Cutaneous Manifestations in COVID-19–Positive African American Patients

Abstract

Background: The United States of America is the leading country in confirmed cases of and deaths from severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). In April and May 2020, respectively, 0.2% of patients in a Chinese COVID-19–positive cohort and 20.4% of patients in an Italian COVID-19–positive cohort developed cutaneous abnormalities. Cutaneous abnormalities associated with COVID-19 are not well documented or discussed, and investigation of cutaneous manifestations is necessary to determine if they have any clinical value. Methods: We conducted a retrospective study of COVID-19–positive patients who were admitted to Ochsner–Louisiana State University-Shreveport and Ochsner–Louisiana State University-Monroe facilities in Louisiana. Cutaneous manifestations were determined from clinical notes, descriptions in medical records, and a billing code for skin rashes. Results: Of 1,086 COVID-19–positive patients investigated, 871 were African American and 130 were Caucasian. Only 10 patents exhibited probable COVID-19–induced cutaneous abnormalities: 6 (0.7%) of the 871 African American patients and 4 (3.1%) of the 130 Caucasian patients. Dermatologic abnormalities included pruritic or erythematous rash and hypopigmentation of the face, upper chest, abdomen, and trunk areas. Our data are consistent with the smaller percentage of patients in the Chinese cohort study vs the larger percentage in the Italian cohort study. Conclusion: Our data provide evidence that cutaneous manifestations of COVID-19, especially in African American patients, are rare, but documentation of more cases is necessary to establish a cause and effect for COVID-19–induced skin manifestations.

Epidemiology, clinical profiles, and prognostic value of COVID‐19‐related cutaneous manifestations in African populations: a rapid narrative review

“…3,20 Sachdeva et al conducted a review of the literature on 72 COVID-19-related cutaneous manifestations and found that 12.5% of patients presented with cutaneous lesions prior to the onset of symptoms. 21 As a result, the occurrence of COVID-19-related cutaneous manifestations has steadily increased, paralleling the global spread of SARS-CoV-2. This could be explained by a variant of concerns (VOCs), as one study found that cutaneous manifestations were significantly more common in the Delta wave than in the Omicron wave.…”

“…21,35,36 The immune response to infection also activates Langerhans cells, resulting in vasodilation and spongiosis. 21,35,36 The presence of ACE2, the primary receptor for SARS-CoV-2 entering skin cells, may explain some of the vascular skin lesions associated with COVID-19 infection due to a significant immune antiviral response. 37,38 Maculopapular eruptions may be caused by SARS-CoV-2 particles and immune complex deposition that damage dermal vessels and cause lymphocytic vasculitis.…”

“…found viral particles in the endothelium of erythema pernio‐like lesions in children 33 . COVID‐19 viral infection may cause lymphocytic vasculitis like thrombophilic arteritis caused by immune complex‐activated cytokines 21,35,36 . The immune response to infection also activates Langerhans cells, resulting in vasodilation and spongiosis 21,35,36 .…”

“…The virus can cause cutaneous lesions either directly or indirectly via vascular dysfunctions like thrombotic vasculopathy 38 . In addition, COVID‐19 viral infection may result in vasculitis 21 . SARS‐CoV‐2 binding to ACE2 causes acantholysis and dyskeratosis 16 .…”

“…33 COVID-19 viral infection may cause lymphocytic vasculitis like thrombophilic arteritis caused by immune complex-activated cytokines. 21,35,36 The immune response to infection also activates Langerhans cells, resulting in vasodilation and spongiosis. 21,35,36 The presence of ACE2, the primary receptor for SARS-CoV-2 entering skin cells, may explain some of the vascular skin lesions associated with COVID-19 infection due to a significant immune antiviral response.…”