Transient aquagenic syringeal acrokeratoderma during COVID‐19 outbreak: a retrospective case series of eight patients

Abstract

diverse skin manifestations have been reported to be associated with the disease, most of them concerning skin rashes. 1 We have since identified an increase in the diagnosis of aquagenic syringeal acrokeratoderma (ASA), in consonance with other reports of ASA following excessive exposure to water and disinfectants. 2,3 However, an association between SARS-CoV-2 and ASA has not previously been reported. The objective of this study was to describe cases of ASA presenting during the COVID-19 outbreak and its possible association with SARS-CoV-2 infection.We retrospectively reviewed patients with a diagnosis of ASA consulting either to the emergency department or to the dermatology outpatient clinic in two third-level referral hospitals from March 2020 to March 2021, including virtual consultations. Diagnosis was established by a board-certified dermatologist through symptoms and a water immersion test, where patients were exposed to warm water for 2 min. Patients with a history of ASA or symptoms beginning previous to March 2020 were excluded. The clinical pattern of ASA was documented regarding both palmar and plantar involvement as well as the presence or absence of symptoms (Fig. 1). Known associated risk factors such as hyperhidrosis, cystic fibrosis or atopic dermatitis were recorded. All patients were asked about COVID-19 symptoms such as fever, cough or dyspnoea. When available, RT-PCR nasopharyngeal swabs for SARS-CoV-2 results were registered. No skin biopsies were performed due to virtual consultation and lack of patients' consent.The study population comprised 8 patients (3 men and 5 women), with ages ranging from 5 to 34. Demographic and clinical data of the patients are depicted in Table 1. All patients presented with bilateral palmar ASA, while none reported the involvement of the soles. Out of 8 patients, 5 tested positive for SARS-CoV-2 while one reported symptoms compatible with COVID-19 pneumonia, with no PCR available. The former reported onset of ASA days after the diagnosis of COVID-19 infection, while the latter described the beginning of ASA immediately after the first pneumonia symptoms. All of these patients