Maculopapular eruptions associated to COVID ‐19: A subanalysis of the COVID‐Piel study

Abstract

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. This article is protected by copyright. All rights reserved.

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

“…Erythematous papules may also be arranged in a morbilliform pattern [23]. In a subanalysis of the COVID-Piel Study [4] on maculopapular eruptions including also purpuric, erythema multiforme-like, pityriasis rosea-like, erythema elevatum diutinum-like and perifollicular eruptions, morbilliform exanthems were the most frequent maculopapular pattern ( n = 80/176, 45.5%) [24]. This study showed that in most cases lesions were generalized, symmetrical and started on the trunk with centrifugal progression.…”

“…This study showed that in most cases lesions were generalized, symmetrical and started on the trunk with centrifugal progression. In the same subanalysis, hospital admission due to pneumonia was very frequent (80%) in patients with a morbilliform pattern [24]. In this group, the main differential diagnoses are represented by exanthems due to viruses other than SARS-CoV-2 and drug-induced cutaneous reactions.…”

Inflammation and Vascular Injury as the Basis of COVID-19 Skin Changes: Preliminary Analysis of 23 Patients from the Literature

“…High D-Dimer was reported to associate with maculopapular eruptions. 24 Increasing D-dimer might be related to the circulatory disorder of the multiple organ system including skin caused by the virus and the pathogenesis of skin changes such as vascular occlusive dermatosis in COVID-19 patients.…”

COVID-19–specific skin changes related to SARS-CoV-2: Visualizing a monumental public health challenge

“…Skin lesions linked with COVID-19 are noteworthy ( 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ). Cutaneous findings with the infection itself may produce skin changes which have been classified into 6 categories with three distinct indicative patterns: vesicular (varicella-like), vasculopathic, and chilblains-like (including “COVID fingers” or “COVID toes”) ( Fig 1 , Fig 2 , Fig 3 ) plus three less suggestive ones: dermatitic, maculopapular, and urticarial morphologies ( Fig.…”

“…A Spanish study classified the cutaneous manifestations associated with COVID-19 five clinical patterns: acral erythema with vesicles or pustules (pseudo-chilblain), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%) ( 19 ). From these maculopapular eruptions seven maculopapular patterns were delineated: 1) morbilliform, 2) other maculopapular, 3) purpuric, 4) erythema multiforme-like, 5) pityriasis rosea-like, 6) erythema elevatum diutinum-like, and 7) perifollicular ( 20 ).

Fig 1 Vasculopathic COVID-19 skin, a distinct indicative pattern (COVID-19 with dermatologic manifestations and implications: An unfolding conundrum.

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