In the context of COVID-19 pandemic, teledermatology is being favoured over in-person consultation in order to avoid the possibility of virus transmission. 1 In France, COVID-19 was not known to cause cutaneous manifestations before 6 April 2020, when an alert about possible associated skin symptoms was raised to the general public and the professional social network. 2-4 We aimed to assess the impact of alerting about COVID-associated lesions on the activity of urgent teledermatology (TD) and the activity of dermatologic emergencies unit (DEU) of two university hospitals during this pandemic. This study was conducted between 30 March and 10 April 2020. These two institutions provide urgent consultations via a DEU and a store-and-forward teledermatology, between dermatologists and other healthcare professionals, with rapid responses. All consultations in the DEU and urgent TD were retrieved, and the number of consultations for suspicious COVID-associated lesions and non-COVID lesions was collected Figure 1 Number of patients with suspicious COVID-associated lesions and non-COVID lesions in teledermatology consultations.

Angiotensin-converting enzyme 2 (ACE 2) is expressed by several cells in the body, like the epithelial cells of the lungs and the blood vessels. It is a host receptor for severe acute respiratory syndrome coronavirus [SARS-CoV] and SARSCoV-2. 1 ACE inhibitors and angiotensin II type I receptor blockers (ARBs) cause an upregulation of ACE2. 2 Patients with hypertension and diabetes are at increased risk of COVID-19 infection. 2 This can possibly be because they are frequently treated with ACE inhibitors and ARBs, which increase the host receptor of the virus. 2 Carvedilol is a drug with vasodilating properties, initially designed for managing hypertension and coronary artery disease. Unlike ACE inhibitors that increase the expression of ACE 2, carvedilol decreases its expression. 3 This is why, ACE inhibitors or ARBs prescribed for hypertensive patients can be replaced by carvedilol during this pandemic. Moreover, not only patients on ACE inhibitors or ARBs can benefit from carvedilol. Since carvedilol decreases the expression of ACE, which is the COVID-19 host receptor, it can be useful for all COVID-19 patients.On the other hand, carvedilol can fight COVID-19 by another mechanism. Carvedilol has interleukin 6 (IL-6) suppressing properties. 4 Detectable serum SARS-CoV-2 viral load is closely associated with drastically elevated IL-6 level in critically ill COVID-19 patients. 5 So, carvedilol can be used to target IL-6, which plays a major role in the inflammatory cascade of COVID-19.In conclusion, we hypothesize that by downregulating ACE and by having anti-IL-6 properties, carvedilol has the potential to block 2 pathogenic pathways of COVID-19.

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