scholarly journals Skin Manifestations in COVID-19: Prevalence and Relationship with Disease Severity

2020 ◽  
Vol 9 (10) ◽  
pp. 3261 ◽  
Author(s):  
Priscila Giavedoni ◽  
Sebastián Podlipnik ◽  
Juan M. Pericàs ◽  
Irene Fuertes de Vega ◽  
Adriana García-Herrera ◽  
...  
Keyword(s):  
Skin Lesions ◽  
Direct Immunofluorescence ◽  
Cutaneous Lesions ◽  
Background Data ◽  
Skin Biopsies ◽  
Systemic Symptoms ◽  
Clinicopathological Patterns ◽  
Grover’S Disease ◽  
Clinicopathological Pattern ◽  
Lung Infiltrates

Background: Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Methods and Materials: Retrospective analysis of a prospectively collected cohort of patients with SARS-CoV-2 infection in a teaching hospital in Barcelona, Spain, from 1 April to 1 May 2020. Clinical, microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Results: Fifty-eight out of the 2761 patients (2.1%) either consulting to the emergency room or admitted to the hospital for COVID-19 suspicion during the study period presented COVID-19 related skin lesions. Cutaneous lesions could be categorized into six patterns represented by the acronym “GROUCH”: Generalized maculo-papular (20.7%), Grover’s disease and other papulo-vesicular eruptions (13.8%), livedo Reticularis (6.9%), Other eruptions (22.4%), Urticarial (6.9%), and CHilblain-like (29.3%). Skin biopsies were performed in 72.4%, including direct immunofluorescence in 71.4% and immunohistochemistry in 28.6%. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Conclusion: Cutaneous lesions in patients with COVID-19 appear to be relatively rare and varied. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19.

Photosensitization Induced by Heterophyllaea pustulata in Goats: Sequential Development of Skin Lesions

2021 ◽  
Vol 58 (3) ◽  
pp. 568-573
Author(s):  
Juan F. Micheloud ◽  
Lluís Luján ◽  
Luis A. Colque-Caro ◽  
Susana C. Núñez-Montoya ◽  
Claudio G. Barbeito ◽  
...  
Keyword(s):  
Cell Death ◽  
Oral Dose ◽  
Skin Lesions ◽  
Crust Formation ◽  
Cutaneous Lesions ◽  
Protein Ratio ◽  
Dermal Fibrosis ◽  
Sequential Development ◽  
Treatment Changes ◽  
Skin Biopsies

Five adult Saanen goats received a single oral dose of Heterophyllaea pustulata containing 42.25 μg/kg rubiadin (anthraquinone) and 3 adult goats were untreated controls. All goats were exposed to sunlight and sequential ear skin biopsies were collected before treatment and at 32 hours, 3 days, 8 days, and 15 days after treatment. Changes at 32 hours after dosing included epidermal spongiosis, single cell death and acantholysis, an increased BAX/BCL-2 protein ratio, and dermal edema. Lesions at day 3 included epidermal and adnexal necrosis, crust formation, and acanthosis. Acanthosis, hyperkeratosis, and dermal fibrosis and neovascularization were present at day 15. The pro-apoptotic (BAX)/anti-apoptotic (BCL-2) protein ratio increased at 32 hours, whereas epidermal and dermal PCNA immunolabeling increased between days 8 and 15 after treatment. The cutaneous lesions were consistent with sunlight-induced damage, and the occurrence in treated but not control goats indicates photosensitization.

scholarly journals Localized Bullous Pemphigoid on the Site of Knee Arthroplasty: A Case Report

2016 ◽  
Vol 8 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Lucija Kosi ◽  
Jelena Perić ◽  
Milica Pantović ◽  
Gorana Bijelić ◽  
Jelica Vukićević Sretenović ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Knee Arthroplasty ◽  
Skin Lesions ◽  
Direct Immunofluorescence ◽  
Topical Steroids ◽  
Cutaneous Lesions ◽  
Predisposing Factor ◽  
Dermatological Examination ◽  
The Right ◽  
Split Skin

