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Morales González ADR. Manifestaciones dermatológicas asociadas a la gravedad de la infección por COVID-19. Estudio observacional transversal retrospectivo de 144 pacientes. PIEL 2022. [PMCID: PMC9343741 DOI: 10.1016/j.piel.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introducción Material y métodos Resultados Conclusiones
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Mashayekhi F, Seirafianpour F, Pour Mohammad A, Goodarzi A. Severe and life-threatening COVID-19-related mucocutaneous eruptions: A systematic review. Int J Clin Pract 2021; 75:e14720. [PMID: 34411409 PMCID: PMC8420487 DOI: 10.1111/ijcp.14720] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Earlier diagnosis and the best management of virus-related, drug-related or mixed severe potentially life-threatening mucocutaneous reactions of COVID-19 patients are of great concern. These patients, especially hospitalised cases, are usually in a complicated situation (because of multi-organ failures), which makes their management more challenging. In such consultant cases, achieving by the definite beneficial management strategies that therapeutically address all concurrent comorbidities are really hard to reach or even frequently impossible. METHODS According to the lack of any relevant systematic review, we thoroughly searched the databases until 5 October 2020 and finally found 57 articles including 93 patients. It is needed to know clinical presentations of these severe skin eruptions, signs and symptoms of COVID in these patients, time of skin rash appearance, classifying drug-related or virus-related skin lesions, classifying the type of skin rash, patients' outcome and concurrent both COVID-19 therapy and skin rash treatment. RESULT Severe and potential life-threatening mucocutaneous dermatologic manifestations of COVID-19 usually may be divided into three major categories: virus-associated, drug-associated, and those with uncertainty about the exact origin. Angioedema, vascular lesions, toxic shock syndrome, erythroderma, DRESS, haemorrhagic bulla, AGEP, EM, SJS and TEN, generalised pustular figurate erythema were the main entities found as severe dermatologic reactions in all categories. CONCLUSION We can conclude vascular injuries may be the most common cause of severe dermatologic manifestations of COVID-19, which is concordant with many proposed hypercoagulation tendencies and systemic inflammatory response syndrome as one of the most important pathomechanisms of COVID-19 so the skin may show these features in various presentations and degrees.
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Affiliation(s)
- Farzaneh Mashayekhi
- Department of General MedicineRasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Farnoosh Seirafianpour
- Student Research CommitteeSchool of MedicineIran University of Medical SciencesTehranIran
| | - Arash Pour Mohammad
- Student Research CommitteeSchool of MedicineIran University of Medical SciencesTehranIran
| | - Azadeh Goodarzi
- Department of DermatologyRasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
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Najar Nobari N, Seirafianpour F, Dodangeh M, Sadeghzadeh-Bazargan A, Behrangi E, Mozafarpoor S, Goodarzi A. A systematic review of the histopathologic survey on skin biopsies in patients with Corona Virus Disease 2019 (COVID-19) who developed virus or drug-related mucocutaneous manifestations. Exp Dermatol 2021; 30:1233-1253. [PMID: 33977531 PMCID: PMC8239817 DOI: 10.1111/exd.14384] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/21/2022]
Abstract
The mucocutaneous manifestations of Corona Virus Disease 2019 (COVID‐19) logically may reflect systemic visceral involvements. These findings are visible and easy to approach like biopsies for exact histopathologic evaluations. This systematic review was conducted to collect the mucocutaneous histopathologic data of COVID‐19 patients for future investigations and interpretations. The COVID‐19 dermatology resource of the Centre of Evidence‐Based Dermatology (CEBD) at the University of Nottingham, PubMed, Scopus, Google Scholar and Medscape was searched for relevant English articles published by June 3, 2020. This review included 31 articles, involving 459 patients. The common primary virus‐related mucocutaneous manifestations are easy to approach in the course of COVID‐19. The authors of this study supposed dermatopathological findings as the predictors of the nature of potential systemic involvements and outcomes of COVID‐19. Scrutinizing these findings can help with adopting more effective therapeutic and management strategies; nevertheless, this review found the severity and time of onset of symptoms not to be associated with the laboratory and histopathological findings. Deterioration of clinical conditions and laboratory tests was also not related to the histopathological findings. It is recommended that meta‐analyses be conducted in the future to detail on these data for having more comprehensive and better conclusion.
