COVID-19 skin treatments ‘little explored’, say Italian dermatologists

Writing in Clinics in Dermatology​​, a team of dermatologists from Italy conducted a review on English-language literature published throughout 2020 on the types of therapies that had been used thus far to relieve discomfort and accelerate skin healing in COVID-19 patients. Literature analysis was then amplified with data from an observational retrospective study performed on patients at the Dermatology Unit of the Alessandro Manzoni Hospital in Lecco, Italy.

Findings showed that whilst skin involvement in the COVID-19 disease had “progressively gained the attention of the medical community”​ – a widely referenced study from Spain, for example, identified five major skin manifestations​ – therapeutic approaches to manage cutaneous COVID-19 manifestations remained a “little explored area”.​

Targeted skin treatments for COVID-19 ‘relegated’ ​

The review found most COVID-19 skin reports related to chilblain/pernio-like cutaneous manifestations and specified that “no treatment was needed”. ​Occasionally, topical corticosteroids were suggested to relieve any discomfort caused by skin lesions or antihistamines were administered.

“Unfortunately, both from the literature review and the authors’ personal experience found at the Lecco Hospital [Italy], skin disease has been relegated to a general wait and see approach,” ​the dermatologists wrote.

“Dealing with a very new disease, priority has been given not to worsen the infection course,”​ they said.

Early on, for example, use of systemic corticosteroids was initially avoided for fear of prolonging the COVID-19 disease duration and increasing the mortality rate. But now, actual guidelines derived from randomized clinical trials, included strong recommendations for the use of corticosteroids in critically ill patients with COVID-19. There had also been lots of controversy relating to antihistamines because of their effects on the QT interval when monitoring the heart.

Moving forward, the dermatologists said this widespread ‘wait and see’ approach ought to change. “The exponential rise of pandemic COVID-19 affects all of medicine, notwithstanding dermatology.”​

‘Consensus protocols’ on COVID-19 skin treatments warranted​

They said that whilst skin manifestations of COVID-19 were often “mild and self-limited”,​ they nevertheless caused discomfort.

“As dermatologists, our primary aim is to support patients with the highest standard of cares and relieve sufferance, even with lesions not being life-threatening​.”

Even patients with mild or asymptomatic COVID-19 “might benefit from a targeted skin treatment, to shorten its duration and reduce discomfort”​, they said.

“Patients’ discomfort related to skin lesions should not be undervalued, and intervention to accelerate healing should be provided. Consensus protocols are warranted to assess the best skin targeted treatments in COVID-19 patients.”​

Future implications for cosmetic formulations? ​

Whilst skin ‘treatments’ were firmly outside the remit of cosmetics, CosmeticsDesign-Europe spoke to expert personal care consultant Dr Barbara Brockway to find out if there were any ideas for the beauty industry to consider, given this review’s findings.

Asked if there was potential for topical cosmetic products to be used alongside dermatology treatments, Brockway said: “No. Until more is known about the mechanisms underpinning the different COVID-19 skin manifestations, we must leave this to dermatologists. We know too little and as vaccines get taken up by more and more of us, we will see COVID-19 and its skin manifestations gradually disappearing from the landscape.”​

Brockway said cosmetic scientists were indeed heavily invested in innovation – making advances through uptake of new techniques including next-generation sequencing, proteomics and metabolomics – but innovation was not focused on skin treatments because this was outside of industry’s remit.​

There might, however, be some scope for collaboration, she said. “Undoubtedly, sharing the cosmetic formulators' skills that enable the creation of stable delightful products, with the dermatologists/pharmaceutical and medical scientists developing skin treatments, would help ensure the experience of using topical treatments is pleasant. There has always been a 'two-way street' between cosmetic scientists and dermatologists (and now with the microbiologists studying the skin microbiome)​.”

Source: Clinics in Dermatology​
Published online ahead of print on December 14, 2020 – doi: 10.1016/j.clindermatol.2020.12.003​​
Title: “COVID-19-related skin manifestations: Update on therapy”​
Authors: L. Atzori, S. Recalcati, C. Ferreli, L. Hoenig and F. Rongioletti