Histology of skin lesions establishes that the vesicular rash associated with COVID‐19 is not ‘varicella‐like’

Mahé, A.; Birckel, E.; Merklen, C.; Lefèbvre, Patrick; Hannedouche, C.; Jost, Marion; Droy-Dupré, L.

doi:10.1111/jdv.16706

Cited by 53 publications

(54 citation statements)

References 8 publications

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“…Of the 84 contributions accepted for our analysis, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14. , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , ...…”

Section: Resultsunclassified

Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns

Rongioletti

Ferreli

Sena

et al. 2021

Clinics in Dermatology

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Section: Resultsunclassified

Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns

Rongioletti

Ferreli

Sena

et al. 2021

Clinics in Dermatology

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“…According to Mahé et al, these exanthems histologically show acantholysis, intraepidermal vesicles with suprabasal clefts, prominent, “pomegranate-like” dyskeratosis and suspected viral inclusions in multinucleated cells. The authors of that report proposed the term “COVID-19-associated acantholytic rash”, rather than “varicella-like rash” [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Aerosolized uptake of SARS-CoV-2 leads to infection of the functional receptor angiotensin-converting enzyme (ACE) type II (ACE2)-expressing target cells such as alveolar type 2 or other unknown target cells. ACE2 is present in the skin in the basal layer of the epidermis, in endothelial cells of dermal blood vessels and in eccrine adnexal tissue [ 65 ]; a direct pathogenic effect of the virus in the epidermis via ACE2, leading to acantholysis and dyskeratosis, has been proposed [ 58 ]. COVID-19-endotheliitis via ACE2 could explain the systemic impaired microcirculatory function in different vascular beds and their clinical sequelae in patients with COVID-19 [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

2020

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In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions—and in severe cases, microvascular injury and thrombosis—associated with COVID-19, and provide important clues to their pathological mechanisms.

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“…Mahé et al [32] reported on 3 patients with typical COVID-19-associated papulovesicular rash, in which the histological pattern of skin lesions showed prominent acantholysis and dyskeratosis associated with the presence of an unilocular intraepidermal vesicle in a suprabasal location. Based on these histopathological findings, the authors refused the term “varicella-like rash” and proposed a term which was more suitable in their view: “COVID-19-associated acantholytic rash.” Histopathological findings of another case of papulovesicular eruption revealed extensive epidermal necrosis with acantholysis and swelling of keratinocytes, ballooning degeneration of keratinocytes and signs of endotheliitis in the dermal vessels [33].…”

Section: Papulovesicular Exanthemmentioning

confidence: 99%

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

et al. 2020

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Background: Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), which was isolated for the first time in Wuhan (China) in December 2019. Common symptoms include fever, cough, fatigue, dyspnea and hypogeusia/hyposmia. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported in the last few months. Summary: The polymorphic nature of COVID-19-associated cutaneous manifestations led our group to propose a classification, which distinguishes the following six main clinical patterns: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric “vasculitic” pattern. This review summarizes the current knowledge on COVID-19-associated cutaneous manifestations, focusing on clinical features and therapeutic management of each category and attempting to give an overview of the hypothesized pathophysiological mechanisms of these conditions.

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Histology of skin lesions establishes that the vesicular rash associated with COVID‐19 is not ‘varicella‐like’

Abstract: appropriate diagnosis for our case. The patient's complete response to steroid therapy, which usually causes deterioration in COVID-19 cases, supports our diagnosis. It is important to be aware of the similar clinical manifestations between EGPA and COVID-19.

Cited by 53 publications

References 8 publications

Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns

Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

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