key: cord-0831198-9vpfv0z8
authors: Lim, S.Y.D.; Tey, H.L.
title: Response to: “Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases”: Vesicular eruption in COVID‐19 – to exclude varicella
date: 2020-07-01
journal: Br J Dermatol
DOI: 10.1111/bjd.19347
sha: ab379a0d0a232f2e56323af4813ebfba2f85ac3f
doc_id: 831198
cord_uid: 9vpfv0z8

We read with interest the classification of cutaneous manifestations in Coronavirus disease 19 (COVID‐19) by C. Galván Casas et al.(1) In particular, vesicular eruptions are characterized as monomorphic vesicles, involving the trunk, happening early in the course of the disease, and occasionally preceding other symptoms(1‐3). However, investigations to exclude other causes of widespread vesicular eruption, in particular, varicella, were absent. In our clinical experience to date, we have had four patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection presenting with vesicular eruptions, which were subsequently confirmed to be true varicella with microbiological and serological investigations.

This article is protected by copyright. All rights reserved In our clinical experience to date, we have had four patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting with vesicular eruptions, which were subsequently confirmed to be true varicella with microbiological and serological investigations (Table 1) .

All four patients were young to middle-aged men with no previous history of varicella infection, vaccination or exposure, presenting with vesicular eruptions of variable durations. Each patient had some features not completely typical of varicella -two described no or mild pruritus, two did not report any prodromal symptoms, and two presented with monomorphic vesicular eruptions early in the course of varicella infection. They were all given systemic antiviral therapy with acyclovir or valacyclovir with resolution.

In a patient presenting with a widespread vesicular eruption, differential diagnoses include infections, a drug-induced blistering process, and an autoimmune blistering disease. Among the infections, varicella, disseminated zoster, disseminated herpes, smallpox and rickettsialpox are possible causes. 

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Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases

Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients

Clinical and histological characterization of vesicular COVID-19 rashes: A prospective study in a tertiary care hospital

Disseminated herpes simplex virus and varicella zoster virus co-infection in an immunocompetent patient

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