Abstract Localized bullous pemphigoid is a rare variant of bullous pemphigoid, and its exact etiopathogenesis is yet to be elucidated. We present a case of a 74-year-old Caucasian male with a 3-month history of skin lesions that appeared 9 months after he underwent a knee arthroplasty. Dermatological examination showed several pruritic tense bullae on the right knee, localized around the surgical scar, as well as erosions covered with crusts. The diagnosis of localized bullous pemphigoid was confirmed by direct immunofluorescence test (conventional and split-skin). The patient was treated with potent topical steroids, which led to complete resolution of cutaneous lesions. We suppose that the occurrence of localized bullous pemphigoid in our patient may be explained by the concept of “immunocompromised district” in which one disease (surgery) caused an immunological alteration which is a predisposing factor for the development of secondary disease such as localized bullous pemphigoid.

scholarly journals A Systematic Review of Clinical Studies on Mucocutaneous Manifestations of COVID-19: Virus-Related and Drug-Related

2021 ◽  
Author(s):  
Elham Behrangi ◽  
Mohammadreza Ghassemi ◽  
Afsaneh Sadeghzadeh-Bazargan ◽  
Masoumeh Roohaninasab ◽  
Niloufar Najar Nobari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Symptoms ◽  
Skin Lesions ◽  
The Body ◽  
Inclusion Criteria ◽  
Cutaneous Lesions ◽  
Drug Induced ◽  
Skin Biopsies ◽  
Dermatologic Manifestations ◽  
Primary Skin Lesions

Coronavirus could affect almost any part of the body including the skin. In this systematic review, the primary skin lesions resulting from the direct activity of the virus or the medications used for treatment and the changes in the behavior of the virus regarding the occurrence of these symptoms over time were assessed. PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, Cochrane Skin were searched for all published articles from February 19 to July 1, 2020, which met the inclusion criteria. Thirty-six related articles were extracted. Twenty-eight studies reported virus-related mucocutaneous eruptions and 8 articles, the drug-reactions. Data of 583 patients were included. Skin lesions of COVID-19 could be caused by both the virus itself or the influence of drugs used for the treatment. Morbilliform rashes, urticaria, and acral-vasculopathic cutaneous lesions were at the forefront of primary COVID-dependent skin lesions with no significant change during time, Also, Hydroxychloroquine, lopinavir/ritonavir, paracetamol, and antibiotics were reported as the main causes of drug-induced rashes. Since dermatologic manifestations may occur prior or simultaneously/after other COVID clinical symptoms, so they may helpful in patients’ early diagnosis or prediction of internal organ involvements via histopathologic evaluations of skin biopsies especially about vasculopathic and vasculitic, respectively.

scholarly journals Lymphomatoid Papulosis in a Case of Atypical Secondary Syphilis

2019 ◽  
Vol 14 (4) ◽  
pp. e32-e33
Author(s):  
Xin (Peter) Mu ◽  
Ian Mazzetti
Keyword(s):  
Clinical History ◽  
Skin Lesions ◽  
Secondary Syphilis ◽  
Low Grade ◽  
Cutaneous Lesions ◽  
Syphilis Infection ◽  
Lymphomatoid Papulosis ◽  
History Of ◽  
Skin Biopsies ◽  
Syphilis Serology