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Affiliation(s)
- Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Farnoosh Seirafianpour
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Dodangeh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghzadeh-Bazargan
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Morales‐Perez MJ, Gallardo‐Calero I, Rivas‐Nicolls D, Gelabert Mestre S, Garcia Forcada I, Soldado F. Reconstruction of COVID-19 vasculitis-related thumb necrosis with a microsurgical free flap. Microsurgery 2021; 41:393-395. [PMID: 33580968 PMCID: PMC8014876 DOI: 10.1002/micr.30719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/21/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022]
Affiliation(s)
- María José Morales‐Perez
- Hand, Wrist and Elbow Surgery UnitHospital Universitari Joan XXIIITarragonaSpain
- Hand and Upper ExtremityInstituto Cugat, Hospital QuironsaludBarcelonaSpain
| | - Irene Gallardo‐Calero
- Hand Surgery Unit, Orthopaedic Surgery DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Universidad Autónoma de BarcelonaBarcelonaSpain
| | - Danilo Rivas‐Nicolls
- Plastic Surgery Department and Burn CenterVall d'Hebron Barcelona Hospital CampusBarcelonaSpain
| | | | | | - Francisco Soldado
- Pediatric Upper Limb and MicrosurgeryBarcelona University Children Hospital HM NensBarcelonaSpain
- Unidad UCA Mikel Sanchez, Vithas San JoséVitoria‐GasteizSpain
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Ricardo Criado P, Pincelli TPH, Criado RFJ, Abdalla BMZ, Belda Junior W. Potential interactions of SARS-CoV-2 with human cell receptors in the skin: Understanding the enigma for a lower frequency of skin lesions compared to other tissues. Exp Dermatol 2020; 29:936-944. [PMID: 32867008 DOI: 10.1111/exd.14186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/21/2020] [Accepted: 08/21/2020] [Indexed: 12/28/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a new public health problem, with a total of 10.577.263 documented COVID-19 cases worldwide and 513.441 deaths up to the present date. Few cases of disease-related cutaneous manifestations have been reported in the literature, and such manifestations are scarce. Integumentary manifestations from COVID-19 include exanthemas and papular dermatoses, urticarial eruptions, atopic dermatitis, vesiculobullous lesions and skin signs of hypercoagulable states, such as acral ischaemia, livedo and retiform purpura. Most common extracutaneous manifestations from the disease include headache, cough, anosmia, ageusia, fever, dyspnoea, nausea, diarrhoea and cardiovascular events. The objectives of this review were to discuss the role of human cell receptors described as interaction targets of SARS-CoV-2, as well to understand the current state of knowledge on skin expression of these receptors, in order to substantiate future research. The authors present a thorough literature review on SARS-CoV-2 and its possible interaction with cell receptors and human tissues including the skin. They discuss a molecular hypothesis to explain the lower prevalence of dermatological manifestations from direct SARS-CoV-2 infection. Distinct human cell receptors binding the virus appear to be less expressed in the skin compared to other organs. Additionally, the presence of resolvins and the disintegrin metalloprotease ADAM17 provide a putative protection to the skin, explaining the majority of COVID-19 manifestations to be extracutaneous. This review represents an excellent opportunity for future studies using skin biopsies from COVID-19 patients to investigate molecular expression in the pathophysiology of cutaneous manifestations of the disease.
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Affiliation(s)
- Paulo Ricardo Criado
- Dermatology Department, Centro Universitário Saúde ABC, Santo André, Brazil.,LIM-50, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | - Walter Belda Junior
- LIM-50, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Ciaffi J, Meliconi R, Ruscitti P, Berardicurti O, Giacomelli R, Ursini F. Rheumatic manifestations of COVID-19: a systematic review and meta-analysis. BMC Rheumatol 2020; 4:65. [PMID: 33123675 PMCID: PMC7591274 DOI: 10.1186/s41927-020-00165-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Different proportions of musculoskeletal or autoimmune manifestations associated with COVID-19 have been reported in literature. We performed a systematic review and meta-analysis with the aim of assessing the prevalence of rheumatic manifestations in patients affected by COVID-19, as initial symptom or during disease course. METHODS A database search was run on May 18th, 2020, using two distinct strategies. We were interested in the percentage of symptoms of potential rheumatologic interest observed in large population studies of COVID-19 cases, and in identifying uncommon autoimmune disorders described in patients with COVID-19. For manifestations individually reported, a meta-analysis was performed taking into consideration the proportion of COVID-19 patients presenting the symptom. RESULTS Eighty eight original articles were included in the systematic review and 51 in the meta-analysis. We found pooled estimates of 19% for muscle pain and 32% for fatigue as initial symptom of COVID-19 presentation and, respectively, of 16 and 36% during the disease course. Only one article discussed arthralgia as unique symptom. Additionally, we found that vasculitis, chilblains, presence of autoantibodies commonly found in patients with rheumatic diseases, or autoimmune haematological and neurological disorders have all been reported in patients with COVID-19. CONCLUSIONS In conclusion, our review and meta-analysis emphasises that symptoms potentially leading to rheumatologic referral are common in patients with COVID-19. Therefore, COVID-19 is a new differential diagnosis to bear in mind when evaluating patients with musculoskeletal symptoms and rheumatologists might play a crucial role in identifying COVID-19 cases in early phases of the illness.