Exacerbation of atopic dermatitis skin lesions in SARS-CoV-2 disease

Atopic dermatitis (AD, eczema), is a chronic skin disease caused by incorrect reactions of the immune system. Common symptoms are defined using Hanifin and Rajka diagnostic standards. In AD the skin barrier is defective, pruritus threshold is lowered and there is higher sensitivity to various stimuli. For these reasons there are lots of factors such as environmental allergens, psychological stress, perspiration, chemical irritants, temperature fluctuations, exposure to wool and lanolin, which can exacerbate atopic dermatitis [1]. Moreover, there is a connection between viral infections and aggravation of AD which probably occurred in the presented case [2, 3].
Coronavirus disease caused by SARS-CoV-2 is still undergoing extensive research regarding the clinical presentation in various patients. This virus is constantly evolving, there are new mutations and because of that, complete clinical manifestation has not been fully discovered yet. The main symptoms resemble influenza with headache, dry cough, loss of smell, low fever, sore throat, nasal congestion, fatigue, myalgia, arthralgia, nausea and diarrhoea. Most patients are asymptomatic or oligosymptomatic. There is still little known about the skin manifestation connected with SARS-CoV-2 [3].
A 23-year-old woman has been suffering from atopic dermatitis since infancy. This condition was diagnosed using Hanifin and Rajka diagnostic criteria at the age of 10. She fulfils four out of four major criteria. There is a positive family history (her father has allergic rhinoconjunctivitis), pruritus, typical localization and chronic character. The patient has been using an emollient preparation, topical glucocorticosteroids and calcineurin inhibitors so far with a moderate effect. The patient does not suffer from either atopic or chronic disease.
Control of the disease had been satisfying for approximately 5 years without need for hospitalization. In February 2021, a strong exacerbation occurred. Five days earlier, the patient had contact with a person infected with coronavirus who was presenting with symptoms of infection and later confirmed the presence of antibodies. Unusual was the fact that skin lesions included places where they usually had not appeared before. They were located over a large area and were significantly more severe – skin was reddened all over the neck, décolleté, nape, dorsal parts of the hands, wrists and in the knee fossa (Figures 1 A–C).
Later there was...


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