Mucocutaneous patterns identified in hospitalized patients with COVID-19
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Mucocutaneous patterns such as ulcers and purpura were commonly observed among individuals hospitalized with COVID-19, according to a study.
Sergey Rekhtman, MD, PharmD, MPH, of the department of dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and colleagues aimed “to estimate prevalence of mucocutaneous findings, characterize morphologic patterns and describe relationship to course in hospitalized adults with COVID-19.”
The prospective cohort study included 296 adults hospitalized with COVID-19 at two tertiary care hospitals between May 11 and June 15, 2020.
Results showed that 35 patients (11.8%) experienced at least one disease-related eruption. Ulcers comprised the largest share of those events, at 37.1%, followed by purpura (25.7%), necrosis (14.3%), non-specific erythema (11.4%), morbilliform eruption (11.4%), pernio-like lesions (11.4%) and vesicles (2.9%).
Clinician also observed anatomic site specificity in the patterns of eruptions. For example, all nine of the purpuric lesions occurred on the extremities, while all five of the necrotic lesions were on the toes, and red erythema was most commonly observed on the face, neck and chest. The morbilliform pattern occurred most frequently on the trunk, while the hands or feet were the site of pernio-like lesions. The one patient with a vesicular eruption had it on their abdomen.
Looking at COVID-19 outcomes, compared with patients who did not have mucocutaneous findings, those with mucocutaneous findings required mechanical ventilation more frequently, 61% vs. 30% (P < .001). Other outcomes that were more common in the mucocutaneous group compared with the non-mucocutaneous group included the use of vasopressors (77% vs. 33%), initiation of dialysis (31% vs. 9%), thrombosis (17% vs. 11%) and in-hospital mortality (34% vs. 12%), but these differences were not statistically significant.
When the researchers stratified patients by ventilation status and presence or absence of rash, no clinically meaningful differences were reported with regard to age, BMI, neutrophil-to-lymphocyte ratio and D-dimer.
The researchers noted that the findings were limited by the failure to perform skin biopsies.
“Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19,” they wrote. “Mucocutaneous disease may be linked to more severe clinical course.”
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