Telogen effluvium (TE) is one of the most common form of hair loss in women. Many triggers have been identified, as stress, drugs, trauma, endocrine disease, nutritional deficiencies, and febrile states. We report three cases of TE occurred after severe Sars‐Cov‐2 infection and provide our clinical management, according to Sars‐Cov‐2 hygiene measures. Only one case report has been found in the literature associating anagen effluvium during severe Sars‐Cov‐2 infection. Other studies reported the exacerbation of a preexisting TE, correlated to the stress of lockdown. In our cases, patients never had a TE diagnosis before and did not report previous evident hair loss. TE can be associated with post severe Sars‐Cov‐2 infection. From our revision of the literature, this is the first case‐series describing TE in post severe Sars‐Cov‐2 patients. Further studies are needed to evaluate the relationship between TE and Sars‐Cov‐2 infection.

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To the Editor, Since the beginning of the well-known severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, skin involvement both in adults and children has been signaled. 1,2 However, large-scale studies describing skin manifestations and their etiopathogenic correlation with coronavirus disease 2019 (COVID-19) in detail have not been reported yet. Through the analysis of emerging data from literature 3 and the direct observation of three patients with COVID-19 (SARS-CoV-2 detection from nasopharyngeal swab samples through RNA extraction) and dermatological manifestations, we have hypothesized different mechanisms for their development. CASE 1: A 55-year-old woman was admitted to the Infectious Diseases Department of the General Regional Hospital of Ancona for pyrexia, dry cough, and dyspnea. Upon admission, she had undergone nasopharyngeal swab for SARS-CoV-2 isolation, with positive laboratory report. The day before, she had performed a chest X-ray showing a right parahilar pulmonary consolidation. At the admission, high-resolution computed tomography scan of the chest revealed a diffuse bilateral ground-glass opacity, then diagnosis of COVID-19 interstitial pneumonia was made. Her comorbidities included obesity (BMI = 30.2) and hypertension, in treatment with Bisoprolol Fumarate 5 mg once a day. Dermatological consultation was immediately requested for skin rash appeared 72 hours before hospital admission. It was therefore observed a generalized urticarial skin rash characterized by erythematous, smooth, slightly elevated papules and wheals, associated to severe pruritus. The patient did not report neither similar episodes in the past, nor allergies to drugs or foods. Furthermore, the patient had not taken any new medication before the rash appeared. Blood test revealed normal blood count (no lymphopenia or lymphocytosis or eosinophilia), slight increase of procalcitonin serum level (0.14 ng/mL), C-reactive protein (CRP, 12.1 mg/dL), and liver enzymes (glutamic oxaloacetic transaminase [GOT], glutamate pyruvate transaminase [GPT], lactate dehydrogenase [LDH], gamma-glutamyl ranspeptidase [GGT] fourfold levels). A systemic treatment with intravenous daily administration of betamethasone sodium phosphate 4 mg and chlorphenamine maleate 10 mg, in addition to antiviral therapy with lopinavir/ritonavir for pneumonia, was started. In the LETTER TO THE EDITOR | 2333 A careful personal and family history should be collected for each patients, even if paucisymptomatic, in this subset of patients (with a careful epidemiological investigation of possible COVID-19 infection), claiming for SARS-CoV-2 nasofaryngeal swab.

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Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock: a case report.