Cutaneous manifestations of COVID-19 in a tertiary COVID-19 referral hospital in the Philippines

Abstract

Background: Reports on COVID-19 skin manifestations and associated clinical outcomes are limited. Like viral diseases, cutaneous findings may be present and can help in confirmation and prognostication among those suspected or diagnosed with COVID-19.

Objective: To determine COVID-19 cutaneous manifestations and their association with disease severity and course.

Methods: This study was conducted in a designated COVID-19 referral hospital from January 1 to March 31, 2021. Skin manifestations recorded from January 1 to February 17 were retrospectively gathered. Reports from February 18 to March 31 were prospectively collected using a dermatologic checklist which was incorporated into all official medical records.

Results: A total of 507 confirmed patients with COVID-19 were included. COVID-19 skin signs were detected in 39 patients (7.7%). Morbilliform lesions were most common. Skin signs were significantly associated with severe or critical cases (odds ratio, 3.4; 95% CI, 1.3-8.7) and mortality (relative risk, 2.9; 95% CI, 2.0-4.2).

Limitations: Underestimation of prevalence of COVID-19 skin signs due to exclusion of outpatient and discharged patients and the subjective assessment in the retrospective part.

Conclusion: Cutaneous signs were significantly associated with severe/critical COVID-19 as well as death among 507 hospitalized patients in a Philippine COVID-19 referral hospital.

Keywords: COVID-19; clinical outcome; cutaneous manifestations; disease severity; skin.

Fig 1

Clinical cutaneous findings in patients with COVID-19. Multiple erythematous macules and papules spread over the face (A), thighs (B-D), and the upper portion of the arm (E).

Fig 2

Histopathologic review of 4-mm punch biopsies taken from morbilliform skin eruptions in patients with COVID-19. A, Section showed superficial to deep sparse perivascular and perieccrine lymphocytic infiltrates with rare eosinophils, with inset showing a focal area of mild perivascular infiltrate of neutrophils, neutrophilic dust, and extravasated erythrocytes in the reticular dermis, with fibrin deposition involving a vessel. B, Section showed mild perivascular infiltrates of lymphocytes and occasional neutrophils in the papillary to mid dermis, with inset showing a focal area of extravasated erythrocytes surrounding a vessel with endothelial swelling and fibrin deposition.