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), via Pupilli 1, 40136 Bologna, Italy
| | - Riccardo Meliconi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), via Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Rheumatology, University of Bologna, Bologna, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Onorina Berardicurti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), via Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Rheumatology, University of Bologna, Bologna, Italy
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Mawhirt SL, Frankel D, Diaz AM. Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers. Curr Allergy Asthma Rep 2020; 20:75. [PMID: 33047260 PMCID: PMC7549735 DOI: 10.1007/s11882-020-00974-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW COVID-19 (coronavirus viral disease 2019), due to the novel SARS-CoV-2, may present with different types of cutaneous manifestations of varying pathophysiology. During the ongoing pandemic, publications reporting dermatologic findings in COVID-19 continue to emerge. RECENT FINDINGS Cutaneous vasculopathy and microthrombus-related changes including acral and sacral lesions, retiform purpura, livedo reticularis, and cutaneous vasculitis are notable findings in adult patients. Other exanthems include urticaria or angioedema, morbilliform/maculopapular exanthems, erythema multiforme, and vesicular eruptions. Increased recognition of these findings, especially those consistent with cutaneous microthrombi or vasculitis, is of particular importance. Additionally, occupational dermatologic disease related to extended personal protective equipment (PPE) use, such as skin damage and irritant or allergic contact dermatitis (ACD), represents another emerging problem amidst the pandemic. In this review, we highlight the various cutaneous manifestations associated with COVID-19 in adult patients and occupational dermatitis in health care workers (HCWs) caring for this patient population.
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Affiliation(s)
- Stephanie L Mawhirt
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA.
| | - David Frankel
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA
| | - Althea Marie Diaz
- Department of Medicine, 222 Station Plaza North, Suite 509, Mineola, New York, USA
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Buhl T, Beissert S, Gaffal E, Goebeler M, Hertl M, Mauch C, Reich K, Schmidt E, Schön MP, Sticherling M, Sunderkötter C, Traidl‐Hoffmann C, Werfel T, Wilsman‐Theis D, Worm M. COVID‐19 und Auswirkungen auf dermatologische und allergologische Erkrankungen. J Dtsch Dermatol Ges 2020; 18:815-825. [PMID: 32881343 PMCID: PMC7461475 DOI: 10.1111/ddg.14195_g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Die durch das Coronavirus SARS‐CoV‐2 verursachte Krankheit COVID‐19 hat sich zu einer Pandemie entwickelt. Bei der Betrachtung von dermatologischen und allergologischen Krankheiten, die potenziell von COVID‐19 betroffen sind, stehen wir vor komplexen Herausforderungen, die Pathogenese und Beeinflussung verschiedener immunologischer Signalwege einschließen. Medizinische Behandlungen müssen daher im Zusammenhang mit dieser Infektion oft neu bewertet und in Frage gestellt werden. Dieser Übersichtsartikel fasst den aktuellen Wissensstand zu COVID‐19 hinsichtlich der wichtigsten dermatologischen und allergologischen Erkrankungen zusammen. Es werden aber auch die medizinischen Bereiche beschrieben, für die keine ausreichenden Daten vorliegen. Unter Zusammenfassung der publizierten Daten und grundsätzlicher pathophysiologischer Überlegungen werden hier Schlussfolgerungen für das Management unserer Patienten während der Pandemie gezogen. Wir konzentrieren uns auf häufige Hauterkrankungen mit komplexer immunologischer Pathogenese: Psoriasis, Ekzeme einschließlich atopischer Dermatitis, Typ‐I‐Allergien, blasenbildende Autoimmundermatosen, Kollagenosen, Vaskulitiden und Hautkrebserkrankung. Da viele weitere Hauterkrankungen verwandte oder vergleichbare immunologische Reaktionsmuster aufweisen, können pathophysiologisch ähnliche entzündliche Dermatosen möglicherweise auch mit ähnlichen therapeutischen Überlegungen und Schlussfolgerungen während der Pandemie behandelt werden. Daher soll diese Übersicht Behandlungsempfehlungen auf der Basis bisher publizierter Daten und Empfehlungen zu Therapieentscheidungen auch über die hier diskutierten, häufigsten Erkrankungen hinaus liefern.
