key: cord-1021033-r8pnzqa4
authors: Rubio‐Muniz, C.A.; Puerta‐Peña, M.; Falkenhain‐López, D.; Arroyo‐Andrés, J.; Agud‐Dios, M.; Rodriguez‐Peralto, J.L.; Ortiz‐Romero, P.L.; Rivera‐Díaz, R.
title: The broad spectrum of dermatological manifestations in COVID‐19. Clinical and histopathological features learned from a series of 34 cases
date: 2020-06-11
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16734
sha: 0ec348661ae9182b092ea8ea17168612d39be9f3
doc_id: 1021033
cord_uid: r8pnzqa4

Since the outbreak of Coronavirus Disease (COVID‐19) pandemic began in Europe, a plethora of cutaneous manifestations have been related to this infection(1,2). However, their underlying mechanism and prognostic relevance remain unclear. Thus, we collected data from all COVID‐19 cases presenting with skin manifestations in our hospital in Madrid during one month.

The broad spectrum of dermatological manifestations in COVID-19. Clinical and histopathological features learned from a series of 34 cases. Dear Maculopapular exanthems were the most frequent manifestation observed (10), followed by pseudo-chilblain (9), targetoid lesions (5), palpable purpura (4), acute urticaria (3) and vesicular lesions (2). The remaining 3 cases showed livedo reticularis, urticarial exanthem and prurigo lesions.

Maculopapular exanthems (Figure 1 , F) were unspecific and mostly appeared at a late stage of COVID-19. The morphology observed in early exanthems, prior pharmacological interference, was indistinguishable from those in the delayed presentations.

In early-onset cases, histopathology showed moderate epidermal spongiosis and perivascular lymphocytic infiltrate with eosinophils in the dermis, whereas the analysis of the delayed lesions showed perivascular lymphocytic infiltrate and histiocytes among collagen fibres without mucin deposits.

Numerous patients with COVID-19 pneumonia displayed atypical targetoid lesions ( Figure 1 , E), with histopathological features of erythema multiforme, around 20 days after respiratory symptoms onset. Although the lesions appeared when COVID-19 treatment had commenced in all cases, given the dramatic increase of frequency, we believe that the underlying mechanism is a delayed immune response to the virus.

This article is protected by copyright. All rights reserved Therefore, these lesions might be caused by a mixed mechanism including cellular immune response and prothrombotic state trigged by the virus.

Although the age distribution in our sample is similar to those reported in overall COVID-19 patients 5 , the mortality rate (0%) is far lower and the proportion of affected females is higher in our cohort. Such trend amongst the study population is mirrored in previous COVID-19 skin manifestations series 1 . Thus, we think that cutaneous signs of the infection are more frequent in women and appear to be associated with a better prognosis. Therefore, the dermatological indicators in COVID-19 may act as prognostic factors and heralding signs and henceforth guide diagnostic and isolation protocols for affected patients.

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

Cutaneous manifestations in COVID-19: a first perspective

Acral cutaneous lesions in the Time of COVID-19

Coronavirus (COVID-19) infection-induced chilblains: a case report with histopathological findings

Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China (2019): a singlecentered, retrospective study

Acknowledgment section: the patients in this manuscript have given written informed consent to publication of their case details

This article is protected by copyright. All rights reserved