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Endothelial injury generated directly by intracellular viral replication and by ACE2 downregulation, exposing cells to angiotensin II in the absence of the modulator effects of angiotensin 1–7 (Vinciguerra et al., 2020), and vascular chronic inflammation promoting the development of tissue macrophages overloaded by cholesterol (foam cells), both increase the possibility of acquiring a severe COVID-19 infection (Vinciguerra et al., 2020

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13 In the current study, in Group B (derma roller with copper peptide) patients with Fitzpatrick skin type 5 had a greater decline compared to those patients with Fitzpatrick skin type 5 in Group A (dermaroller monotherapy), suggesting faster response in darker skin tones