A multicenter study of COVID Skin, in which the Spanish Academy of Dermatology and Venereology (AEDV) has participated, has observed patients with COVID-19 or suspected disease for weeks and has managed to classify the cutaneous manifestations caused by COVID-19. The work was published in the prestigious British Journal of Dermatology and is freely available. It has been possible to conclude that the type of skin lesion a patient presents is closely related to the patient’s prognosis.
The analysis, carried out on 375 cases, and the use of a consensus method have shown that five patterns of skin manifestations can be established:
- chilblain-like eruptions on acral areas (19%);
- vesicular eruptions (9%)
- urticariform lesions (19%)
- maculopapular rashes (47%)
- livedo-reticularis or necrosis (6%)
Each of these patterns has been associated with specific patient characteristics, evolution and severity of the disease.
Acral chilblain-like eruptions (hands and feet)
This type of lesions was detected in 19% of cases, in younger patients, in the late stages of the COVID-19 process and in some cases in early stages with a duration of 12.7 days and were associated with a less severe evolution. They appeared as erythematous or violaceous areas. They were frequently asymmetric.
Vesicular eruptions
Detected in 9% of cases, they were seen mainly on the trunk. They consisted of small monomorphous vesicles (lesions very similar to each other), unlike those appearing in varicella which are polymorphous. They sometimes settled on the extremities and could have hemorrhagic content, enlarge or spread.
The study has shown that this type of manifestation is associated with intermediate severity and is more frequent in middle-aged patients. They usually last about ten days and appear together with general symptoms, sometimes before them.
Urticariform lesions
It is the third type of pattern, it has been registered in 19% of the cases, they have been seen mainly on the trunk or scattered over the body, in some cases on the palms of the hands. Their average duration is 6.8 days and they usually produce intense itching.
This type of manifestation has been observed in more severe patients and has most often appeared at the same time as other symptoms associated with COVID-19.
Maculopapules
They were the most frequent manifestations, detected in 47% of cases, the dermatological picture is often similar to that of other viral infections. Sometimes they show specific patterns, such as peri-follicular distribution, or similar to pityriasis rosea or erythema multiforme. They last 8 or 9 days on average. They have also been seen in more severe patients.
Livedo reticularis and necrosis
These lesions are indicative of vascular obstruction. They have been found in 6% of the cases, they have appeared in the oldest and most severe patients (in this group a 10% mortality rate was recorded).
The COVID-19 manifestations in this group were more variable, as is the case of transient livedo reticularis in young patients with good evolution of the process.
The authors state that the cutaneous manifestations are a gradient of disease, ranging from less severe in cases with pseudo-scabies to more severe in patients with livedo-reticularis lesions, with more cases of pneumonia, hospital admissions and need for intensive care.
It cannot be ruled out that there are other causes behind some of these cutaneous manifestations, especially in the case of urticariform lesions or maculopapules, which could have other causes, such as reactions to some of the many drugs they have received.
Reference:
C. Galván Casas*, A. Català , G. Carretero Hernández et al. Classification of the cutaneous manifestations of COVID-19: A rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology. https://doi.org/10.1111/bjd.19163