Mucocutaneous Eruptions Appear to Be Common in Hospitalized COVID Patients

By Scott Baltic

January 15, 2021

NEW YORK (Reuters Health) - Mucocutaneous eruptions (rashes) appear to be relatively common among adults hospitalized for COVID-19, and these eruptions may be connected to a more severe course of illness, researchers in the U.S. report.

They estimate that in a racially diverse cohort, eruptions were present in roughly one of every nine patients, as reported in the Journal of the American Academy of Dermatology.

Distinct morphologic patterns were not observed, undercutting the value of mucocutaneous disease in helping to diagnose COVID-19 among suspected cases, but site specificity in morphologic patterns was seen.

"A relevant issue is not just the prevalence estimate of rash, and characterization of the rashes observed, but that presence of rash was associated with mechanical ventilation, which implies these patients had a more severe illness," said senior author Dr. Amit Garg of the Zucker School of Medicine at Hofstra/Northwell Health, in New Hyde Park, New York.

He told Reuters Health by email that it's possible that microvascular injury in the context of COVID predisposed patients to easy or early injury from pressure caused by mechanical ventilation.

The study is likely to be the first to estimate the prevalence of mucocutaneous disease in a large cohort of hospitalized adults with COVID-19, Dr. Garg added.

It encompassed all adults hospitalized with confirmed diagnoses of COVID-19 between May 11 and June 15 at two tertiary hospitals in metropolitan New York.

Based on mucocutaneous evaluations by two dermatologists, patients with eruptions considered to have been pre-existing, that is, unrelated to COVID, were excluded from the study.

Of the 296 patients for whom all needed information was available, 35 (12%) had at least one eruption related to COVID-19.

The varied morphologic patterns included: ulcer (37%), purpura (26%), necrosis (14%), non-specific erythema (11%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (11%), and vesicles (3%).

"It is noteworthy that morphologic patterns demonstrated site specificity," the authors write. For example, all 13 ulcers appeared on the face, lips, and tongue; all nine of the purpuric lesions were on the extremities; and all five of the necrotic lesions involved the toes.

Patients with eruptions were significantly more likely than those without to require invasive mechanical ventilation.

The report references a recent paper in the same journal, about these researchers' similar study of mucocutaneous disease in children and adolescents with COVID-19 or multisystem inflammatory syndrome in children. In that study, in contrast with this study in adults, Dr. Garg said, rash was associated with an improved clinical course.

Dr. Larisa J. Geskin, director of the Comprehensive Cutaneous Oncology Center at Columbia University, in New York, who was not involved in the study, said the findings themselves are not novel, but added that quantifying this on a population basis is helpful because it reinforces the high percentage of dermatologic findings in COVID patients.

"Skin is like a window" to what's going on inside a patient, she told Reuters Health by phone.

SOURCE: Journal of the American Academy of Dermatology, online December 24, 2020.