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.

A 7-year-old girl presented with proximal muscle weakness and skin lesions. Physical examination revealed violaceous papules on the right forearm in a blaschkoid distribution. Her symptoms and test results were consistent with juvenile dermatomyositis. An unusual superimposed segmental manifestation of this disease is discussed.

Congenital erythropoietic porphyria (CEP) or Günther's disease is a rare autosomal recessive disease resulting from deficient uroporphyrinogen III synthase (UROS) activity mostly due to homozygous mutations in the UROS gene and less frequently in GATA1. 1 CEP commonly presents at birth with cutaneous photosensitivity blistering hypo-and hyperpigmentation severe scarring and deformities. Erythrocyte porphyrin deposition leads to severe hemolysis secondary splenomegaly and pancytopenia which compromises these patients' life expectancy. 1 An exceedingly rare variant of CEP with late-onset (acquired erythropoietic uroporphyria [AEU]) has been described which can be clinically indistinguishable from porphyria cutanea tarda (PCT). Most patients with AEU have a history of myeloid malignancy present with a mild phenotypic expression and with the characteristic urine and blood porphyrin profile of CEP (elevated type I porphyrin isomers) but with normal enzymatic UROS erythrocytic activity and no UROS GATA1 or ALAS2 germline mutations. 2 These cases must be distinguished from patients with germline (homozygous mutants or compound heterozygotes) UROS mutations and mild phenotypic expression (late-onset milder forms of true CEP). 3 Here we report on a patient with AEU associated with myeloid malignancy (AEU-MM) and present a review of the literature.

Dear Editor, Granuloma annulare (GA) is a granulomatous, idiopathic, inflammatory skin disorder characterized by the formation of papules and plaques with annular and acral distribution. 1 GA is often limited and self-resolving, but in some cases, it can be generalized and refractory toThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Recent interest has emerged in the protective role of vitamin D in melanoma survival and is the subject of multiple studies with heterogeneous results. Here, we present a retrospective cohort study of 264 patients with invasive melanoma from a tertiary university hospital. The aim of the study was to analyze the relationship between vitamin D levels and prognosis of melanoma patients. We found that lower vitamin D levels are independently associated with worse overall survival in melanoma patients in concordance with previous studies on other populations. Vitamin D deficiency could play a survival role in melanoma patients,. Future prospective studies are needed to investigate the effect of vitamin D supplementation on melanoma outcomes.

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