key: cord-276549-r5l4pse8
authors: Dastoli, Stefano; Bennardo, Luigi; Patruno, Cataldo; Nisticò, Steven Paul
title: Are erythema multiforme and urticaria related to a better outcome of COVID‐19?
date: 2020-06-09
journal: Dermatol Ther
DOI: 10.1111/dth.13681
sha: 
doc_id: 276549
cord_uid: r5l4pse8

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gering factor, 2 while a little is known about such eruptions not clearly associated to drugs. Eosinophilic cells blood count seems to have a major role in COVID-19 diagnosis and prognosis. Eosinopenia has been associated in up to 81% of cases 3 and was proposed as possible diagnostic marker for the disease. 4 Persistent eosinopenia was associated to higher mortality. 3 On the other hand, an increase of eosinophils in blood was related to an improvement of the overall condition of the patient. 5 Furthermore, patients with pre-existing atopic disease (asthma, rhinitis, and atopic dermatitis) seem to be less affected by COVID-19. 4 Therefore, eosinophilia was associated with a protective effect toward the development of COVID-19. 6 Histopathology of some skin rashes arising during COVID-19 shows a perivascular and dermal infiltrate rich in eosinophilic cells. 7 Various theories have been proposed in order to explain these findings. Eosinopenia may be secondary to cell depletion due to the viral infection or to stress-induced glucocorticoid secretion. 8 Eosinophilia might be beneficial thanks to its antiviral effect, as demonstrated for influenza and parainfluenza virus. 5 We can speculate that the non-drug related EM and U might be associated to systemic eosinophilia secondary to a strong response to COVID-19, and therefore possibly to a better outcome of the disease. Indeed, nondrug-induced EM has been mostly reported in young healthy nonhospitalized COVID-19 patients. 9 U not related to drug reaction was reported in up to 4% of COVID-19 patients, 10 In conclusion, we might suppose that EM and U, when associated to eosinophilia, could be related to a better outcome of COVID-19.

However, more clinical data would be needed to prove this association.

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