key: cord-0685141-gvq3ah8w
authors: Assaf, Joy; Sarkis, Julien; Merhy, Reine; Jabbour, Rita; Zeinaty, Perla; Helou‐Mallat, Josiane
title: Cutaneous maculopapular and vesicular lesions as the only presentation of COVID‐19
date: 2021-08-25
journal: Int J Dermatol
DOI: 10.1111/ijd.15876
sha: 4f4d8fd2b43788e8e43e9df3c7d6036f8409cdad
doc_id: 685141
cord_uid: gvq3ah8w

nan

Additionally, there are only two case reports of EM secondary to the COVID-19 vaccine. The first one is a 58-year-old woman with a history of EM reactive to herpes labialis who developed typical targetoid lesions limited to her palms and soles hours after each of the BNT162b2 vaccine doses. 3 The second one described a 74-year-old woman who was admitted to the hospital because of disseminated atypical EM lesions that presented a day after the BNT162b2 first dose. 4 This clinical picture has been labeled as Rowell syndrome by authors due to the patient showing antinuclear antibody (ANA) titers of 1/640.

It is necessary to underline that vaccine-induced EM has been known for a long time, with 984 cases reported to the Vaccine Adverse Event Reporting System. 1 Moreover, EM-like reactions have already been linked to COVID-19 infection, both as typical acral lesions in younger individuals and more widespread, atypical lesions in adults. 5 SARS-CoV-2 spike protein, the structure codified in mRNA COVID-19 vaccines, has been demonstrated immunohistochemically in endothelial cells and eccrine ducts epithelium in those cases. 5 Consequently, EM secondary to COVID-19 vaccination would be an expected complication in some cases.

It is also notable that this is the first COVID-19 vaccine-related EM having its onset after the second dose. Although their exact timing in the disease course is still not evident, an early recognition of these cutaneous manifestations would help in a prompt diagnosis and management of this new viral illness. 2 Hence, identifying asymptomatic COVID-19 patients with only skin findings is of great public health value. 3 To this extent, we report the case of a maculopapular exanthem (Fig. 2a,b) . A screening for syphilis was negative. The patient was treated with topical clobetasol 0.05% cream and an oral antihistaminic drug. On follow-up, the eruption resolved after 14 days with a negative RT-PCR test for COVID-19, and treatment was discontinued.

To date, most reported skin findings have been preceded or followed by other COVID-19 signs. 2 In a recent review article, Zhao et al. 4 found that skin lesions occurred on average 

COVID-19: an overview for dermatologists

The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries

Pernio-like skin lesions associated with COVID-19: a case series of 318 patients from 8 countries

COVID-19 and cutaneous manifestations: a systematic review

Cutaneous manifestations and considerations in COVID-19 pandemic: a systematic review