The analysis and technical support for this study were done by the Spanish Academy of Dermatology (Research Unit). C. Galv an Casas and A. Catal a contributed equally as first authors.
Background Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized. Objective To describe and classify cutaneous reactions after SARS-CoV-2 vaccination. Methods A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional
Background
A previous study has defined the maculopapular subtype of manifestations of COVID‐19.
Objectives
To describe and classify maculopapular eruptions associated with COVI‐19.
Methods
We carried out a subanalysis of the maculopapular cases found in the previous cross‐sectional study. Using a consensus, we defined 7 clinical patterns. We described patient demographics, the therapy received by the patient and the characteristics of each pattern.
Results
Consensus lead to the description of 7 major maculopapular patterns: Morbilliform (45.5%), Other maculopapular (20.0%), Purpuric (14.2%), Erythema multiforme‐like (9.7%), Pytiriasis rosea‐like (5.7%), Erythema elevatum diutinum‐like (2.3%) and Perifollicular (2.3%). In most cases, maculopapular eruptions were coincident (61.9%) or subsequent (34.1%) to the onset of other COVID‐19 manifestations. The most frequent were cough (76%), dyspnea (72%), fever (88%), and astenia (62%). Hospital admission due to pneumonia was frequent (61%). Drug intake was frequent (78%). Laboratory alterations associated with maculo‐papular eruptions were high C‐reactive protein, high D‐Dimer, lymphopenia, high ferritin, high LDH, and high IL‐6.
Limitations
The impossibility to define the cause–effect relationship of each pattern.
Conclusion
We provide a description of the cutaneous maculopapular manifestations associated with COVID‐19. The cutaneous manifestations of COVID‐19 are wide‐ranging and can mimic other dermatoses.
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A clinical, histopathological and microbiological correlation is essential to corroborate this diagnosis. Solitary lesions are easily treated with surgery, but larger or multiple lesions may require long medical treatments combined with surgery and modification of immunosuppressive medication. The list of dematiaceous fungi implicated in cutaneous infections is expanding, in line with the availability of more sophisticated identification methods and the increasing number of immunosuppressed patients.
Main skin manifestations of COVID-19 have been recently classified. However, little is known about cutaneous histopathological patterns and the presence of SARS-CoV-2 in these skin lesions. We present a healthy 29-year-old man who developed a leucocytoclastic vasculitis for COVID-19 with positive SARS-CoV-2 PCR in skin biopsy.
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