 8. doi: 10.1111/dth.13538.
9. Emergency Use Authorization | FDA [Internet]. [cited 2020 Apr 25]. Available from:https://www.fda.gov/emergency-preparedness-and-response/mcmlegal- regulatory-and-policy-framework/emergency-use-authorization.
10. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019- nCoV) in vitro. Cell Res. 2020;30(3):269–71.
11. Savarino A, Di Trani L, Donatelli I, Cauda R, Cassone A. New insights into the antiviral effects of chloroquine. Lancet Infect Dis. 2006;6(2):67–9.
12. Yao X, Ye F, Zhang M, et al. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020. doi:10.1093/cid/ciaa237.
13. Gautret P, Lagier J-C, Parola P, Meddeb L, Mailhe M, Doudier B, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;105949.
14. Schwartz RA, Janniger CK: Generalized pustular figurate erythema. a newly delineated severe cutaneous drug reaction linked with hydroxychloroquine. Dermatol Ther. 2020; 33(3):e13380. doi: 10.1111/dth.13380. PMID: 32253799.
15. Coulombe J, Boccara O. Hydroxychloroquine-related skin discoloration. Can Med Assoc J. 2017;189(5):E212.
16. Nutho B, Mahalapbutr P, Hengphasatporn K, Pattaranggoon NC, Simanon N, Shigeta Y, et al. Why are lopinavir and ritonavir effective against the newly emerged Coronavirus 2019?: Atomistic insights into the inhibitory mechanisms. Biochemistry. 2020. doi:10.1021/acs.biochem.0c00160. [Epub ahead of print] PubMed PMID: 32293875.
17. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020.
18. Borras-Blasco J, Navarro-Ruiz A, Borras C, Castera E. Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection. J Antimicrob Chemother. 2008;62(5):879–88.
19. Ghosn J, Duvivier C, Tubiana R, Katlama C, Caumes E. Acute generalized exanthematous pustulosis induced by HIV postexposure prophylaxis with lopinavir-ritonavir. Clin Infect Dis. 2005;41(9):1360–1.
20. Zha L, Li S, Pan L, Tefsen B, Li Y, French N, et al. Corticosteroid treatment of patients with coronavirus disease 2019 (COVID-19). Med J Aust. 2020. doi: 10.5694/mja2.50577. [Epub ahead of print] PubMed PMID: 32266987.
21. Organization WH. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. World Health Organization; 2020.
22. Zhao JP, Hu Y, Du RH, Chen ZS, Jin Y, Zhou M, et al. Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia. Chinese J Tuberc Respir Dis. 2020;43(3):183–4.
