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

Abstract

COVID-19 is an infectious disease caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). Vesicular skin rashes have been reported as associated with COVID-19, but there is little information about this cutaneous manifestation. We designed a prospective observational study of patients diagnosed with COVID-19 who had vesicular lesions. Clinical characterization of skin findings was conducted by dermatologists. When possible, histological analysis and detection of SARS-CoV-2 in the content of the vesicles was performed. In total, 24 patients were included. A disseminated pattern was found in 18 patients (75%), and a localized pattern was found in 6 (25%). Median duration of the skin rash was 10 days. Of the 24 patients, 19 (79.2%) developed the skin rash after the onset of COVID-19 symptoms. Histological examination in two patients was consistent with viral infection, SARS-CoV-2 was not detected in four patients. This single-centre study shows the clinical characteristics of vesicular skin rashes in patients with COVID-19.

Figure 1

(a–h) Disseminated vesicular rash associated with COVID‐19. (a) Patient 1: papules and vesicles of varying sizes affecting the whole trunk, proximal arms and legs. (b) Patient 2 had scattered vesicles and pustules on the trunk, with a slight tendency to cluster. (c, d) Patient 3 had (c) morbilliform rash involving the whole trunk, with disseminated vesicles predominantly affecting upper extremities and (d) the palms were also involved. (e, f) Histological examination showing (e) an intraepidermal vesicle containing scattered multinucleated and ballooned keratinocytes, with mild acantholysis, while (f) a deeper section of the vesicle reveals more extensive damage, with epidermal detachment and confluent keratinocytic necrosis, and the vesicle contains fibrinoid material with acute inflammation. Haematoxylin and eosin, original magnification (e) × 200; (f) × 100. (g, h) Localized COVID‐19 vesicular rash: (g) monomorphic papules and vesicles exclusively located on the anterior trunk, at an early stage; (h) close‐up view of the monomorphic vesicles and pustules on the chest.