Occurrence of severe cutaneous adverse drug reactions is predictable, and dire effects can be avoided if the medical community is aware of the problem. 6, and HIV. Thus, reporting cases is usually of paramount importance to allow pharmacovigilance companies BI-1347 to estimate the effective incidence. Table I shows drugs empirically used to treat COVID-19 and several possible skin reaction patterns for quick discussion by clinicians. Table I List of main drug categories and selected active principles currently used or under evaluation for COVID-19 management, with PR65A possible related cutaneous adverse reactions from the literature 2016; 43(3):321-324. Halevi A, et?al. 2000;34(1):32-34. Ib?ez, M.D, et?al. 2020;S0190-9622(20)30564-8. Bodard Q, et?al. 2020;41:289-292. Liccioli G, et?al. 2019;104(1-2):57-59. Schwartz RA, et?al. 2020;33(3):e13380. Pai SB, et?al. 2017; 49(1):132-134. Murphy M, et?al. 2001;26(5):457-458. Lopinavir/ritonavir?or darunavir/ritonavirPruritus Maculopapular rash Urticaria angioedema Seborrheic dermatitis Alopecia Scleroderma-like lesions Lichenoid drug eruption Lipodystrophy Nail, oral, or skin hyperpigmentation Paronychia AGEP Erythema multiforme SJS Vasculitis TEN DRESS Ghosn J, et?al. 2005;41(9):1360-1361. Calista D. 2005;15(2):97-98. Manfredi R, et?al. 2006;20(18):2399-2400. Cvetkovic RS, et?al. 2008;22(12):1389-1397. Pistone G, et?al. 2014;6(2):145-149. Introcaso CE, et?al. 2010;63(4):549-561. Sharma A, et?al. 2008;74(3):234-237. TocilizumabRash Pruritus Urticarial eruption Skin infections Ulcer Psoriasiform dermatitis Anaphylaxis Hypersensitivity reaction Koryrek ?M, et?al. 2016;35(2):145-152. Bannwarth B, et?al. 2019;11(3):317-321. RemdesevirRashes Grein J, et?al. 2020;382(24):2327-2336. Baricitinib tocilizumabUrticaria angioedema Rash Palmoplantar pustulosis Herpes simplex/zoster Psoriasiform dermatitis Melanoma Nonmelanoma skin BI-1347 cancers Praveen D, et?al. 2019;7(1):001383. Matsushima Y, et?al. 2019;11(3):317-321. Antibiotic (azithromycin or other targeted drugs for secondary infections)Pruritus Maculopapular exanthem Urticaria angioedema Anaphylaxis Fixed drug eruption AGEP Vasculitis SJS-TEN DRESS Shaeer MK, et?al. 2019;7(3):135 Balakirski G, et?al. 2017;36(4):307-316. Sriratanaviriyakul N, et?al. 2014;8:332. Khaldi N, et?al. 2005;12(3):e264-e268. Williams DA. 2000; 165(8):636-637. Antifungals (allylamine, imidazoles, or others for opportunistic infections)Pruritus Maculopapular exanthem Urticaria angioedema AGEP SJS Exfoliative dermatitis Subacute LE Castellsague J, et?al. 2002;2:14. Chaudhary RG, et?al. 2019;10(2):125-130. Beltraminelli HS, et?al. 2005;152(4):780-783. Systemic BI-1347 corticosteroid (mainly dexamethasone)Atrophy, skin fragility Purpura Red stretchmarks Hypertrichosis Acneiform eruption Systemic hypersensitivity Liu D, et?al. 2013;9(1):30. Kannan S, et?al. 2015;47(6):696-698. Watts TJ, et?al. 2019;81(5):384-386. Barbaud A, et?al. 2016;22(45):6825-6831. Heparin (low excess weight molecular)Maculopapular, exanthema Urticarial type I reaction Delayed type hypersensitivity AGEP Skin necrosis type III Arthus reaction Phan C, et?al. 2014;141(1):23-29. Klos K, et?al. 2007;57(4):718-721. Wtschert R, et?al. 1999;20(6):25-30. IvermectinEdema of face and extremities Papular rash Bullous skin lesions TEN Burham GM. 1993;87:313-317. Seegobin K, et?al. 2018;36(5):887-889. Interferons (; )Hair loss Induce, reveal, or worsen some dermatoses (atopic dermatitis, psoriasis, sarcoidosis, lichen) Sarcoidosis, lupus Polymorphic erythema Vasculitis Lichenoid drug eruption Descamps V.?2005;34(21):1668-1672. Li C, et?al. 2019;47(7):3453-3457. Verma P, et?al. 2017;29(6):380-382. Bush AE, et?al. 2017;16(7):714-716. Lorcy S, et?al. 2016;143(5):336-346. IVIgUrticaria Maculopapular exanthem Anaphylaxis Alopecia Erythema multiforme Lichenoid dermatitis Eczematous eruptions Pompholyx Purpura Vasculitis Berk-Krauss J, et?al.?2018;4(3):170-173. Gerstenblith MR, et?al. 2012;66(2):312-316. Cohen Aubart F, et?al. 2009;20(1):70-73. Vecchietti G, et?al. 2006;142(2):213-217. Open in a separate window Expected incidence of the events might range from common (1/100 and? 1/10 uncovered persons) for pruritus, urticaria, and maculopapular exanthem to rare (1/10,000 and? 1/1000) for the majority of other reactions and to very rare for severe drug reactions (5/1 million for AGEP, SJS, and DRESS and 1/1 million for TEN). em AGEP /em , Acute BI-1347 generalized exanthematous pustulosis; em DRESS /em , drug reaction with eosinophilia and systemic symptoms syndrome; em GPEF /em , generalized pustular figurate erythema; em IVIg /em , intravenous immunoglobulins; em SJS /em , Stevens-Johnson syndrome; em TEN /em , harmful epidermal necrolysis. A typical example of a wide spectrum of cutaneous adverse drug reactions associated with a drug used to treat COVID-19 is usually hydroxychloroquine, which is usually associated with acute generalized exanthematous pustulosis, drug reaction with eosinophilia systemic symptoms, and lethal harmful epidermal necrolysis.3 Antibiotics, as well as antiretrovirals, are?associated with a high risk of drug eruptions,2 whereas other experimental drugs, such as remdesivir, are poorly characterized in the literature, with unknown frequencies and risk factors for cutaneous adverse drug reactions. Tocilizumab is usually a potential inhibitor of multiple cytochrome enzymes, including CYp450, and increased levels of concomitant drugs?or unstable metabolites may BI-1347 lead to skin toxicity, as well as delayed hypersensitivity reactions. Intravenous immunoglobulins are associated with cutaneous adverse events in up to 6% of patients. A recent Italian study on skin manifestations associated with COVID-19 revealed that approximately 40%.