AbstractLymphomatoid papulosis is an indolent cutaneous lymphoproliferative disorder that presents as recurrent self-resolving papulonodular skin lesions. Currently, there are no known causes for lymphomatoid papulosis and definitive diagnosis is only made histologically. A 64-year-old man presented with a 6-week history of bilateral leg pains, low-grade fevers, and a widespread eruption of painless erythematic papules. Despite testing positive for syphilis serology, he lacked the typical clinical history for classic syphilis and therefore, skin biopsies were performed to confirm the diagnosis. Unexpectedly, the skin biopsies revealed lymphomatoid papulosis which resolved with antibiotic treatments for syphilis. Considering the synchronous resolution of the patient’s syphilis infection and his cutaneous lesions, this is the first report of findings to suggest syphilis as a possible cause for lymphomatoid papulosis. Clinicians should appreciate the possibility of alternative diagnosis for cutaneous presentations in settings of confirmed syphilis infections. RESUMELa papulose lympho-matoïde est un trouble lymphoprolifératif cutané indolent qui se présente sous la forme de lésions cutanées papulonodulaires auto-résolutives récurrentes. Actuellement, il n’y a pas de causes connues de la papulose lymphomatoïde et le diagnostic définitif n’est posé que sur le plan histologique. Un homme de 64 ans a présenté une histoire de 6 semaines de douleurs bilatérales aux jambes, de fièvres de bas grade et d’éruptions généralisées de papules érythémateuses indolores. Malgré un test sérologique positif pour la syphilis, il n’avait pas les antécédents cliniques typiques de la syphilis classique et des biopsies cutanées ont donc été effectuées pour confirmer le diagnostic. De façon inattendue, les biopsies cutanées ont révélé une papulose lymphomatoïde qui s’est résorbée grâce à des traitements antibiotiques contre la syphilis. Compte tenu de la résolution synchrone de l’infection syphilitique du patient et de ses lésions cutanées, il s’agit du premier rapport de résultats suggérant que la syphilis est une cause possible de papulose lymphomatoïde. Les cliniciens devraient apprécier la possibilité d’un diagnostic alternatif pour les présentations cutanées dans les contextes d’infections syphilitiques confirmées.

Neutrophilic dermatoses

2013 ◽  
pp. 1426-1433
Author(s):  
Pia Moinzadeh ◽  
Thomas Krieg
Keyword(s):  
Skin Diseases ◽  
Inflammatory Diseases ◽  
Diagnostic Procedures ◽  
Inflammatory Cells ◽  
Skin Lesions ◽  
Cutaneous Lesions ◽  
Neutrophilic Dermatoses ◽  
Systemic Symptoms ◽  
Dermal Infiltrate ◽  
Exanthematous Pustulosis

Neutrophilic dermatoses (ND) comprise a heterogeneous group of non-infectious skin diseases characterized by a diffuse epidermal and/or dermal infiltrate consisting of polymorphonuclear neutrophilic inflammatory cells throughout the different skin layers. Depending on the localization of this infiltrate, patients may present with a variety of skin lesions such as pustules/vesiculopustules (epidermal infiltrate), plaques or papules (dermal infiltration), nodules or ulcerations (deep dermal/subcutaneous infiltrate) and also with possible systemic symptoms, such as leucocytosis, arthralgias, myalgia, and malaise. Based on the clinical picture of cutaneous lesions and further systemic symptoms the patients can be subdivided into different entities. These include Sweet’s syndrome (SS), pyoderma gangrenosum (PG), rheumatoid neutrophilic dermatitis, bowel-associated dermatosis-arthritis syndrome, subcorneal pustular dermatosis (Sneddon Wilkinson), acute generalized exanthematous pustulosis (AGEP), acrodermatitis continua of Hallopeau (ACH), palmoplantare pustuloses (PPP), pustular bacterid (PB), neutrophilic eccrine hidradenitis, and Behçet’s disease. The pathogenesis is still not fully elucidated but it has been hypothesized that it is associated with immunological dysfunctions, with abnormal cytokine signalling, causing an uncontrolled recruitment of neutrophilic cells. ND can be triggered by underlying systemic inflammatory diseases, malignancies, haematological disorders and/or medication use. Diagnostic procedures include detailed physical examination, laboratory tests, and histopathological assessments. The therapeutic management of ND is mainly based on systemic steroids in acute cases and immunosuppressive or immunomodulatory drugs in chronic forms. Underlying systemic conditions have to be diagnosed and treated as early as possible to avoid complications.

scholarly journals A Case of Extensive Grover’s Disease in a Patient with a History of Multiple Non-Melanoma Skin Cancers

