Impact of COVID-19 on autoimmune blistering diseases

Abstract

Since the beginning of the COVID-19 outbreak, attention has gradually moved from the respiratory manifestations of the disease toward its dermatologic aspects. The need for wearing personal protective measures and their cutaneous side effects, detection of related or specific COVID-19 skin eruptions, and the evaluation of certain risk groups of immunosuppressed dermatologic patients have initiated significant discussions about various therapeutic interventions and, in particular, about biologic therapy for psoriasis and for autoinflammatory, orphan, or malignant cutaneous disorders. Autoimmune bullous dermatoses have been of concern due to their chronic course, at times life-threatening prognosis, and the need for prolonged and often aggressive immunomodulatory therapy. We have summarized the current knowledge regarding the impact of COVID-19 infection on autoimmune bullous dermatoses, including recommendations for the main treatment strategies, available patient information, and the registries organized for documentation during the COVID-19 pandemic.

Fig. 1

Varicelliform eruption with multiple umbilicated vesicles in a patient who tested positive for IgM-SARS-CoV-2. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Fig. 2

Varicelliform vesicles and flaccid bullae on normal skin typical for PV in a patient who tested positive for IgM-SARS-CoV-2. (Same patient as in Figure 1.) SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Fig. 3

Tense blisters and multiple erosions in a patient with BP who was the contact person to an IgM-SARS-CoV-2 positive relative. BP, bullous pemphigoid; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Fig. 4

Severe ocular scarring in a patient with MMP who later developed pneumonia and died from pulmonary insufficiency. MMP, mucous membrane pemphigoid.