The Fitzpatrick scale has been in use for skin colour typing according to the tanning potential of skin since its inception in [1975][1976]. Thomas Fitzpatrick developed the scale to classify persons with 'white skin' in order to select the correct amount of UVA in Joules/cm 2 for PUVA treatment for psoriasis. Since then, it has been widely used in Dermatology to gauge the skin's reaction to UV exposure, tanning potential, assessment of sunburn risk and amount of sun protection required for individual patients. However, the use of this scale has been of limited utility because of different self-perception in different areas of the world, particularly among those with skin of colour. Skin cancer risk is loosely inversely correlated with the initial genetic/inherent amount of melanin (most research has focused on eumelanin) present in the skin, although the pattern of exposure and amount of UV radiation required causing DNA damage varies widely according to different cancers. In this review, we have shown that the Fitzpatrick scale is neither correct nor adequate to reflect sunburn and tanning risk for skin of colour. Therefore, it may give both patients and physicians a false sense of security that there is little risk that people of colour can develop skin cancers. We have reviewed the small but not insignificant risk of skin of colour developing skin cancers and emphasise that there remains much research that needs to be done in this field. Abbreviations: Asian, persons tracing their origins to primarily Asian origins; Black, non-Hispanic persons of primarily African origins; Hispanic, Persons tracing their origins to primarily Central or South American origins; White, non-Hispanic persons of primarily European Caucasian origins. Peter Goon and Nick J. Levell are joint senior authors.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Bullous pemphigoid (BP) appears to be rising in incidence across the Western World, especially in the elderly. Some of the pathogenetic mechanisms involving antigen mimicry and antibody cross‐reactivity have been elucidated for cases associated with neurological disease and certain drugs. There have been reports of cutaneous manifestations of Covid‐19 (SARS‐Cov2 infection) as the pandemic has raged across the world. We report here a case of prolonged Covid‐19, symptomatic with dermatoses only, which was seen to evolve initially from a maculo‐papular exanthema with acral vesicular dermatitis, into classical BP disease. This was confirmed histologically by positive skin autoantibody serology, direct IMF on peri‐lesional skin and also salt‐split IMF. Although possible that the development of BP could be a purely co‐incidental finding during Covid‐19, we suggest that it is more likely that prolonged SARS‐Cov2 infection triggered an autoimmune response to the basement membrane antigens, BP 180 and 230. To our knowledge, this is the first case of BP developing during concurrent Covid‐19 disease. It will be necessary to continue dermatological surveillance as the pandemic continues, to collate data on BP incidence and to test these patients for Covid‐19 disease. As the pandemic continues, even potential and rare associations such as this will be clarified eventually.

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compatible with KP, but papules appeared with linear and short paths during sea baths and were not triggered by scratching, suggesting possible contacts with polyps full of planula-like particles. In South Brazil, epidemic outbreaks of injuries caused by the jellyfishes O. sambaquiensis and C. lactea are frequent, mainly in summer. 9,10 These cause rounded plaques and papules distributed in short paths, being marks of contact with the body and short tentacles. Intense burning pain is an immediate symptom and skin lesions are usually seen in the affected areas. 9,10 On the other hand, envenomations caused by L. unguiculata, do not allow the visualization of any round mark and the contacts (with any of the life cycle forms) and cause itching not pain. 1-4,9,10 We conclude that SBE with papules and linear plaques, with no signs of post-itchy trauma caused by nails and arising during sea baths can mimicking envenomations by the jellyfish species O. sambaquiensis and C. lactea being a new clinical pattern. However, the two entities can be differentiated by the clinical aspects and epidemiology of the diseases. Acknowledgement We thank Dr. F abio Lang da Silveira for allowing the photographs of L. unguiculata (Fig. 2d,e). ACM was supported by CNPq (309440/2019-0). The patients in this manuscript have given written informed consent to the publication of their case details.