COVID-19 and Cutaneous manifestations Dear Editor We found that the article on 'Cutaneous manifestations in COVID-19: a first perspective' is very interesting. 1 Recalcati noted that 20.4% of the patients have cutaneous problem and mentioned that this is the first report on this clinical aspect of COVID-19. The wide spectrum of dermatological problem in patients with COVID-19 is an interesting clinical data. Based on our experiences in Thailand, the second country that COVID-19 occurred, almost all patients have no significant dermatological presentation. In fact, in caring patient with severe illness, skin disorder might not be completely investigated. The role of dermatologist in caring COVID-19 patients might be overlooked. An important question is whether the dermatological problem in COVID-19 has any clinical impact on diagnosis and treatment of disease. Some skin disorders in COVID-19 might result in missed diagnosis. For example, the petechiae rash might result in incorrect diagnosis as dengue.

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appropriate diagnosis for our case. The patient's complete response to steroid therapy, which usually causes deterioration in COVID-19 cases, supports our diagnosis. It is important to be aware of the similar clinical manifestations between EGPA and COVID-19.

PurposeHeterozygous missense STAT1 mutations leading to a gain of function (GOF) are the most frequent genetic cause of chronic mucocutaneous candidiasis (CMC). We describe the case of a patient presenting a new GOF mutation of STAT1 with the clinical symptoms of CMC, recurrent pneumonia, and persistent central erythema with papulopustules with ocular involvement related to rosacea-like demodicosis.MethodsGenetic analysis via targeted next-generation sequencing (NGS; NGS panel DIPAI v.1) exploring the 98 genes most frequently involved in primary immunodeficiencies, including STAT1, was performed to identify an underlying genetic defect.ResultsNGS identified a novel variant of STAT1, c.884C>A (exon 10), p.T295Y, not previously described. This variant was found to be gain of function using an in vitro luciferase reporter assay. Rosacea-like demodicosis was confirmed by substantial Demodex proliferation observed via the microscopic examination of a cutaneous sample. A review of literature retrieved 20 other cases of STAT1 GOF mutations associated with early-onset rosacea-like demodicosis, most with ocular involvement.ConclusionWe describe a new STAT1 GOF mutation associated with a phenotype of CMC and rosacea-like demodicosis. Rosacea-like demodicosis appears as a novel and important clinical phenotype among patients with STAT1 GOF mutation.

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