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Inicio Medicina Clínica (English Edition) Skin findings in the COVID-19 pandemic in the Region of Murcia
Journal Information
Vol. 155. Issue 1.
Pages 41-42 (July 2020)
Vol. 155. Issue 1.
Pages 41-42 (July 2020)
Scientific letter
DOI: 10.1016/j.medcle.2020.05.001
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Skin findings in the COVID-19 pandemic in the Region of Murcia
Hallazgos cutáneos en la pandemia de COVID-19 en la Región de Murcia
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Beatriz Pérez-Suáreza, Teresa Martínez-Menchónb, Eugenia Cutillas-Marcoc,
Corresponding author
ecutillas@aedv.es

Corresponding author.
a Servicio de Dermatología, Hospital General Universitario Morales Meseguer, Murcia, Spain
b Servicio de Dermatología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
c Servicio de Dermatología, Hospital General Universitario Reina Sofía, Murcia, Spain
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Tables (1)
Table 1. Demographic and clinical data of cases with COVID-19 or in close contact with confirmed cases.
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Dear Editor:

Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) infection is the cause of the so-called coronavirus disease 2019 (COVID-19), which has currently spread causing a global pandemic.1

There is little information about cutaneous involvement caused by this virus, mainly collected in an initial series of adult patients from Lombardy1 (maculopapular, urticariform, or varicelliform rashes) and isolated cases of petechial rashes,2 digital gangrene and livedoid lesions.3 We report a descriptive and multicenter case series collected in our setting.

During the week of 13th to 19th April 2020, all suspected cases of cutaneous lesions caused by COVID-19 from the Region of Murcia were collected by tele-consultation or visit to admitted patients. To do this, we requested primary care doctors to electronically report any cutaneous findings in patients with disease confirmed by diagnostic tests or in their cohabitants.

During the study period, 196 cases were confirmed by serology (Polymerase ChainReaction [PCR]) in our region. That means that from 1463 initial cases, a total of 1659 were reached at the end of data collection.

Throughout these 7 days, of the 86 cases initially assessed, 16 met the requirements of de novo cutaneous lesion development together with positive evidence of infection or close contact with cohabitants of COVID-19 disease confirmed by diagnostic tests (Table 1). The mean age of this group was 29 years (range: 8 months–85 years, median:21 years). 56% of cases occurred in women.

Table 1.

Demographic and clinical data of cases with COVID-19 or in close contact with confirmed cases.

Case  Age (years)  Sexa  Type of lesion  Siteb  Fever  Respiratory  Cutaneous onset  Admission  ICU  TestCOVID-19  Close COVID-19 contact 
Hives  UL  No  No  NA  No  No  No  Yes 
Chilblain  Feet  No  No  NA  No  No  No  Yes 
16  Chilblain  Feet  No  No  NA  No  No  –  Yes 
Rash  Face  YES  Yes  17 days later  No  No  PCR  Yes 
43  Rash  ULLL  Yes  Yes  3 days later  No  No  IgM+  Yes 
47  Papules and bruises  UL  Yes  Yes  14 days later  Yes  No  IgM+  Yes 
56  Hives  Trunk  No  Yes  37 days later  Yes  Yes  PCR+  NK 
62  Ulcer  Sacral  No  Yes  20 days later  Yes  Yes  PCR+  NK 
85  Acrocyanosis  Hands and feet  No  Yes  24 days later  Yes  No  PCR+  NK 
10  70  Erythema multiforme  Circumoral  No  Yes  18 days later  Yes  Yes  PCR+  NK 
11  Hives  General  Yes  No  2 days before  No  No  PCR  Yes 
12  34  Follicular papules  General  Yes  No  14 days later  No  No  PCR  Yes 
13  Hives  General  No  No  NA  No  No  PCR  Yes 
14  18  Tinea  Neck  Yes  Yes  4 days later  No  No  PCR+  NK 
15  Rash  TrunkUL  No  No  NA  No  No  No  Yes 
16  25  Keratosis pilaris  ULLL  No  Yes  NA  No  No  PCR+  NK 
15  Rash  TrunkUL  No  No  NA  No  No  No  Yes 
16  25  Keratosis pilaris  ULLL  No  Yes  NA  No  No  PCR+  NK 
a

Gender: M: male; F: female.

b

Site: location of lesions: LL: lower limbs; UL: upper limbs.

