Cutaneous manifestations in COVID-19. Observational study in a specialized interzonal hospital in the Province of Buenos Aires

Abstract

Background: since the first description of a viral infection caused by a new coronavirus in Wuhan, China, on December 2019, skin lesions with different patterns have been identified, which have been associated with the severity of the disease.

Objectives: 1) to determine the most frequent types of cutaneous-mucosal patterns; 2) to establish the relationship of skin patterns with the severity of the disease and the time of presentation; 3) to determine if the cutaneous-mucosal pattern could be the only clinical finding of COVID-19 infection. Design: an observational, prospective, longitudinal and analytical study.

Methods: we evaluated the close household contacts of hospitalized patients with a confirmed diagnosis of COVID-19 and the healthcare personnel who suffered from this disease and their close contacts assisted at the Interzonal Specialized Acute and Chronic Hospital (HIEAyC) San Juan de Dios (La Plata, Provincia de Buenos Aires) from June 21st to October 31st 2020.

Results: we found 83 out of 1,145 (7.25%) patients with skin lesions. The patterns found can be depicted as follows: maculopapular in 37 (44.6%), urticarian in 16 (19.3%), perniosis-like in 12 (14.5%), vesicular in 5 (6%) livedoid-necrotic in 4 (4.8%), mixed in 4 (4.8%), and others in 5 (6%). The maculopapular, urticarian and vesicular patterns showed a significant association with the mild forms of the disease. In the simile perniosis pattern, was presented as the only manifestation. The presentation of retiform purpura did not show a significant association with the severity of the disease. 57.8% of the lesions appeared during the appearance of other suspected symptoms of COVID-19, while 25.3% (n = 21) appeared as the only manifestation.

Conclusions: the most relevant data of this study were the finding of mixed patterns scarcely reported in the bibliography and that skin manifestations were the only symptom of SARS-CoV-2 infection in 25.3% of the patients, placing the dermatologist as an indispensable participant in the health team, which diagnoses, monitors and treats these patients. We believe that one of the greatest strengths of our work is the representativeness of the sample size in relation to Latin American publications so far.