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Affiliation(s)
- Timo Buhl
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum GöttingenDeutschland
- Niedersächsisches Institut für BerufsdermatologieUniversitätsklinikum GöttingenDeutschland
| | - Stefan Beissert
- Klinik für DermatologieUniversitätsklinikum Carl Gustav CarusTU DresdenDeutschland
| | - Evelyn Gaffal
- Klinik für DermatologieUniversitätsklinikum MagdeburgDeutschland
| | - Matthias Goebeler
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinik WürzburgDeutschland
| | - Michael Hertl
- Klinik für DermatologiePhilipps‐UniversitätMarburgDeutschland
| | - Cornelia Mauch
- Klinik für DermatologieUniversitätsklinik KölnDeutschland
| | - Kristian Reich
- Translational Research in Inflammatory Skin DiseasesIVDPUniversitätsklinikum Hamburg‐EppendorfDeutschland
| | - Enno Schmidt
- Klinik für DermatologieUniversität zu LübeckDeutschland
- Lübecker Institut für Experimentelle Dermatologie (LIED)Universität zu LübeckDeutschland
| | - Michael P. Schön
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum GöttingenDeutschland
- Niedersächsisches Institut für BerufsdermatologieUniversitätsklinikum GöttingenDeutschland
| | - Michael Sticherling
- Klinik für DermatologieFAU Erlangen‐Nürnberg und Universitätsklinikum ErlangenDeutsches Zentrum für Immuntherapie (DZI)ErlangenDeutschland
| | - Cord Sunderkötter
- Klinik für Dermatologie und VenerologieUniversitätsklinikum Halle‐WittenbergHalle (Saale)Deutschland
| | - Claudia Traidl‐Hoffmann
- Institut für UmweltmedizinUNIKA‐T AugsburgTechnische Universität München und Helmholtz Zentrum MünchenDeutsches Forschungszentrum für Gesundheit und UmweltDeutschland
- Ambulanz für UmweltmedizinUniversitätsklinikum AugsburgDeutschland
| | - Thomas Werfel
- Abteilung für Immundermatologie und AllergieforschungKlinik für Dermatologie und AllergologieMedizinische Hochschule HannoverDeutschland
| | - Dagmar Wilsman‐Theis
- Klinik für Dermatologie und AllergologieUniversitätsklinikumFriedrich‐Wilhelms‐UniversitätBonnDeutschland
| | - Margitta Worm
- Abteilung für Allergologie und ImmunologieKlinik für DermatologieVenerologie und AllergologieCharité ‐ Universitätsmedizin BerlinDeutschland
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Amoxicillin. REACTIONS WEEKLY 2020. [PMCID: PMC7442184 DOI: 10.1007/s40278-020-82307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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10
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Buhl T, Beissert S, Gaffal E, Goebeler M, Hertl M, Mauch C, Reich K, Schmidt E, Schön MP, Sticherling M, Sunderkötter C, Traidl-Hoffmann C, Werfel T, Wilsman-Theis D, Worm M. COVID-19 and implications for dermatological and allergological diseases. J Dtsch Dermatol Ges 2020; 18:815-824. [PMID: 32717116 DOI: 10.1111/ddg.14195] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022]
Abstract
COVID-19, caused by the coronavirus SARS-CoV-2, has become pandemic. A further level of complexity opens up as soon as we look at diseases whose pathogenesis and therapy involve different immunological signaling pathways, which are potentially affected by COVID-19. Medical treatments must often be reassessed and questioned in connection with this infection. This article summarizes the current knowledge of COVID-19 in the light of major dermatological and allergological diseases. It identifies medical areas lacking sufficient data and draws conclusions for the management of our patients during the pandemic. We focus on common chronic inflammatory skin diseases with complex immunological pathogenesis: psoriasis, eczema including atopic dermatitis, type I allergies, autoimmune blistering and inflammatory connective tissue diseases, vasculitis, and skin cancers. Since several other inflammatory skin diseases display related or comparable immunological reactions, clustering of the various inflammatory dermatoses into different disease patterns may help with therapeutic decisions. Thus, following these patterns of skin inflammation, our review may supply treatment recommendations and thoughtful considerations for disease management even beyond the most frequent diseases discussed here.
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Affiliation(s)
- Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Evelyn Gaffal
- Department of Dermatology, University Hospital Magdeburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Germany
| | - Michael Hertl
- Department of Dermatology, Philipps University, Marburg, Germany
| | - Cornelia Mauch
- Department of Dermatology, University Hospital Cologne, Germany
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, IVDP, University Medical Center Hamburg-Eppendorf, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Germany.,Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Germany
| | - Michael Sticherling
- Department of Dermatology, FAU Erlangen-Nuremberg and University Hospital Erlangen, German Center Immunotherapy (DZI), Erlangen, Germany
| | - Cord Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle-Wittenberg, Halle (Saale), Germany
| | - Claudia Traidl-Hoffmann
- Institute of Environmental Medicine, UNIKA-T Augsburg, Technical University Munich and Helmholtz-Zentrum Munich, German Research Center for Environmental Health, Germany.,Outpatient Clinic for Environmental Medicine, University Hospital Augsburg, Germany
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Germany
| | - Dagmar Wilsman-Theis
- Department of Dermatology and Allergology, University Medical Center, Friedrich Wilhelm University, Bonn, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Germany
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