Skin manifestations in patients hospitalized with confirmed COVID-19 disease: a cross-sectional study in a tertiary hospital

Abstract

Background: COVID-19 cutaneous manifestations have been recently described and classified in five different clinical patterns, including acral erythema-edema (pseudo-chilblain), maculopapular exanthemas, vesicular eruptions, urticarial lesions, and livedo or necrosis.

Objectives: The objective of this study was to examine the skin of hospitalized patients with a confirmed diagnosis of COVID-19 disease and describe the real prevalence of skin manifestations.

Methods: A cross-sectional study, which included hospitalized patients in Cruces University Hospital from April 14-30, 2020, with a laboratory-confirmed diagnosis of COVID-19 (with polymerase chain reaction and/or serology tests), was conducted. Entire body surface examination was performed by experienced dermatologists to search for cutaneous manifestations related to COVID-19 disease.

Results: From a sample of 75 patients, 14 (18.7%) developed cutaneous manifestations possibly related to COVID-19. We found six patients with acral erythema-edema (pseudo-chilblain) (42.8%), four patients with maculopapular exanthemas (28.6%), two patients with urticarial lesions (14.3%), one patient with livedo reticularis-like lesions (7.15%), and one patient with vesicular eruption (7.15%).

Conclusions: Our study provides a more plausible relationship between the main cutaneous patterns and COVID-19 in hospitalized patients as all of them had a confirmatory laboratory test. Skin manifestations are frequent but mild with spontaneous resolution. These findings are nonspecific and can be similar to other viral infections and adverse drug reactions in hospitalized patients.

Figure 1

Clinical features of COVID‐19 positive patient with skin vascular symptoms. An 82‐year‐old male with pseudo‐chilblain pattern on distal fingers of the hand beginning 9 days before respiratory symptoms and lasting a duration of 2 weeks

Figure 2

Clinical images (a) and (b) of widespread erythematous exanthema with predilection for the trunk in an 84‐year‐old man. The exanthema began 2 weeks after the onset of respiratory symptoms with spontaneous resolution after 15 days. (c) A 71‐year‐old man with livedo reticularis‐like lesions on both legs and buttocks

Figure 3

Vesicular pattern on the trunk of an 86‐year‐old male. The vesicles appeared 4 days after the onset of respiratory disease. A sample of one of the vesicle's fluid was taken for PCR of COVID‐19, herpes simplex, and varicella zoster virus with a negative result