COVID-19 Dermatology: Reports In JAAD Say That More COVID-19 Patients Manifesting Chicken-Pox Lesions On Skin
: Reports are appearing in JAAD (Journal Of American Academy of Dermatology ) that numerous COVID-19 patients are now manifesting chicken-pox like lesions on their skin, a condition known as Varicella-like exanthema.
In one report submitted by Italian researchers and doctors, a study was made on 22 patients who displayed these dermatological symptoms. . https://www.jaad.org/article/S0190-9622(20)30657-5/pdf
The researchers said that during the COVID-19 outbreak in Italy, they had observed a varicella-like papulovesicular exanthem as a rare but specific COVID-19 associated skin manifestation. Eight Italian dermatology units collected clinical data from 22 patients with COVID-19 (microbiologically proven by nasopharyngeal swab) and no history of new medications in the previous 15 days who developed varicella-like lesions. The median age was 60 years, and 72.7% of patients (n ¼ 16/22) were male. The median latency time from systemic symptoms to exanthem was 3 days (range, -2 to 12 days). The median duration of skin manifestations was 8 days (range, 4-15 days). Lesions were scattered in most patients (n ¼ 16; 72.7%), and they were diffuse in 6 (27.3%) patients. Predominance of vesicles was observed in 12 (54.5%) patients. No variations in the papulovesicular presentation were observed in the case series.
The trunk was always involved, in some cases in association with the limbs (n ¼ 4; 18.2%) No facial or mucosal involvements were scored. Itching, which was generally mild, was reported in 9 (40.9%) patients. In all patients who underwent skin biopsy (n ¼ 7), histologic findings were consistent with viral infection.
The most common systemic symptom was fever (n ¼ 21/22; 95.5%), followed by cough (n ¼ 16; 72.7%), headache (n ¼ 11; 50%), weakness (n ¼ 11; 50%), coryza (n ¼ 10; 45.5%), dyspnea (n ¼ 9; 40.9%), hyposmia (n ¼ 4; 18.2%), hypogeusia (n ¼ 4; 18.2%), pharyngodynia (n ¼ 1; 4.5%), diarrhea (n ¼ 1; 4.5%), and myalgia (n ¼ 1; 4.5%). Death occurred in 3 (13.6%) patients.
This is the first series on this varicella-like exanthem as a specific COVID-19 associated cutaneous picture, unlike the nonspecific cutaneous manifestations such as erythematous rash or urticaria reported by earlier by other doctors elsewhere whose typical features are frequent trunk involvement, usually scattered distribution, and mild/absent pruritus, the latter being in line with most viral exanthems but unlike true varicella. Lesions generally appear 3 days after systemic symptoms and disappear by 8 days, without leaving scarring. A limitation of this study was missing histologic evaluation in some cases.
The researchers said that if further studies validate their findings, this early skin manifestation will represent a useful clue for suspecting COVID-19 in asymptomatic/paucisymptomatic patients.
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