Patient‐reported skin reactions to 5% 5‐fluorouracil in treatment of actinic keratosis

COVID-19 diagnosis.She was treated with azithromycin at the beginning of the pandemic in her skilled nursing facility before succumbing.A 65-year-old man with PV and obesity on mycophenolate mofetil who received rituximab 5 months prior was treated with decadron and bamlanivimab and recovered without hospitalization.Altogether, six patients were treated with rituximab, three with mycophenolate mofetil, five with methotrexate (each alone or in combination with prednisone), and five with topical steroids alone or in combination with tetracycline antibiotics.All five patients treated with topical corticosteroid/ tetracycline recovered.Two required hospitalizationa 99year-old woman who had a BP flare after recovery and entered hospice care soon thereafter and a 102-year-old woman with BP treated with tocilizumab and supplemental oxygen.The five patients in the methotrexate group recovered at home.The three patients treated with mycophenolate mofetil recovered, one after intensive care unit admission, tocilizumab, high-dose steroids and ventilation, and one after a hospital course complicated by embolic stroke, deep vein thrombosis and pulmonary embolism.The recovery of 17 of 19 patients with AIBD who had documented SARS-CoV-2 infection in our single institution cohort, despite advanced age and comorbidities, is reassuring.The two deaths were in individuals treated with rituximab < 6 months before infection, suggesting that recent rituximab therapy may increase risk of poor outcomes.These findings complement observations of decreased hospitalization rates of infected patients with AIBD with increasing intervals post rituximab 3 and a 4Á04-fold increase in death among rheumatology patients on rituximab, 4 and likely reflect the kinetics of B cell reconstitution following depletion.7 Thus, our data provide specific rational supporting expert guidelines to weigh the risks of rituximab relative to other immunosuppressive therapies for AIBD during this pandemic.8 Although larger datasets are needed, our observations suggest that patients on rituximab be counselled about the increased risks for poor COVID-19 outcomes.Patients should be vaccinated prior to therapy when possible, and dermatologists should consider confirming response with SARS-CoV-2 spike protein IgG serologies.Finally, the observations in this cohort, although small, provide rationale for the immediate use of COVID-19 monoclonal antibodies such as bamlanivimab, etesevimab, casirivimab and imdevimab after SARS-CoV-2 detection in dermatology patients treated with rituximab in the previous 6 months.