What are the cutaneous manifestations of covid-19 like?
At the beginning of this pandemic we thought that COVID-19 infection had no skin manifestations; now, almost two months later, it has been found that 20% of patients have skin manifestations.
We must understand that we are dealing with a new disease, which we are learning to know and understand a little more each day. We know that this virus can affect many organs and therefore the clinical manifestations are very varied.
In the skin we can find rashes similar to urticaria (i.e. with generalized and itchy wheals or welts), rashes similar to those seen with other viruses, pustular lesions and a type of lesions that are more specific which are vascular lesions similar to bruises, chilblains or purpuric lesions, this type of vascular lesions have been described more frequently in children and adolescents, with good general condition or with the infection already resolved.
It is difficult to draw conclusions, but everything seems to indicate that COVID-19 can somehow damage the vascular endothelium (inner lining of blood vessels) and somehow favor coagulation, so it is easy to see these vascular manifestations.
How can we distinguish them from normal ones?
It is important not to be carried away by the fear of being infected by coronavirus, fortunately most of the skin lesions we see in children and adolescents, and also in adults correspond to normal and common dermatoses (urticaria, eczema, psoriasis, purpura, infectious exanthema…).
The most sensible thing to do is to make an epidemiological correlation, that is, if there is contagion in the family circle or the patient presents symptoms suggestive of infection by COVID-19, the patient should be carefully evaluated, identifying the skin lesions and determining with the pertinent tests the state, severity and possibility of contagion of the patient.
Dermatologists are trained to make this type of diagnosis, so in the presence of a dermatosis, do not hesitate to consult us.
How can we treat them?
Once again I have to say that the treatment is still not well agreed upon, in general we will use symptomatic treatment: if there is inflammation we will use an anti-inflammatory, if there is itching an antihistamine, if there are coagulation alterations we will be able to evaluate antiaggregants, etc.
There is no standard, we still have a long way to go to have a single or even preventive protocol in recently infected patients, the study, observation and monitoring of patients will provide answers to these questions.
How serious are they?
Fortunately, skin lesions usually resolve spontaneously and do not add to the severity of the picture. Although it is too early to draw conclusions, the feeling is that patients with vascular lesions such as chilblains on the heels, toes, etc. do not usually have serious manifestations of the disease or it may even have already resolved.
I would like to insist that there should be no hysteria or excessive concern about the appearance of skin lesions. If there is a need, remember that dermatologists have never ceased to be available for emergencies and for any patient who needs them.