2021 ◽  
pp. 553-557
Author(s):  
Mareike Kotzerke ◽  
Fouad Mitri ◽  
Alexander Enk ◽  
Ferdinand Toberer ◽  
Holger Haenssle
Keyword(s):  
Oral Therapy ◽  
Topical Therapy ◽  
Skin Lesions ◽  
Squamous Cell Carcinomas ◽  
Skin Cancers ◽  
History Of ◽  
Skin Biopsies ◽  
Grover’S Disease ◽  
Acantholytic Dyskeratosis ◽  
Melanoma Skin

We report on a 69-year-old man who presented with itching and erythematous papules on his torso and extremities, which were resistant to topical therapy with antibiotics and steroids. Physical examination revealed multiple erythematous papules on his back, neckline, and lower extremities. The lesions had appeared 4 years earlier and usually worsened with heat or extensive sweating. Histopathology of previous skin biopsies had shown multiple cutaneous squamous cell carcinomas or was non-conclusive. Thus, a re-biopsy was performed, revealing acanthosis and focal acantholytic dyskeratosis. These clinical and anamnestic findings lead to the diagnosis of extensive Grover’s disease (GD). Oral therapy with isotretinoin 30-mg QD led to the regression of the skin lesions. Topical adapalene, as well as topical corticosteroids, were later prescribed for maintenance therapy.

scholarly journals Histological Patterns of Skin Lesions in Tuberous Sclerosis Complex: A Panorama

2021 ◽  
Vol 8 (3) ◽  
pp. 236-252
Author(s):  
Marine Cascarino ◽  
Stéphanie Leclerc-Mercier
Keyword(s):  
Tuberous Sclerosis ◽  
Tuberous Sclerosis Complex ◽  
Genetic Disorders ◽  
Dental Enamel ◽  
Skin Lesions ◽  
Consensus Conference ◽  
Pediatric Hospital ◽  
Cutaneous Lesions ◽  
Skin Biopsies ◽  
Minor Criteria

Tuberous Sclerosis Complex (TSC) is a multisystem genetic disease characterized by cutaneous and extracutaneous hamartomas. The diagnosis is based on the association of major and minor criteria, defined by a consensus conference updated in 2012. The clinical examination of the skin is crucial because seven diagnostic criteria are dermatological: four major (hypomelanotic macules, angiofibroma or fibrous cephalic plaques, ungual fibromas, shagreen patches) and three minor criteria (confetti skin lesions, dental enamel pits, intraoral fibromas). Skin biopsy is commonly performed to assert the diagnosis of TSC when the clinical aspect is atypical. Histopathology of TSC cutaneous lesions have been poorly reported until now. In this article, we review the histologic features described in the literature and share our experience of TSC skin biopsies in our pediatric hospital specialized in genetic disorders. Both hypomelanotic lesions and cutaneous hamartomas (angiofibroma/fibrous cephalic plaques, ungual fibromas, shagreen patches) are discussed, including the recent entity called folliculocystic and collagen hamartoma, with a special emphasis on helpful clues for TSC in such lesions.

Cutaneous and Systemic Necrotizing Vasculitis in Swine

1998 ◽  
Vol 35 (2) ◽  
pp. 108-116 ◽  
Author(s):  
S. Thibault ◽  
R. Drolet ◽  
M.-C. Germain ◽  
S. D'Allaire ◽  
R. Larochelle ◽  
...  
Keyword(s):  
Mononuclear Cells ◽  
Systemic Vasculitis ◽  
Skin Lesions ◽  
Cutaneous Lesions ◽  
Prrs Virus ◽  
Skin Biopsies ◽  
Polymerase Chain ◽  
Generalized Lymphadenopathy ◽  
Synovial Membranes ◽  
Epidemiologic Characteristics

