key: cord-0883413-boxxq1a1
authors: García‐Legaz Martínez, Marta; Martínez‐Doménech, Álvaro; Magdaleno‐Tapial, Jorge; Valenzuela‐Oñate, Cristian; Partarrieu‐Mejías, Felipe; Lorca‐Spröhnle, Javier; Casanova‐Esquembre, Andrés; Pérez‐Ferriols, Amparo; Alegre‐de Miquel, Víctor
title: Acute acral cutaneous manifestations during the COVID‐19 pandemic: a single center experience
date: 2020-06-26
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16777
sha: 3a1f65da370eb28397f52ad8ed66057f3350d94e
doc_id: 883413
cord_uid: boxxq1a1

Coronavirus disease 2019 (COVID‐19), caused by severe acute respiratory syndrome‐related coronavirus 2 (SARS‐CoV‐2), was first reported in China on December 2019. Almost 5 months into the pandemic, little is still known about cutaneous manifestations in COVID‐19. In fact, the prevalence of cutaneous signs varies greatly in the literature, ranging from 0.2% to 20.4%. Given their potential association with COVID‐19, acral lesions have received special attention worldwide, both in the medical literature and the media. Our aim is to share our experience regarding acral manifestations during this pandemic.

into the pandemic, little is still known about cutaneous manifestations in COVID-19. In fact, the prevalence of cutaneous signs varies greatly in the literature, ranging from 0.2% to 20.4%. 1, 2 Given their potential association with COVID-19, acral lesions have received special attention worldwide, both in the medical literature and the media. Our aim is to share our experience regarding acral manifestations during this pandemic.

We report a case series including all patients consulting at our tertiary care dermatology department for suspected COVID-associated cutaneous lesions during April 2020, in particular those with acral lesions. All patients were tested for SARS-CoV-2 through nasopharyngeal exudate polymerase chain reaction (PCR) and serum serology, as well as for other exanthematic viruses (parvovirus B-19, measles, rubella and human herpesvirus-6 (HHV6)).

Twenty-six patients were included, 14 (54%) men and 12 (46%) women. The mean age was 28 years, noting 8 (30,7%) were under the age of 14. Most cases were urgent outpatient consultations.

The predominant manifestation was acral rash (19/26; 73.08%). Less common eruptions were maculopapular (4/26; 15.38%), urticariform (2/26; 7.69%) and chickenpox-like rashes (1/26; 3.85%).

Regarding the 19 patients with acral manifestations, they presented perniosis-like lesions with variable degrees of erythema, edema and petechiae or purpuric macules. Thirteen (68.42%) referred pruritus and 9 (47.36%) pain. None had respiratory symptoms and only 2 (10,5%) reported having fever previously. We found that nasopharyngeal PCR was negative in all cases at onset of lesions. Most patients tested negative for SARS-CoV-2 serology and presented with predominantly petechial or purpuric lesions ( 

This article is protected by copyright. All rights reserved Out of 7 patients with non-acral manifestations, 4 (57.14%) and 5 (71.42%) reported fever or respiratory symptoms, respectively, prior to cutaneous lesions. Nasopharyngeal PCR was negative in all cases at the moment of consultation. We identified two cases with positive IgG who presented with maculopapular and chickenpox-like eruptions.

The "COVID-piel" study reported 5 rashes associated with COVID-19, maculopapules and acral pseudo-chilblain being the most frequent 3 

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