Abstract
Background: Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Methods and Materials: Retrospective analysis of a prospectively collected cohort of patients with SARS-CoV-2 infection in a teaching hospital in Barcelona, Spain, from 1 April to 1 May 2020. Clinical, microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Results: Fifty-eight out of the 2761 patients (2.1%) either consulting to the emergency room or admitted to the hospital for COVID-19 suspicion during the study period presented COVID-19 related skin lesions. Cutaneous lesions could be categorized into six patterns represented by the acronym “GROUCH”: Generalized maculo-papular (20.7%), Grover’s disease and other papulo-vesicular eruptions (13.8%), livedo Reticularis (6.9%), Other eruptions (22.4%), Urticarial (6.9%), and CHilblain-like (29.3%). Skin biopsies were performed in 72.4%, including direct immunofluorescence in 71.4% and immunohistochemistry in 28.6%. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Conclusion: Cutaneous lesions in patients with COVID-19 appear to be relatively rare and varied. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19.
Highlights
Our findings suggest that skin lesions are a relatively uncommon manifestation of COVID-19 and emphasize the importance of histopathology in the characterization of skin lesions during the COVID-19 pandemic
Differentiating chilblain-like lesions from idiopathic and lupus-associated chilblain lesions, and other types of lesions such as generalized maculopapular or urticarial eruptions from drug reactions, is essential, given the frequency and characteristics of the former and the difficulties posed by the latter due to the large number of drugs usually concomitantly received by COVID-19 patients
Inspired by Galván-Casas et al proposed classification [17], we divided the cutaneous lesions into the following six groups: (1) Chilblain-like lesions, (2) Generalized maculopapular eruptions, (3) Grover’s disease and other papulo-vesicular eruptions, (4) Livedo reticularis, (5) Urticarial eruptions, (6) Other eruptions: lesions that did not meet any of the previous criteria
Summary
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread to acquire pandemic proportions since the first outbreak was declared in Wuhan, the capital of Hubei Province, China, in December 2019 [1]. the most common manifestations of COVID-19 are fever and respiratory symptoms such as cough and shortness of breath, other manifestations are relevant, and subacute manifestations such as organizing pneumonia and decreased pulmonary function, or drug interactions and side effects are increasingly gaining attention as the knowledge on COVID-19 pathophysiology and natural history accumulates [2,3,4,5,6,7,8,9].Recently, skin lesions have been described as potential manifestations of COVID-19. There are insufficient data on the prevalence and histopathology of skin lesions associated with COVID-19, as well as the associated clinical, analytical, and radiological findings. Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19
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