June 24, 2021

Skin and coronavirus, six unusual symptoms not to be overlooked


They can be confused with chicken pox, hives, vasculitis and chilblains. They appear to be the signs of common skin diseases, but they could also be manifestations of Sars-CoV-2, associated with various stages of the disease. This is why those who manifest six alarm bells, identified by an Italian research published in the scientific journal Journal of the American Academy of Dermatology, should undergo a swab to check for the presence of the virus. The study was conducted on 200 patients throughout Italy and the third for the number of patients observed worldwide – underlines Ketty Peris, president of the Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases (SIDeMaST), who supported the work -. And six “phenotypes” emerged to which particular attention should be paid, namely: a clinical picture similar to urticaria; a morbilliform rash in both the limbs and trunk; a chickenpox-like skin reaction; the presence of chilblains-like lesions; the so-called “livedo reticularis”, similar to trauma bruising; and finally, vasculitis, with a vinous red color and possible ulcer formation on the lower limbs.

If in doubt talk to your doctor and take a swab

What has emerged so far from various surveys that in about 10-20% of Covid patients appear skin rashes and, precisely through the biopsy of a 25-year-old patient suffering from urticaria on the arms, in recent days it has been hypothesized that the virus circulated in Milan already in November 2019, well before the identification of patient 1 in Codogno on 20 February 2020. Since the beginning of the Covid-19 pandemic SIDeMaST has been active by carrying out several scientific studies focused on skin diseases and SARS-CoV2 infection and carrying out numerous support activities for patients suffering from skin diseases – says Peris, director of dermatology at the Gemelli Polyclinic in Rome -. This new study, coordinated by Professor Marzano, is particularly interesting because it confirms that the skin can be a sign of a new coronavirus infection. For this reason, it is essential to check our skin even more, because it could warn us and warn us in advance about what is happening in our body, giving us the opportunity to move in advance and help us make an early diagnosis of the disease and also avoid possible further contagions. Especially if the skin lesions are associated with known systemic symptoms (sore throat, cough, fever, decreased or loss of smell or taste, fever, shortness of breath) or in case of contact with people positive for the virus it is important that people do not neglect and discuss it with their family doctor or dermatologist. And if the doubt is well founded, it is necessary to proceed with the rhino-pharyngeal swab, which allows the identification of the viral RNA, and the serological test.

The new Italian study on 200 patients

The goal of the Italian study just published

and coordinated by Angelo Valerio Marzano, Full Professor of Dermatology and Director of the School of Specialization in Dermatology and Venereology at the University of Milan, was to statistically correlate the 6 specific skin pictures with the severity of the Covid-19 disease and its symptoms. last (fever, pneumonia, respiratory distress, etc). With the support of SIDeMaST, 21 Italian Dermatology Centers contributed to the collection of clinical data of patients with skin manifestations associated with the virus. The investigations were conducted in the first phase of the pandemic, in March 2020. The severity of the Coronavirus infection was classified according to 4 levels: asymptomatic state, mild, moderate and severe severity. The patients examined were predominantly male (54%), with a mean age at the time of diagnosis of 57 years. 31 patients (15.5%) were asymptomatic, while 51 (25.5%) had a mild form of the disease. 47.5% of patients (95) had a moderate form, and 11.5% (23) a severe form. Furthermore, 86 of 195 patients (with 43% data available) had experienced at least one comorbidity. These are the percentages of the skin phenotypes identified: urticarial 13.2%, erythematous or morbilliform 27.4%, similar to chickenpox 16.2%, chilblains 25.4%, bruising 3.6%, vasculitis 10.7%: The average duration of skin manifestations observed – explains Marzano – was 12 days; that of the chilblains was 22 days. Furthermore, we found that chilblains were the prevalent symptom among young people and were associated with an almost always asymptomatic manifestation of the virus, while all the other phenotypes were linked to a more or less severe form. In this regard, two important works previously conducted at an international level had assumed that the most serious skin lesions were related to a more severe form of Coronavirus, thus establishing a direct proportion between aggressive skin symptoms and the severity of Covid. A correspondence which, on the other hand, according to our studies, does not exist: there is no direct link between the severity of the skin manifestation and that of Sars-CoV-2 disease. Rather, a link exists between increasing age and increasing disease severity.

January 27, 2021 (change January 27, 2021 | 18:40)

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