A systemic vasculitis involving particularly the skin and kidneys has been recently described in swine under the name dermatitis/nephropathy syndrome. Twelve pigs with gross cutaneous lesions typical of this condition were necropsied, and morphologic, immunohistochemical, microbiologic, and epidemiologic characteristics were studied. The pigs were divided into three groups comprising eight pigs with acute lesions, two with chronic lesions, and two with acute lesions kept for sequential skin biopsies. Acute skin lesions consisted of round to irregular, red to purple macules and papules that often coalesced to form large, irregular patches and plaques. With time, the lesions became covered by crusts and faded gradually, sometimes leaving scars. Characteristic distribution included the perineal area of the hindquarters, limbs, dependent parts of the abdomen and thorax, and margins of the ears. In the acute phase of the disease, necrotizing and leucocytoclastic vasculitis of small-caliber blood vessels were observed within the dermis and panniculus and in various extracutaneous locations such as the renal pelvis and synovial membranes. All pigs had macroscopic evidence of pneumonia and generalized lymphadenopathy. Microscopically, they had interstitial pneumonia and perivascular cuffing of mononuclear cells in various tissues including skin. The presence of immunoglobulins and complement was demonstrated by immunofluorescence in and around necrotic vessels of the skin in the early stages. Porcine reproductive and respiratory syndrome (PRRS) virus (PRRSV) antigens were detected by immunohistochemistry in macrophages located around vessels of the tissues examined (skin and kidneys) in acute and chronic cases. PRRSV RNA was demonstrated by reverse transcription-polymerase chain reaction in lung and spleen homogenates from all pigs. The PRRSV was isolated in cell culture from 11 of the pigs. These findings suggest that PRRSV infection may play a role in the pathogenesis of this systemic vascular disease of swine.

Neutrophilic dermatoses

2013 ◽  
pp. 1426-1433
Author(s):  
Pia Moinzadeh ◽  
Thomas Krieg
Keyword(s):  
Skin Diseases ◽  
Inflammatory Diseases ◽  
Diagnostic Procedures ◽  
Inflammatory Cells ◽  
Skin Lesions ◽  
Cutaneous Lesions ◽  
Neutrophilic Dermatoses ◽  
Systemic Symptoms ◽  
Dermal Infiltrate ◽  
Exanthematous Pustulosis

Neutrophilic dermatoses (ND) comprise a group of non-infectious skin diseases characterized by a diffuse epidermal and/or dermal infiltrate consisting of polymorphonuclear neutrophilic inflammatory cells throughout the different skin layers. Depending on the localization of this infiltrate, patients may present with a variety of skin lesions such as pustules/vesiculopustules (epidermal infiltrate), plaques or papules (dermal infiltration), nodules or ulcerations (deep dermal/subcutaneous infiltrate) and also with possible systemic symptoms, such as leucocytosis, arthralgias, myalgia, and malaise. Depending on the localization of neutrophilic cells in the skin, the clinical picture of cutaneous lesions and further systemic symptoms the patients can be subdivided into different subgroups. These include Sweet’s syndrome (SS), pyoderma gangrenosum (PG), rheumatoid neutrophilic dermatitis, bowel-associated dermatosis-arthritis syndrome, subcorneal pustular dermatosis (Sneddon Wilkinson), acute generalized exanthematous pustulosis (AGEP), acrodermatitis continua of Hallopeau (ACH), palmoplantare pustuloses (PPP), pustular bacterid (PB), neutrophilic eccrine hidradenitis, and Behçet’s disease. The pathogenesis is still not fully elucidated but it has been hypothesized that it is associated with immunological dysfunctions, with abnormal cytokine signalling, causing an uncontrolled recruitment of neutrophilic cells. ND can be triggered by underlying systemic inflammatory diseases, malignancies, haematological disorders and/or medication use. Diagnostic procedures include detailed physical examination, laboratory tests, and histopathological assessments. The therapeutic management of ND includes systemic steroids in acute cases and immunosuppressive or immunomodulatory drugs in chronic forms. Underlying systemic conditions have to be diagnosed and treated.

scholarly journals Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199719
Author(s):  
Juan Carlos Palomo-Pérez ◽  
Maria Elisa Vega-Memije ◽  
David Aguilar-Blancas ◽  
Erik González-Martínez ◽  
Lucia Rangel-Gamboa
Keyword(s):  
Respiratory Symptoms ◽  
Case Series ◽  
Signs And Symptoms ◽  
Skin Lesions ◽  
World Health ◽  
Medical Community ◽  
Atypical Pneumonia ◽  
Cutaneous Lesions ◽  
Cutaneous Manifestations ◽  
Mexican Patients

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

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