Introduction: The novel coronavirus is rapidly spreading around the world. Since the public announcement of the COVID-19 outbreak, several concerns have been raised by dermatologists as well as pemphigus patients who take immunosuppressive drugs. In this paper, we review the literature about the common treatment of pemphigus with a focus on the lessons from similar epidemics to find a proper suggestion to manage pemphigus in the COVID-19 pandemic era. The effect of many of the drugs used for treatment of Pemphigus vulgaris (PV) on COVID-19 is not clear. We also do not have data on the impact of this autoimmune disease, which may involve the mucous membranes, on the acquisition or course of COVID-19. We are currently in the midst of a pandemic and evaluating the effect of COVID-19 on the population of susceptible patients suffering from auto-immune diseases like pemphigus is essential. The evidence on best ways to manage patients with underlying conditions, such as pemphigus, during the outbreak of COVID-19 is evolving and the data is updated every day.
Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25(3):278-80.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020.
Stanley JR, Amagai M. Pemphigus, bullous impetigo, and the staphylococcal scalded-skin syndrome. New England Journal of Medicine. 2006;355(17):1800-10.
Wu H, Wang ZH, Yan A, Lyle S, Fakharzadeh S, Wahl JK, et al. Protection against pemphigus foliaceus by desmoglein 3 in neonates. New England Journal of Medicine. 2000;343(1):31-5.
Kridin K, Zelber-Sagi S, Bergman R. Pemphigus vulgaris and pemphigus foliaceus: differences in epidemiology and mortality. Acta dermato-venereologica. 2017;97(8-9):1095-9.
Wang LS, Wang YR, Ye DW, Liu QQ. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence. Int J Antimicrob Agents. 2020:105948.
Zhao CY, Murrell DF. Pemphigus vulgaris: an evidence-based treatment update. Drugs. 2015;75(3):271-84.
Gheisari M, Faraji Z, Dadras MS, Nasiri S, Robati RM, Moravvej H, et al. Methylprednisolone pulse therapy plus adjuvant therapy for pemphigus vulgaris: an analysis of 10 years' experience on 312 patients. Dermatol Ther. 2019;32(5):e13057.
Kunisaki KM, Janoff EN. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. The Lancet infectious diseases. 2009;9(8):493-504.
Pishgahi M, Dadkhahfar S, Robati RM, Kheradmand Z, Shahidi-Dadras M, Zargari O, et al. Electrocardiographic changes after high-dose corticosteroid pulse therapy in pemphigus patients. Journal of Dermatological Treatment. 2018:1-4.
Shahidi-Dadras M, Pishgahi M, Tabary M, Kheradmand Z, Araghi F, Dadkhahfar S, et al. Cardiac function in pemphigus vulgaris patients before and after steroid pulse therapy. J Dermatolog Treat. 2020:1-5.
Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. The Lancet. 2020;395(10223):473-5.
Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS medicine. 2006;3(9).
Guo L, Han Y, Li J, Chen Q, Ren Y, Wu Q, et al. Long-term outcomes in patients with severe acute respiratory syndrome treated with oseltamivir: a 12-year longitudinal study. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL MEDICINE. 2019;12(10):12464-71.
Ni Y-N, Chen G, Sun J, Liang B-M, Liang Z-A. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Critical Care. 2019;23(1):99.
Sinha P, Chatterjee M, Vasudevan B. Pemphigus vulgaris: A dermatological sequel of severe H1N1 infection. Indian dermatology online journal. 2014;5(2):216.
Didona D, Maglie R, Eming R, Hertl M. Pemphigus: Current and Future Therapeutic Strategies. Frontiers in Immunology. 2019;10(1418).
Murrell DF, Peña S, Joly P, Marinovic B, Hashimoto T, Diaz LA, et al. Diagnosis and Management of Pemphigus: recommendations by an International Panel of Experts. Journal of the American Academy of Dermatology. 2018.
Joly P, Maho-Vaillant M, Prost-Squarcioni C, Hebert V, Houivet E, Calbo S, et al. First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. The Lancet. 2017;389(10083):2031-40.
Cho A, Bradley B, Kauffman R, Priyamvada L, Kovalenkov Y, Feldman R, et al. Robust memory responses against influenza vaccination in pemphigus patients previously treated with rituximab. JCI insight. 2017;2(12).
Kasperkiewicz M, Eming R, Behzad M, Hunzelmann N, Meurer M, Schulze‐Koops H, et al. Efficacy and safety of rituximab in pemphigus: experience of the German Registry of Autoimmune Diseases. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2012;10(10):727-31.
Chiu H-Y, Chang C-Y, Hsiao C-H, Wang L-F. Concurrent cytomegalovirus and herpes simplex virus infection in pemphigus vulgaris treated with rituximab and prednisolone. Acta dermato-venereologica. 2013;93(2):200-1.
Wei K, Wang Y, Wang W, Chen W. Fatal infection of Pneumocystis jiroveci pneumonia in a pemphigus patient treated with rituximab. Journal of the European Academy of Dermatology and Venereology. 2017;31(8):e350-e1.
Atkinson JR, Bergmann CC. Protective humoral immunity in the central nervous system requires peripheral CD19-dependent germinal center formation following coronavirus encephalomyelitis. Journal of virology. 2017;91(23):e01352-17.
Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chemical Neuroscience. 2020.
Murrell DF, Pena S, Joly P, Marinovic B, Hashimoto T, Diaz LA, et al. Diagnosis and management of pemphigus: Recommendations of an international panel of experts. J Am Acad Dermatol. 2020;82(3):575-85 e1.
Atzmony L, Hodak E, Leshem YA, Rosenbaum O, Gdalevich M, Anhalt GJ, et al. The role of adjuvant therapy in pemphigus: a systematic review and meta-analysis. Journal of the American Academy of Dermatology. 2015;73(2):264-71.
Kim S-H, Ko J-H, Park GE, Cho SY, Ha YE, Kang J-M, et al. Atypical presentations of MERS-CoV infection in immunocompromised hosts. Journal of infection and chemotherapy. 2017;23(11):769-73.
Brown AE, Motaparthi K, Hsu S. Rituximab and intravenous immunoglobulin as alternatives to long-term systemic corticosteroids in the treatment of pemphigus: a single center case series of 63 patients. Dermatol Online J. 2018;23(12).
Zhang L, Liu Y. Potential interventions for novel coronavirus in China: A systematic review. Journal of Medical Virology. 2020;92(5):479-90.
Lew TW, Kwek T-K, Tai D, Earnest A, Loo S, Singh K, et al. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. Jama. 2003;290(3):374-80.
Pathoulas JT, Stoff BK, Lee KC, Farah RS. Ethical Outpatient Dermatology Care During the Coronavirus (COVID-19) Pandemic. Journal of the American Academy of Dermatology.
Devaux CA, Rolain J-M, Colson P, Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? International Journal of Antimicrobial Agents. 2020:105938.
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet.