Reply: Introducing special cutaneous "sign" tribute to health care workers managing new coronavirus disease (COVID-19)-new additions.

After our initial contribution of introducing a special cutaneous “sign” tribute to health care workers managing the new coronavirus disease (COVID-19) and subsequently a few additions by Darlenski et al, I should like to clarify my stance on their suggestions. , We could add the medics who have sacrificed their lives to fight the COVID-19 pandemic, as well as the medical staff who are currently risking their precious lives for the same cause when defining this special sign. This sign mainly includes classic cutaneous changes following the heavy use of personal protective medical equipment on the face; hence, there is no rationale to adding skin lesions elsewhere in the same population also created by the extensive use of these medical devices as suggested by the same authors. ,

The newly introduced special cutaneous sign should be dedicated to the memory of those medical personnel who have sacrificed their precious lives, as well as to those who currently serve with the COVID-19 epidemic control and treatment care units, possessing peculiar pressure injuries (erythema, deep indentations, and ulcerations) on their faces related to the various personal protective equipment they have worn. This should be described as a manifestation of the “COVID-19 MS sign” (“MS” stands for medical staff).

Apart from that, although my colleagues, both locally and internationally, highly support and endorse the newly described clinical sign, a few have questioned the application of this sign for health care workers and for those who have not displayed complete clinical pictures of their faces after the prolonged use of protective medical equipment. As a result, I should like to add the new descriptive term “partial COVID-19 MS sign” related to “COVID-19 MS sign” denoted and depicted in Table 1 and Figure 1 .

Table 1

A. Type of pressure injuries 1. Erythema 2. Deep indentations 3. Ulcerations

B. Sites of facial injury 1. Forehead 2. Bridge of the nose 3. Cheeks (2 sites) 4. Retro-auricular area (2 sites)

C. Point system and definition Any of the given injury on the mentioned facial site—1 point The total number of sites is 6; hence, total number of points—6 points 1–3 points: partial COVID-19 MS sign 4–6 points: COVID-19 MS sign/complete COVID-19 MS sign

MS, medical staff.

Fig. 1

Complete & Partial Covid 19 MS Sign.