Dear Editor, Recent demonstration of ACE2 and TMPRSSs expressions, both necessary for entry of the virus into the host cells, in human epidermis suggests that skin might be a cellular host and a potential transmission route for SARS-CoV-2 , especially in skin fragility conditions 1 .
Epidermolysis bullosa (EB) is a skin fragility disorder caused by mutations in genes expressed in the cutaneous basement membrane zone 2, 3 . While an International consensus panel recently provided recommendations for prevention and multidisciplinary care of EB patients during the COVID-19 pandemic 4 , the phenotypic outcome in these patients in comparison to the general population has not been reported; however EB patients, particularly those with syndromic forms, may be at higher risk for infection with severe complications 4, 5 . Here, we reported three EB patients infected by COVID-19 during this pandemic. year-old male who experienced low-grade fever, pleuritic chest pain, myalgia, and dry cough (Figure 1e-g) 7 . This mutation was disclosed by gene-targeted next-generation sequencing panel for EB 8 . He initially adhered to most recommendations of isolation; however, he worked as a construction worker and experienced mild signs of infection. A nasopharyngeal swab specimen for SARS-CoV-2 was positive. Since his symptoms were mild, homequarantine was recommended. After one week, his symptoms were resolved without any specific treatment.
Patients with chronic diseases such as EB, may face health issues during the COVID-19 pandemic 9 . It has been suggested that disrupted epidermal barrier may provide an entry route for SARS-CoV-2 10 This article is protected by copyright. All rights reserved.
Our patients did not experience a severe course of COVID-19 despite some EB related complications, including severe anemia, esophageal strictures and growth retardation; in addition, one of the kidneys of the third patient was non-functional. Two patients experienced transient symptoms while in home-quarantine, and the third one required hospitalization. Thus, the severity of the COVID-19 in these EB patients was in the spectrum experienced by the general population. However, further clinical studies are required to investigate the prevalence and course of COVID-19 in EB patients. This article is protected by copyright. All rights reserved.