NK: not known; NA: not applicable; ICU: intensive care unit.

Cutaneous onset: offset between systemic respiratory symptoms and cutaneous lesions.

The most common cutaneous reaction was hives (25%), followed by rashes (19%) and chilblain-like lesions (12%). Furthermore, we found another group of heterogeneous cutaneous lesions of remarkably diverse origin (infectious, vascular, inflammatory, traumatic, keratosis pilaris, and acrocyanosis). Thirty seven percent of cases associated fever and 56% respiratory symptoms, from cough to double pneumonia.

Unlike the series reported in Lombardy1 in which the most common cutaneous manifestation was erythematous rash, hives was the most common finding in our series. Previous studies showed that the most common cause of hives in children is infections, especially those of the respiratory tract.4

Keratosis pilaris is a common finding in children with atopic diathesis. We have found no evidence in the scientific literature of keratosis pilaris onset in patients with COVID-19. We do not know the mechanisms that may justify this finding in the context of COVID-19 disease.

One of the findings in our series is acrocyanosis. This sign reflects the peripheral hypoxia in probable relation to the thrombotic phenomena that have been described in the disease, both cutaneously3 as well as in other organ's vessels, including the lungs, heart, or brain, or by processes such as disseminated intravascular coagulation.5 In our case, we observed this finding in a patient with respiratory failure who required hospital admission.

This study has some limitations. Firstly, a restricted access to diagnostic tests, which excluded cases that presented with guiding symptoms of COVID-19, but which were not confirmed by PCR or serology; on the other hand, the elective use of tele-dermatology has made it difficult to take biopsies of these lesions.

More studies are needed that collect cutaneous manifestations in patients with COVID-19. Knowledge of these cutaneous reactions and study of the temporal patterns of onset of these findings could help to identify patients without other symptoms of this disease, especially in those regions where diagnostic tests are not available.

Acknowledgements

The authors wish to thank doctors Joaquín López, Javier Ruiz, José Pardo, Inmaculada de la Hera, Carolina Pereda and Marisa Cáceres for sharing with us the cases they have treated for the preparation of this article.

References
[1]
S. Recalcati.
Cutaneous manifestations in COVID-19: A first perspective.
J Eur Acad Dermatol Venereol, (2020),
[2]
J. Jimenez-Cauhe, D. Ortega-Quijano, M. Prieto-Barrios, O.M. Moreno-Arrones, D. Fernandez-Nieto.
Reply to “COVID-19 can present with a rash and be mistaken for Dengue”: Petechial rash in a patient with COVID-19 infection.
[3]
I.F. Manalo, M.K. Smith, J. Cheeley, R. Jacobs.
A dermatologic manifestation of COVID 19: transient livedo reticularis.
[4]
G. Ricci, A. Giannetti, T. Belotti, A. Dondi, B. Bendandi, Cipriani, et al.
Allergy is not the main trigger of urticaria in children referred to the emergency room.
J Eur Acad Dermatol Venereol, 24 (2010), pp. 1347-1348
[5]
Y. Deng, W. Liu, K. Liu, Y.Y. Fang, J. Shang, L. Zhou, et al.
Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study.

Please cite this article as: Pérez-Suárez B, Martínez-Menchón T, Cutillas-Marco E. Hallazgos cutáneos en la pandemia de COVID-19 en la Región de Murcia. Med Clin (Barc). 2020;155:41–42.

Copyright © 2020. Elsevier España, S.L.U.. All rights reserved
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