Coronavirus: the five manifestations of COVID-19 on the skin

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Until now, the skin manifestations caused by the new coronavirus have gone unnoticed. However, recently, a job published in the magazine British Journal of Dermatology, and who has received the support of the Spanish Academy of Dermatology and Venereology, threw that Skin lesions can be classified into five patterns associated with a specific prognosis of COVID-19 infection.

After having collected and analyzed 375 cases – either by meeting clinical criteria or by laboratory confirmation and concomitant skin changes without a known cause – the study “COVID Skin” You can already offer your conclusions. In addition to collecting information on the health status of the participants, it is also have taken pictures of each of the skin problems, something that no other study so far had accomplished.

Analysis and use of a consensus method have shown that can be set five patterns of skin manifestations: chilblain-like rashes in acral areas (19%); vesicular eruptions (9%); urticarial lesions (19%); maculopapuleous eruptions (47%) and livedo-reticularis or necrosis (6%).

The cutaneous manifestations of the disease have been made easier to read, thanks to the multicenter study in which almost a hundred Spanish dermatologists, lead by Cristina Galván Casas, of the Dermatology Service of the Hospital Universitario de Móstoles in Madrid; Alba Català Gonzalo, from the Dermatology and Venereology Service of the Plató Hospital in Barcelona and Gregorio Carretero Hernández, of the Dermatology Service of the University Hospital Gran Canaria Doctor Negrín de Las Palmas de Gran Canaria.

“What we have seen, in addition to categorizing skin manifestations into five groups, is a disease gradient, from less severe in cases where there were pseudo-chilblains to more severe in patients with livedo-reticularis lesions, who had more cases of pneumonia, hospital admissions and need for intensive care ”, the doctor points out Ignacio García-Doval, director of the Research Unit of the Spanish Academy of Dermatology and Venereology (AEDV).

Each of these patterns has been associated with specific patient characteristics, evolution and severity of the disease:

The chilblain-like acral rashes (hands and feet) they appeared as areas of erythema or violaceous, vesicles and pustules. They are frequently asymmetric. This type of injury was detected in 19% of cases, in younger patients, in the late stages of the COVID-19 process, lasting 12.7 days and associated with a less severe prognosis.

The vesicular eruptions, detected in 9% of cases, They have been seen mainly on the trunk. They consisted of small monomorphic vesicles (very similar lesions between them) unlike those that appear in chickenpox that are polymorphic. Sometimes they 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 for about ten days and appear along with general symptoms, sometimes before them.

The urticarial lesions, the third type of pattern, have been recorded in 19% of cases, They have been seen mainly on the trunk or scattered throughout the body, in some cases on the palms of the hands. Its average duration is 6.8 days. They usually produce intense itching. This type of manifestation has been observed in more severe patients and more frequently they have appeared at the same time as other symptoms linked to COVID-19.

Maculo-papules, the demonstrations more frequent, were detected in 47% of cases, the dermatological picture is frequently similar to that of other viral infections. Sometimes you show specific patterns, such as the 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.

Finally, the lesions that lead to vascular obstruction, such as livedo-reticularis and necrosis, Have been found in 6% of cases, have appeared in older and more severe patients (10% mortality was recorded in this group). The patients showed different degrees of involvement, including areas of acral or trunk ischemia. However, the COVID-19 manifestations in this group were more variable, as is the case of the transient reticular livedo in young patients with good evolution of the process.

Adriana Raimondi, dermatologist doctor member of the Argentine Society of Dermatology and the American Academy of Dermatology, says that “dermatologists We have an obligation to think of COVID-19 in patients with vascular-type lesions, from those categorized in this study and asking the corresponding questions such as whether the patient has had fever, cough, or loss of taste or smell. ” “Dermatological injuries come to join the group of already known symptoms,” said the specialist in dialogue with this medium.

“The work is very complete and has a review of a very high number of cases. What dermatologists know is that all viral diseases can have cutaneous manifestations. This is very varied in the presentation but we are used to seeing different types of manifestations as the study shows and COVID-19 does not escape these characteristics “, warned about the study.

For Raimondi is about vascular type lesions. “Often the wide range of skin manifestations They can be mistaken for an allergic reaction in both the trunk and the limbs. However, Consultation against these injuries is particularly important because sometimes infected patients are asymptomatic and it could be a single manifestation or one that alerts to make the diagnosis, “he concluded.

“The Spanish research allows us to see the dermatological manifestations from least to most serious. Patients with livedo reticularis or necrosis were patients coming to a intensive therapy, pneumonia and a very poor prognosis ”, explained in dialogue with Infobae Claudia Sánchez, Dermatologist at Halitus Medical Institute.

It must be taken into account, clarifies the research, that It cannot be ruled out that there are other causes behind some of these skin manifestations, especially in the case of urticarial lesions or maculopapules, which could have other causes, such as reactions to one of the many drugs they have received. However, this work was not intended to know the causes behind these manifestations, but establish cutaneous semiology and analyze its diagnostic and prognostic value.

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