Spiny keratoderma, a late COVID‐19 manifestation?

Abstract

Metapneumovirus, Bocavirus, Respiratory syncytial virus, Adenovirus, and Enterovirus), but it was found to be negative. Lung involvement was not detected in thoracic tomography. Hydroxyzine (1 mg/kg/day), systemic methylprednisolone (1 mg/ kg/day), and phenyramine (1 mg/kg/day) treatments given for urticaria were thought to be resistant to treatment. Vitamin D (1,000 U/day) was added empirically to the patient's treatment. The patient's fever did not recur. The patient was discharged on the 5th day, after examinations for COVID-19 returned to normal and urticaria regressed. Overall, the therapy lasted 10 days. After discharge, hydroxyzine and phenyramine treatments were continued to the follow-up visit. On the 10th day, no pathology was observed in the physical examination and laboratory tests in the outpatient clinic control. Then, all medications were discontinued.elIn most pediatric cases, the diagnosis of COVID-19 may be delayed because of the cases presenting as an asymptomatic individual or with rare symptoms such as skin findings initially, or these patients may be missed without any diagnosis. [2][3][4][5] Our case presented with isolated symptoms such as urticarial rash that started suddenly and had fever of 38°C for 1 day, and COVID-19 was not considered by the pediatricians in which it was seen in the first place, and the patient was sent home with an antihistamine. This may pose a risk to ensuring the transmission control of SARS-CoV-2. Clinicians should be more careful in terms of the symptoms and positive physical examination findings of COVID-19 in the pediatric population, especially because of the start of face-to-face education in schools and the removal of restrictions on children.With this presentation, when acute urticaria and/or angioedema is encountered and rarely occurs in the patient, it is of great importance to bring the COVID-19 viral infection to mind and to narrow the contact circle and to treat the disease.

Lichen spinulosus following COVID‐19 infection: Another possible cutaneous manifestation of COVID‐19?

“…COVID-19 infection has been associated with various dermatologic manifestations including urticarial eruption, pseudo-chilblain, maculopapular rash and vesicular lesions. 1 Recently, a case of new-onset spiny keratoderma in association with COVID-19 has been reported by Dominguez-Santas et al 2 Similar to the case described in this letter, we would like to share our experience with a patient who developed folliculocentric hyperkeratotic papules following mildly symptomatic COVID-19.…”

“… 2 In this case, a 68‐year‐old man presented with milimetric, spiny, keratotic papules in both palms 1 month after mild COVID‐19 infection. 2 Similar to our patient, no infectious disease such as HIV and hepatitis, drug or malignancy which would trigger lichen spinulosus, was detected in the case reported by Dominguez‐Santas et al 2 Furthermore, Tammaro et al 10 recently reported a case of severe palmar hyperkeratosis and hematochezia observed in a 85‐year‐old man who had interstitial pneumonia, myocarditis, and severe respiratory failure due to COVID‐19. The severity of cutaneous hyperkeratosis showed correlation with the deterioration of clinical symptoms in this case.…”

Spiny keratoderma: A review of case reports and histopathological descriptions

“…Of the 58 articles, 10 were case series, resulting in 84 SpK cases for analysis (Table 1). The individual cases were published in the USA (32), 1,3,8,9,12,16,18,20,24,[30][31][32][33][34]37,45,47,49,53 Spain (12), 14,22,23,26,28,29,36,39,50,54,58 Saudi Arabia (7), 10 Italy (6), 2,13,19,46,55 Japan (6), 11,21,25,40,52 Brazil (4), 5,42 United Kingdom (3), 41,57 Australia…”

“…Of those, 41 cases had a reported history of systemic disease-13 with type II diabetes mellitus, 9,25,33,34,38,40,41,43,44,46,56,58 10 with hyperlipidemia, 18,25,39,43,53,55,56 7 with pulmonary disease including COPD and asthma, 7,14,18,21,44,47,52 and 3 with chronic kidney disease. 38,44,56 Other systemic conditions associated with SpK included pulmonary tuberculosis, 14 SARS-CoV-2 infection, 54 protein S deficiency, 5 Darier disease, 17 type IV hyperlipoproteinemia, 19 autosomal dominant polycystic kidney disease, 16 and sarcoidosis. 7 The average reported age was 47.9 in hereditary cases and 63.6 in sporadic cases.…”

“…Of the 58 articles, 10 were case series, resulting in 84 SpK cases for analysis (Table 1). The individual cases were published in the USA (32), 1,3,8,9,12,16,18,20,24,30–34,37,45,47,49,53 Spain (12), 14,22,23,26,28,29,36,39,50,54,58 Saudi Arabia (7), 10 Italy (6), 2,13,19,46,55 Japan (6), 11,21,25,40,52 Brazil (4), 5,42 United Kingdom (3), 41,57 Australia (3), 43,56 India (2), 48,51 Germany (2), 35,44 Israel (1), 27 Turkey (1), 4 France (1), 17 Scotland (1), 38 Austria (1), 15 South Africa (1), 7 and Canada (1) 6 . Of the 84 total cases, 33 (39.3%) were female and 51 (60.7%) were male.…”