Manifestaciones cutáneas en pacientes con COVID-19. Estudio prospectivo / Skin manifestations in patients with COVID-19. A prospective study

Resumen Desde marzo 2020 se describieron lesiones cutáneas asociadas a COVID-19. Los objetivos del estudio fueron caracterizar las lesiones cutáneas en estos pacientes, analizar su relación temporal, asociación con la gravedad de la enfermedad, los síntomas extracutáneos y parámetros de laboratorio. Es un estudio prospectivo, observacional, analítico y de corte transversal, en internados con diagnóstico de COVID-19. Se catalogaron las dermatosis en primarias y secundarias. Se incluyeron 45 pacientes, 44.4% con dermatosis primarias y 53.3% con lesiones secundarias. La edad media fue de 46 años (DS: 17), con predominio del sexo masculino (68.9%). Las lesiones primarias aparecieron luego de una mediana de 5 días (RIC: 3-10) del inicio de los síntomas de COVID-19 y las secundarias luego de 14.5 días (RIC: 7-20). Las dermatosis primarias fueron: exantema maculopapuloso (65%), urticariforme (20%, la mitad con lesiones vesiculosas), livedo reticular (10%) y púrpura (5%). Las dermatosis secundarias más frecuentes fueron reacciones adversas a fármacos (37.1%) y dermatosis infecciosas (25.9%). El exantema maculopapuloso se asoció a COVID-19 moderado y las lesiones por presión a COVID-19 grave (p < 0.05). El hallazgo de neutrofilia fue mayor entre aquellos con dermatosis infecciosas secundarias (p < 0.05). No se encontraron diferencias significativas al evaluar otros parámetros de laboratorio, ni síntomas extracutáneos. Este trabajo muestra las manifestaciones cutáneas en internados con COVID-19. El patrón más prevalente fue el exantema maculopapuloso que se asoció con la forma moderada de la enfermedad. La aparición de lesiones luego de las 2 semanas del inicio de los síntomas de COVID-19 se asoció a dermatosis secundarias.

Abstract As of March 2020, skin lesions associated with COVID-19 have been described. The objectives of the study were to char acterize the skin lesions in these patients, analyze their temporal relationship, association with the severity of the disease, extracutaneous symptoms and laboratory parameters. A prospective, observational, analytical and cross-sectional study was conducted in hospitalized patients diagnosed with COVID-19. Dermatoses were clas sified as primary and secondary. Forty-five patients were included, 44.4% with primary dermatoses and 53.3% with secondary lesions. The mean age was 46 years (SD: 17), with a male predominance (68.9%). The primary lesions appeared after a median of 5 days (IQR: 3-10) from the onset of COVID-19 symptoms and the secondary ones after 14.5 days (IQR: 7-20). The primary dermatoses found were maculopapular rash (65%), urticarial (20%, half with vesicular lesions), livedo reticular (10%) and purpura (5%). The most frequent secondary dermatoses were adverse drug reactions (37.1%) and infectious dermatoses (25.9%). Maculopapular rash was associated with moderate COVID-19 and pressure injuries with severe COVID-19 (p < 0.05). The finding of neutrophilia was higher among those with secondary infectious dermatoses (p < 0.05). No significant differences were found when evaluating other laboratory parameters. This work shows the skin manifestations in patients hospitalized with COVID-19 in our environment. The most prevalent pattern was the maculopapular rash that was associated with the moderate form of the disease. The appearance of lesions 2 weeks after the onset of COVID-19 symptoms was associated with secondary dermatoses.

A Case of Infantile Acropustulosis Developed after Treatment of Scabies / 대한피부과학회지

Infantile acropustulosis is characterized by recurrent crops of pruritic vesicopustules that are found primarily on the distal extremities of infants. Herein we report a 20-month-old female baby, who had a past history of scabies, with recurrent episodes of 1-2 mm sized, intensely pruritic vesicopustules on both hands and feet. The mite smear for scabietic mites, Gram stain for bacteria, and KOH smear for dermatophytes of lesion were all negative. Tzank test of the vesicle revealed many neutrophils. She was treated with dapsone (2mg/kg/day) and the pruritic vesicles and pustules had disappeared by 48 hours.

A Case of Infantile Acropustulosis Associated with Scabies / 대한피부과학회지

We report a case of infantile acropustulosis in a 7 month-old female infant who had a family history of scabies in her parents and brother. She had pruritic papulovesicles and pustules, predominantly on the hands and feet. Histopathologically, there was a well-circumscribed unilocular, subcorneal pustule filled with neutrophils, mostly. Under the diagnosis of an infantile acropustulosis associated with scabies, she was treated with a potent topical corticosteroid and oral antihistamines without recurrence.

A case of persistent pustulosis and antecedent scabies / 대한피부과학회지

In 1978, Bjornberg and Friis reported 32 patients with persistent pusi ulosis(PP) on distal extremities, of whom 13 patients were initially diagnosed as scabies. In 1984, Elpern described 7 patients with infantile acropustulosis(IA), of whom 4 patients had antecedant scabies. We report herein a case of PP, which was found in a 18 month-old mal who was treated for scabies at the age of 5 month and 12 month. The pruritic vesicopustules dev',lo ed 2 months after the second treatment for scabies and relapsed for 4 months. We also discuss the relationship between scabies and PP and also between PP and IA.