Not all that glitters is COVID‐19: a case series demonstrating the need for histopathology when skin findings accompany SARS‐CoV‐2 infection

Abstract

Background Descriptions of cutaneous findings associated with COVID-19 have not been consistently accompanied by histopathology or confirmatory testing for SARS-CoV-2. Objective To describe and classify the cutaneous findings with supporting histopathology of confirmed COVID-19 inpatients.Methods We included consecutive inpatients with a confirmed diagnosis of COVID-19 for whom a dermatology consult was requested. A skin biopsy was performed in all cases. Skin findings were classified as being compatible with a cutaneous manifestation of COVID-19 or as representing a distinct clinical entity.Results Twenty-eight patients were studied in whom thirty-one dermatologic diagnoses were made. Twenty-two of the dermatoses were compatible with a cutaneous manifestation of COVID-19; nine entities were not associated with infection by SARS-CoV-2. The most common COVID-19-associated pattern was an exanthematous presentation. In four patients, a new pattern was observed, characterized by discrete papules with varied histopathological findings including a case of neutrophilic eccrine hidradenitis. No cases of pernio-like lesions were identified. Skin findings not associated with COVID-19 represented 29% of diagnoses and included Malassezia folliculitis, tinea, miliaria and contact dermatitis.Limitations There is no gold-standard test to distinguish between viral exanthems and drug reactions.Conclusion A histopathological study is critical before attributing skin findings to a manifestation of COVID-19.

Paucity of cutaneous manifestations of COVID-19 among inpatients at a referral hospital in India

“…One reason for the misleading published data was alluded to by Kittler et al, 23 who observed that expedited peer reviews early on during the pandemic could have led to unfiltered reporting of cutaneous manifestations, whereas Vesely and Perkins 24 pertinently advised caution in the interpretation of skin findings and linked these to COVID-19. Along similar lines, Barrera-God ınez et al 25 emphasized the need for histopathologic confirmation before attributing a skin finding to COVID-19.…”

SARS-CoV-2 Infection and Vaccination Cutaneous Manifestations for the Inpatient Dermatologist

“…Retiform purpura and livedo racemoae have been described in severe COVID-19 with patients requiring critical level care [ 4 ••, 10 ••, 21 ]. Among cutaneous lesions, retiform purpura accounts for 6% of eruptions and occurs predominately in elderly patients with a median age of 66 [ 4 ••].…”

“…Biopsies of these lesions often demonstrate thrombotic vasculopathy with C5b-C9 complement deposition [ 4 ••, 22 ••]. These lesions were often located on the buttocks and/or the extremities [ 4 ••], though they have occurred on the trunk [ 21 ]. In a study published of 4 patients with livedoid and purpuric skin eruptions, patients developed cutaneous thrombosis and pulmonary embolisms despite the use of prophylactic anticoagulation therapy [ 22 ••].…”

Quoi de neuf en dermatologie clinique ?

“…Les mécanismes des éruptions en contexte de COVID-19 seraient l’action directe ou indirecte du virus sur la peau ou les vaisseaux, mais aussi des médicaments ou d’autres cofacteurs [ 26 ]. Les études histologiques des éruptions maculo-papuleuses ou urticariennes liées à la COVID sont peu nombreuses, les images étant compatibles avec une toxidermie ou une éruption virale [ 27 ].…”