Cutaneous manifestations associated with COVID-19 infection at a university hospital in eastern China.

IF 1.4 Q4 IMMUNOLOGY American journal of clinical and experimental immunology Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI:10.62347/BDUC7952
Lingyi Lu, Lu Cao, Jing Zhang, Bingjiang Lin
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Abstract

Background: Coronavirus disease 2019 (COVID-19) affects different organ systems, including the skin. A retrospective analysis of skin manifestations in Chinese outpatient and inpatient settings is lacking. The study aims to analyze cutaneous manifestations in COVID-19 patients and the recurrence or aggravation of previous skin diseases.

Materials and methods: A retrospective cross-sectional study was conducted from November 2022 to July 2023 in a university hospital in eastern China. It involved reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 patients, documenting various skin manifestations and the recurrence or aggravation of pre-existing skin conditions. The pattern of skin lesions and other variables were assessed.

Results: The study included 303 patients, with 127 males and 176 females. Maculopapular rash was the predominant new cutaneous manifestation (54.92%), mainly in middle-aged individuals. Other findings included urticaria (16.39%), herpes zoster (11.89%), and herpes simplex (4.10%), vesicular rashes (2.46%), purpura (2.05%), erythema multiforme (1.64%), livedo reticularis (0.41%) and so on. Severe disease was associated with herpes zoster and livedo reticularis. Critical COVID-19 cases were linked to vesicular rashes, purpura, and erythema multiforme. The mean time for skin lesion emergence post-infection varied from 3 days for seborrheic dermatitis to 17.48 days for herpes zoster. Vasculitic manifestations correlated with elevated D-dimer levels. A total of 59 cases (19.47%) of recurrent or aggravated skin diseases were reported following infection with COVID-19, with dermatitis being the most common, followed by acne and folliculitis, psoriasis, urticaria, bullous pemphigoid, pemphigus, tinea corporis and androgenetic alopecia.

Conclusion: The cutaneous phenotypes delineated in this study expand the dermatologic spectrum associated with COVID-19. Cutaneous manifestations may result from overactive immune responses, complement activation, and microvascular damage. Herpes zoster typically occurs in elderly COVID-19 patients with weaker immune systems or more severe diseases. Purpura and livedo reticularis, although rare, may indicate disease severity. It is possible to predict the course of COVID-19 with different severity through cutaneous manifestations. Recognizing these skin manifestations could aid in predicting COVID-19 severity and guide dermatologists in managing the pandemic response.

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中国东部某大学医院与COVID-19感染相关的皮肤表现。
背景:冠状病毒病2019(COVID-19)影响不同的器官系统,包括皮肤。目前尚缺乏对中国门诊和住院患者皮肤表现的回顾性分析。本研究旨在分析COVID-19患者的皮肤表现以及既往皮肤病的复发或加重情况:一项回顾性横断面研究于 2022 年 11 月至 2023 年 7 月在华东某大学附属医院进行。研究涉及逆转录酶聚合酶链反应(RT-PCR)阳性的 COVID-19 患者,记录了患者的各种皮肤表现以及既往皮肤病的复发或加重情况。对皮损模式和其他变量进行了评估:研究共纳入 303 名患者,其中男性 127 人,女性 176 人。斑丘疹是最主要的新皮肤表现(54.92%),主要发生在中年人身上。其他表现还包括荨麻疹(16.39%)、带状疱疹(11.89%)、单纯疱疹(4.10%)、水泡疹(2.46%)、紫癜(2.05%)、多形性红斑(1.64%)、网状青斑(0.41%)等。重症病例与带状疱疹和筋膜炎有关。COVID-19 重症病例与水泡性皮疹、紫癜和多形性红斑有关。感染后出现皮损的平均时间从3天(脂溢性皮炎)到17.48天(带状疱疹)不等。血管炎表现与 D-二聚体水平升高有关。感染 COVID-19 后,共有 59 例(19.47%)皮肤病复发或加重,其中皮炎最为常见,其次是痤疮和毛囊炎、银屑病、荨麻疹、大丘疹性类风湿、丘疹性荨麻疹、体癣和雄激素性脱发:本研究中描述的皮肤表型扩大了与 COVID-19 相关的皮肤病范围。皮肤表现可能源于过度活跃的免疫反应、补体激活和微血管损伤。带状疱疹通常发生在免疫系统较弱或疾病较严重的 COVID-19 老年患者身上。紫癜和网状青斑虽然罕见,但可表明疾病的严重程度。通过皮肤表现可以预测不同严重程度的 COVID-19 病程。识别这些皮肤表现有助于预测 COVID-19 的严重程度,并指导皮肤科医生管理大流行反应。
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