Clinicopathologic Aspects of a Papulovesicular Eruption in a Patient With COVID-19

Abstract

patients 1 and 2), trichiasis (patients 2 and 4), and excessive tearing (patient 4). Patient 1 had phimosis that was corrected surgically.Discussion | In our experience using etanercept as treatment for patients with SJS-TEN, including in adults, we have made the following noteworthy observations (although these are only anecdotal). First, we found that a response to treatment with etanercept, namely decreased erythema of existing lesions and halting of progression of new lesions, often occurs 24 to 36 hours after administration. Borrowing from the dosing schedule successfully used in the randomized trial of adults by Wang et al, 5 we recommend considering a second dose in patients who continue to have fevers or notable erythematous and/or edematous skin lesions 36 to 48 hours after the initial dose. Second, patients treated with etanercept demonstrate remarkable time to reepithelialization, which corroborates previous findings comparing etanercept with corticosteroids. 5 Unfortunately this evidence is limited, particularly comparing etanercept with burn-level supportive care. Patient 3 demonstrated a remarkable halting of skin disease. We are not aware of any similar reports of preventing skin denudation in patients with SJS-TEN with early intervention using other immunosuppressive medications. Finally, the lack of adverse events (particularly infections) noted in patients in this series and others is encouraging, although further prospective randomized studies are needed. 4,5

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

“…Mahé et al [32] reported on 3 patients with typical COVID-19-associated papulovesicular rash, in which the histological pattern of skin lesions showed prominent acantholysis and dyskeratosis associated with the presence of an unilocular intraepidermal vesicle in a suprabasal location. Based on these histopathological findings, the authors refused the term “varicella-like rash” and proposed a term which was more suitable in their view: “COVID-19-associated acantholytic rash.” Histopathological findings of another case of papulovesicular eruption revealed extensive epidermal necrosis with acantholysis and swelling of keratinocytes, ballooning degeneration of keratinocytes and signs of endotheliitis in the dermal vessels [33]. Acantholysis and ballooned keratinocytes were found also by Fernandez-Nieto et al [31] in 2 patients.…”

“…In our opinion, even if seeking DNA of Herpesviridae family members is ideally advisable, clinical diagnosis may be reliable in most cases, and the role of herpes viruses as mere superinfection in patients with dysfunctional immune response associated with COVID-19 needs to be considered [38]. To our knowledge, SARS-CoV-2 has not been hitherto isolated by means of reverse transcriptase PCR in the vesicle fluid of papulovesicular rash [33, 31].…”

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

“…The characteristics of skin lesions in patients with COVID-19, as described recently in case reports or case series, are summarized in the Table 1 [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ,…”

SARS‐CoV‐2 spike protein is present in both endothelial and eccrine cells of a chilblain‐like skin lesion

“…Dear Editor, Data on SARS-CoV-2 detection in lesional skin are controversial. [1][2][3][4][5][6][7][8] We report a PCR-proven COVID-19 patient with a chilblain-like SARS-CoV-2-positive skin lesion. An 80-year-old woman presented to the emergency department at the end of March 2020.…”

“…1 Reports on direct or indirect SARS-CoV-2 investigation in skin lesions of COVID-19 patients are relatively rare yet. [4][5][6][7][8] Santonja et al 5 recently found granular positivity of spike protein in dermal endothelial cells and epithelial cells of eccrine glands of a RT-PCR-negative patient with chilblain-like lesions. Trellu et al 6 and Ahuoach et al 7 performed RT-PCR for SARS-CoV-2 in two COVID-19 patients with skin eruptions.…”