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. 2021 Apr;84(4):946-952.
doi: 10.1016/j.jaad.2020.12.046. Epub 2020 Dec 25.

Eruptions and related clinical course among 296 hospitalized adults with confirmed COVID-19

Sergey Rekhtman  1 , Rachel Tannenbaum  1 , Andrew Strunk  1 , Morgan Birabaharan  1 , Shari Wright  1 , Nicole Grbic  1 , Ashna Joseph  1 , Stephanie K Lin  1 , Aaron C Zhang  1 , Eric C Lee  1 , Erika Rivera  1 , Michael Qiu  2 , John Chelico  3 , Amit Garg  4
Affiliations

Eruptions and related clinical course among 296 hospitalized adults with confirmed COVID-19

Sergey Rekhtman et al. J Am Acad Dermatol. 2021 Apr.

Abstract

Background: Limited information exists on mucocutaneous disease and its relation to course of COVID-19.

Objective: To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19.

Methods: Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020.

Results: Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance.

Limitations: Skin biopsies were not performed.

Conclusions: Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course.

Keywords: COVID-19; Northwell; SarsCoV-2; adults; eruption; hospitalized; morbilliform; mucocutaneous; necrosis; purpura; rash; ulcer.

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Conflict of interest statement

Conflicts of Interest Dr Garg has received honoraria from AbbVie, Amgen, Boehringer Ingelheim, Incyte, Janssen, Novartis, Pfizer, UCB, and Viela Bio. The rest of the authors have no conflicts to disclose.

Figures

Fig 1
Fig 1
Necrotic ulcer on the face at the placement of a medical device.
Fig 2
Fig 2
Purpura and necrosis involving the foot and toes.
See this image and copyright information in PMC

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