Nearly one-third of patients with coronavirus disease 2019 (COVID-19) have at least 1 dermatologic manifestation, with palmar erythema and scalp erythema most associated with hospitalization, researchers reported in a study published in the Journal of The European Academy of Dermatology and Venereology.

The investigators used an electronic survey to evaluate the prevalence of dermatologic manifestations in patients with COVID-19. Participants were recruited from 66,667 registered cell phone users in Brazil randomly assigned from a database; they were asked to complete the survey and to share it with their personal contacts.

The questionnaire addressed baseline demographics and COVID-19 status (never, suspected, or confirmed). For participants who had suspected or confirmed COVID-19, the survey included clinical outcomes and images of mucocutaneous manifestations. Dermatologic findings were assessed according to disease severity (outpatient vs hospitalized) and main demographic data. The analysis involved only self-reported confirmed cases (by polymerase chain reaction or serology) of COVID-19.

A total of 43,444 participants were included: 39,693 healthy participants, 2322 who were suspected or awaiting confirmation of COVID-19, and 1429 confirmed patients with COVID-19. Male sex (odds ratio [OR], 2.1), age older than 60 years (OR, 3.3), obesity (OR, 1.9), arterial hypertension (OR, 1.8), and diabetes (OR, 2.4) were independently associated with hospitalization (P <.05).


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In addition, 31% (95% CI, 28-33) of patients with COVID-19 had at least 1 dermatologic manifestation. Palmar erythema (OR, 3.6) and scalp erythema (OR, 2.1) were most associated with hospitalization. Papulovesicles were more common in patients younger than 30 years, pseudo-chilblains were more frequent in older adults, and scalp scaling and erythema were more common among nonwhite participants.

Of the 358 patients with COVID-19 who did not have fever or cough, 24.6% (95% CI, 20-29) reported at least 1 mucocutaneous manifestation.

“This survey disclosed a higher prevalence of skin manifestations during COVID-19, probably due to the active inquiring of general symptoms [such] as pruritus, or some less specific lesions (eg, oral and scalp),” stated the investigators. “No cutaneous manifestations reported are specific of COVID-19, as well as they may occur in many viral disorders and drug reactions. This large sample allowed the analysis exclusively of the COVID-19-confirmed cases, minimizing validation bias. Furthermore, the results from suspected/awaiting confirmation patients were comparable.”

The main study limitation was that the patients were not examined by a dermatologist, noted the researchers.

Although “the skin lesions are highly nonspecific, skin may be a clue for COVID-19 diagnosis, especially in low-symptomatic patients,” the study authors concluded.

Reference

Miot HA, Ianhez M, Müller Ramos P. Self-reported cutaneous manifestations in 1,429 Brazilian COVID-19-infected patients. Published online November 2, 2020. J Eur Acad Dermatol Venereol. doi.org/10.1111/jdv.17024