Omalizumab (OMZ) is a recombinant, humanized, and monoclonal immunoglobulin G1 (IgG1) anti-IgE antibody approved in patients 12 years of age and older with chronic spontaneous urticaria (CSU) resistant to H1 antihistamines. OMZ blocks IgE binding to its high-affinity FCεRI, resulting in a reduction in free IgE and IgE-mediated reactions. 1 The data on the use of OMZ during the coronavirus disease 19 (COVID-19) pandemic are limited, and our current knowledge is mainly based on case reports. It is recommended to continue OMZ in patients with mild-to-moderate COVID-19, and to prolong the dose intervals or interrupt the treatment according to the patient-based risk-benefit analysis in case of severe disease. 2,3 The aim of this study was to evaluate 1) the prevalence of COVID-19 infection, 2) maintenance of omalizumab treatment, 3) vaccination status, and 4) exacerbation of urticaria symptoms related to COVID-19 infection or vaccination in patients with CSU using omalizumab during the pandemic.

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Background: Chronic spontaneous urticaria (CSU) is a mast cell-mediated disease, which is sometimes associated with various inflammatory disorders.Omalizumab is a commonly used biological agent, which is a recombinant, humanized, monoclonal antibody against human immunoglobulin E. However, there are only few reports about the combination of omalizumab for CSU with any other biologics for accompanying inflammatory diseases in the literature. The aim of this study was to evaluate the patients whose treatment of omalizumab for CSU were combined with any other biologics for associated inflammatory disorders and to describe whether these combinations might have any safety concerns. Methods:We conducted a retrospective cohort study of adult patients with CSU treated with omalizumab concurrently using another biological agent for their other dermatological conditions.Results: Thirty-one patients, 19 women and 12 men, were evaluated. The mean age was 45.13 years. The median duration of omalizumab was 11 months.Biological agents which patients were treated other than omalizumab were as follows: adalimumab biosimilar (n = 3), ustekinumab (n = 4), secukinumab (n = 17) and ixekizumab (n = 7). The median duration of concurrent use of omalizumab and other biologics was 8 months. None of the drug combinations was stopped because of side effects. Conclusion:This observational study demonstrated that omalizumab treatment for CSU in combination with any other biological agents for dermatological disorders appeared to be well tolerated without any major safety concerns.

Psoriasis is a complex, chronic, and immune-mediated inflammatory disease affecting almost 2.5% of the world population. 1 Psoriasis is primarily a dermatological condition that is most often associated with other comorbidities, including psoriatic arthritis, hypertension, diabetes mellitus, obesity, psychiatric disorders, and systemic inflammation beyond the skin. Effective, safe, and long-term management of psoriasis is important in controlling skin lesions and preventing metabolic and psychiatric comorbidities. 2 New treatment

Introduction: Telogen effluvium (TE) is one of the causes of non-scarring hair loss that occurred commonly 2-3 months after a triggering factor. It was reported that the incidence of TE increased during the COVID-19 (coronavirus disease 2019) pandemic.However, to date, there is no study evaluating the status of COVID-19 before the onset of hair loss in patients with TE. The aim of this study is to evaluate the patients with TE whether they had COVID-19 or not before the onset of their hair loss and to compare the demographic and clinical characteristics and laboratory parameters of those with and without a history of COVID-19. Method:We conducted an observational cohort study of TE patients. The diagnosis of TE depended on anamnesis and physical examination of the patients. Also, hair pull test was performed. Demographic data and the results of COVID-19 real-time polymerase chain reaction (RT-PCR) were recorded from the electronic medical records.Results: Totally, 181 patients with TE were included in the study. Sixty-four of patients (35.4%) had been diagnosed with COVID-19 before the hair loss started. The median duration of development of hair loss was 2 months (range 1-11 months, IQR 3) after COVID-19 diagnosis. In this group, 87.5% of patients (n = 56) had acute TE and 12.5% of patients (n = 8) had chronic TE. The rate of acute TE and the use of vitamin supplements were ignificantly higher (p < 0.001 and p = 0.027, respectively) and the monocyte count in peripheral blood was lower (p = 0.041) in the group diagnosed with COVID-19. Discussion and Conclusion:It was stated that monocytes and macrophages infected by SARS-CoV-2 can produce pro-inflammatory cytokines that play a crucial role in the development of COVID-19-related complications. Also, it was suggested that the number of monocytes tends to be lower in the late recovery stage. The lower monocyte count in patients with a history of COVID-19 in our study may be related to evaluating the patients in the late period of recovery and the migration of circulating monocytes to hair follicles. The history of COVID-19 must be questioned in patients with TE. It should be kept in mind that hair loss that develops after COVID-19 may be presented as chronic TE form too. The exact mechanisms of hair loss induced by COVID-19 are not fully explained; the roles of monocytes on the hair follicles may be one of the responsible mechanisms. How to cite this article: Koç Yıldırım S, Erbağcı E, Demirel Öğüt N. Evaluation of patients with telogen effluvium during the pandemic: May the monocytes be responsible for post COVID-19 telogen effluvium?