The medical community in the past months has seen a flourishing of information related to the SARS‐CoV‐2 virus responsible for the COVID‐19 pandemic. From the early days of the pandemic, the SARS‐CoV‐2 virus has been linked to multiple different types of skin involvement. To the best of our knowledge, we are the first to report on a case of familial clustering of a maculopapular COVID‐19 rash. 8 persons presented COVID‐19 symptoms, 6 were confirmed via SAR‐CoV‐2 chemoluminescent immunoassays, and the 4 related by blood presented skin manifestations. While it has not been fully established if the SARS‐CoV‐2 can in fact cause viral exanthems, our observations regarding the familial clustering and the temporal evolution seen in this family seem to present strong evidence of a viral exanthema related to SARS‐CoV‐2 infection.

The interrelations and sequencing of interleukins are complex (inter)actions where each interleukin can stimulate the secretion of its preceding interleukin. In this paper, we attempt to summarize the currently known roles of IL-4, IL-13, IL-31, and IL-33 from a multi-disciplinary perspective. In order to conduct a comprehensive review of the current literature, a search was conducted using PubMed, Google Scholar, Medscape, UpToDate, and Key Elsevier for keywords. The results were compiled from case reports, case series, letters, and literature review papers, and analyzed by a panel of multi-disciplinary specialist physicians for relevance. Based on 173 results, we compiled the following review of interleukin signaling and its clinical significance across a multitude of medical specialties. Interleukins are at the bed rock of a multitude of pathologies across different organ systems and understanding their role will likely lead to novel treatments and better outcomes for our patients. New interleukins are being described, and the role of this inflammatory cascade is still coming to light. We hope this multi-discipline review on the role interleukins play in current pathology assists in this scope.

SARS-CoV-2 has recently been associated with the reactivation of varicella zoster virus in patients. This is potentially an observation of a local susceptibility of the skin in areas of vesicle formation. This article explores the dermatologic manifestations that have been linked to the SARS-CoV-2 virus, their infectious risk, as well as potential confounding factors. An isotopic response may be occurring due to the occurrence of an immunocompromised district incited by sustained inflammation mediated by inflammatory cytokines.

Sexual contact has been proposed as a route of transmission for the SARS‐CoV‐2 virus, which raises the question of alternate routes of transmission. ¹ Angiotensin‐converting enzyme (ACE)2 receptors (ACE2‐R) may be present in epidermal basal cells, including those at the base of hair follicles, sebaceous and eccrine glands, smooth muscle cells, vascular endothelial cells, renal epithelial cells, and potentially even the testis. ² Recent research shows that although the testicles do carry ACE2‐R and that some patients might present with symptoms of viral orchitis, viral DNA is not found within seminal fluid after infection. Furthermore, it is postulated that the viral load is likely to be too low to cross the blood–testis barrier, and that ACE2‐R concentration in the testis may be insufficient to permit viral entry. ³ However, other types of sexual contact, such as oral–anal contact, may also be implicated in transmission, given that rectal swab testing is positive even with negative nasopharyngeal swabs. ¹, ⁴ It therefore seems relevant to ask whether all tissues that express ACE2‐R are receptive to viral entry, and if they can also be a source of viral shedding. Although some authors have suggested that there is no evidence of sexual transmission for SARS‐CoV‐2, it is still an interesting hypothesis to bear in mind, as it could place some sexual minorities at disproportionately higher risk.

There are a wide variety of disfiguring dermatological conditions whose pathologic substrate is represented by the unwanted deposition of collagen from dermal fibroblasts. Pirfenidone has demonstrated efficiency in the treatment of disordered collagen production when applied topically. Due to a similar mechanism of action, we also hypothesize that a similar medication, nintedanib, might have similar applications. We also propose that a liposomal technology may assist in the penetration of nintedanib and enhance its clinical effects.

Already from the early days of the COVID‐19 pandemic, regulatory agencies have attempted to ascertain the possible routes of SARS‐CoV‐2 viral transmission. It is hypothesized that the lipid bilayer that surrounds the SARS‐CoV‐2 improves its ability to remain stable on sebum‐rich skin and serves as another possible route of contracting the virus. One possible aspect of these observations that has yet to be explored in detail is what role arthropods that have been associated with human skin infestation, such as Demodecidae or Pyemotidae species, play in viral transmission. It seems likely that arthropod‐coronavirus interactions may take place through the molecular attraction forces between the chitin found on the exoskeleton of mites commonly found on human skin and the lipids present on the viral envelope of the SARS‐CoV‐2. We believe this may mean that arthropods are currently an overlooked cofactor in viral infection which may have some important biomedical implications for both prevention and treatment.