Skin complication may not be associated with COVID-19

A form of cutaneous lesions known as acute acro-ischemia was not found to be associated with COVID-19, despite suspicion thereof, according to a study.

Juncal Roca-Ginés, MD, of the department of dermatology at Hospital Universitario y Politécnico La Fe in Valencia, Spain, and colleagues said that some associated skin diseases are emerging as a potential complication of COVID-19. “Cutaneous lesions referred to as acute acro-ischemia have been reported as a possible sign of COVID-19 in adolescents and children,” they wrote.

In the case series study, they prospectively enrolled 20 patients at La Fe University Hospital between April 9 and April 15, 2020. This group was culled from 32 children and adolescents with recent-onset inflammatory lesions that had not been diagnosed by a clinician.

Study protocols stipulated that patients were not exposed to any intervention, pharmacotherapeutic or otherwise.

Clinicians performed reverse transcriptase-polymerase chain reaction (PCR) for SARS-CoV-2, in addition to a range of blood tests, including complete blood cell counts; tests for liver and kidney function; levels of ferritin, lactated dehydrogenase, C-reactive protein, D-dimer, cryoglobulins and urine sediment; serologic tests for enterovirus, Epstein-Barr virus, herpes and other such infections; and immunoglobulin, among others. Six patients also underwent skin biopsy.

The cohort was comprised of seven girls and 13 boys ranging in age from 1 to 18 years.

Seven patients were diagnosed with purpuric maculopapules, six with acral erythema and four with dactylitis, while three patients demonstrated a mixed pattern.

No remarkable hematologic or serologic abnormalities were observed, nor were negative antibodies to COVID-19.

Among the six patients who underwent biopsy, histologic findings revealed characteristics of perniosis.

In addition, none of the patients in the cohort demonstrated indicators or symptoms of COVID-19, such as fever, fatigue, dry cough, anorexia, myalgia, dyspnea, sputum, headache, sore throat, smell or taste disorders, or rhinorrhea.

Despite these findings, the researchers offered three possible explanations for the sudden appearance of the lesions, despite negative indictors of COVID-19. The first is that the patients were in the early stage of disease, which might explain the negative PCR and serologic tests. However, the researchers suggested that this was the least probable explanation.

The second possible reason is that acrocyanosis and perniosis may be subacute manifestations of SARS-CoV-2. However, the absence of risk factors ranging from endotheliitis and thrombosis to diabetes, hypertension and obesity may negate this possibility.

The third explanation is that the quarantine state itself induced perniosis.

However, the researchers wrote that, “The clinical, histologic and laboratory test results were compatible with a diagnosis of perniosis, and no evidence was found to support the implication of SARS-CoV-2 infection.”