ABSTRACT
A wide range of cutaneous signs are attributed to COVID-19 infection. This retrospective study assesses the presence and impact of dermatologic manifestations related to the spread of COVID-19 in Lombardy, the geographic district with the first outbreak in Italy. A cohort of 345 patients with laboratory confirmed COVID-19 was collected from February 1, 2020 to May 31, 2020. Cutaneous signs and dermatologic diagnoses were recorded on admission, and during the course of the disease. Of the 345 patients included in the study, 52 (15%) had new-onset dermatologic conditions related to COVID-19. We observed seven major cutaneous clinical patterns, merged under 3 main groups: Exanthems, vascular lesions, and other cutaneous manifestations. Each subset was detailed with prevalence, age, duration, prognosis, and histology. Cutaneous findings can lead to suspect COVID-19 infection and identify potentially contagious cases with indolent course.
Subject(s)
COVID-19/complications , COVID-19/epidemiology , Skin Diseases/epidemiology , Skin Diseases/virology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Chilblains/pathology , Chilblains/virology , Child , Erythema Multiforme/virology , Exanthema/virology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Prevalence , Prognosis , Retrospective Studies , SARS-CoV-2 , Skin Diseases/pathology , Skin Diseases, Vascular/virology , Urticaria/virology , Young AdultABSTRACT
Skin is one of target organs affected by the novel coronavirus SARS-CoV-2, and in response to the current COVID-19 pandemic, a fast body of literature has emerged on related cutaneous manifestations. Current perspective is that the skin is not only a bystander of the general cytokines storm with thrombophilic multiorgan injury, but it is directly affected by the epithelial tropism of the virus, as confirmed by the detection of SARS-CoV-2 in endothelial cells and epithelial cells of epidermis and eccrine glands. In contrast with the abundance of epidemiologic and clinical reports, histopathologic characterization of skin manifestations is limited. Without an adequate clinicopathologic correlation, nosology of clinically similar conditions is confusing, and effective association with COVID-19 remains presumptive. Several patients with different types of skin lesions, including the most specific acral chilblains-like lesions, showed negative results at SARS-CoV-2 nasopharyngeal and serologic sampling. The aim of this review is to provide an overview of what has currently been reported worldwide, with a particular emphasis on microscopic patterns of the skin manifestations in patients exposed to or affected by COVID-19. Substantial breakthroughs may occur in the near future from more skin biopsies, improvement of immunohistochemistry studies, RNA detection of SARS-CoV-2 strain by real-time polymerase chain reaction-based assay, and electron microscopic studies.
Subject(s)
COVID-19/complications , Skin Diseases/pathology , Skin Diseases/virology , Skin/pathology , Chilblains/pathology , Chilblains/virology , Erythema Multiforme/pathology , Erythema Multiforme/virology , Exanthema/pathology , Exanthema/virology , Humans , Necrosis/virology , Purpura/pathology , Purpura/virology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/complications , Urticaria/pathology , Urticaria/virologySubject(s)
Ambulatory Care/statistics & numerical data , Betacoronavirus/immunology , Chilblains/epidemiology , Coronavirus Infections/complications , Erythema Multiforme/epidemiology , Pneumonia, Viral/complications , Acute Disease/epidemiology , Adolescent , Adult , Betacoronavirus/isolation & purification , COVID-19 , Chilblains/diagnosis , Chilblains/immunology , Chilblains/virology , Child , Child, Preschool , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Dermatology/statistics & numerical data , Dermoscopy/statistics & numerical data , Erythema Multiforme/diagnosis , Erythema Multiforme/immunology , Erythema Multiforme/virology , Female , Humans , Infant , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Referral and Consultation/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Spain/epidemiology , Young AdultABSTRACT
During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS-CoV-2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS-CoV/SARS-CoV-2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID-19, and the positivity for SARS-CoV/SARS-CoV-2 spike protein by immunohistochemistry strongly suggest a link between EM-like lesions and SARS-CoV-2.