Skin rashes in patients with severe COVID-19

Skin findings may be a clinical clue to an underlying thrombotic state in severe novel coronavirus (COVID-19) patients, according to a new study published in the journal JAMA Dermatology.

In the case series, four patients from two academic hospitals in New York City presented with severe COVID-19 and acute respiratory distress syndrome requiring intubation. The patients had skin findings including acral fixed livedo racemosa and retiform purpura, for which the dermatology department was consulted. 

Punch biopsies were performed for all patients. The results of each biopsy demonstrated a pauci-inflammatory thrombogenic vasculopathy involving capillaries, venules, or arterioles or small arteries. In three of the four patients, dermal arterial thrombosis was noted, reminiscent of antiphospholipid syndrome, without any diagnostic confirmation of these antibodies.

These cases add to a growing body of literature supporting livedo racemosa and retiform purpura as cutaneous findings in patients with COVID-19, the researchers said. The authors said that these skin manifestations may be associated with occlusive vascular disease.

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