Identify six skin alterations associated with Covid-19: what they are and how to recognize them
When we talk about Sars-CoV-2 virus infection, we realize that symptoms and signs of infection can be different among people, even if respiratory problems are king. It should therefore not be forgotten that science continues to explore how the effects of the virus in the human body are presented.
In this sense, an Italian study shows how even simple skin alterations could, in some cases, reveal the viral infection. The research was carried out with the support of the Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases (SIDeMaST) and published in the Journal of the American Academy of Dermatology: there are six, in particular, the possible skin manifestations.
The six signs that warn
The research was coordinated by Angelo Valerio Marzano, Full Professor of Dermatology and Director of the School of Specialization in Dermatology and Venereology at the University of Milan. And it highlights six ways of "presentation" of Covid-19 "on the skin": you can have a clinical picture similar to urticaria, a rash that resembles that of measles both in the limbs and in the trunk, a skin reaction varicella type, the presence of lesions similar to chilblains, the livedo reticularis, similar to trauma bruising or a clear vasculitis, with a vinous red color and possible formation of ulcers on the lower limbs.
The study was conducted on 200 patients throughout Italy and is the third for the number of patients observed worldwide. The goal was to statistically correlate the 6 specific skin pictures with the severity of the Covid-19 disease and the symptoms of the latter (fever, pneumonia, breathing difficulties, etc). With the support of SIDeMaST, 21 Italian Dermatology Centers contributed to the collection of clinical data of patients with skin manifestations associated with Covid-19. The investigations were conducted in the first phase of the pandemic, in March 2020.
The parameters taken into consideration included sex, age at the onset of the disease, presence or absence of comorbidities, skin manifestations, presence or absence of mucous lesions, duration of skin manifestations. And again, skin-related symptoms, systemic symptoms, duration of systemic symptoms, latency between skin manifestations and systemic symptoms and disease severity.
The severity of the Coronavirus infection was classified into 4 levels: asymptomatic state, mild, moderate and severe severity. 31 patients (15.5%) were asymptomatic, while 51 (25.5%) had a mild form of the disease. 47.5% of patients (95) had a moderate form, and 11.5% (23) a severe form. Furthermore, 86 of 195 patients (with 43% data available) had at least one comorbidity. These are the percentages of skin phenotypes identified: urticarial 13.2%, erythematous or morbilliform 27.4%, similar to chicken pox 16.2%, chilblains 25.4%, ecchymosis 3.6%, vasculitis 10.7%.
Watch out for the skin!
“The average duration of skin manifestations observed – says Professor Marzano – was 12 days; that of the chilblains was 22 days. Furthermore, we found that chilblains were the prevalent symptom among young people and were associated with an almost always asymptomatic manifestation of the virus, while all the other phenotypes were linked to a more or less severe form ".
“In this regard, two important works previously conducted internationally had assumed that the most serious skin lesions were related to a more severe form of Coronavirus, thus establishing a direct proportion between aggressive skin symptoms and severity of COVID. A correspondence that, on the other hand, according to our studies, does not exist: there is no direct correlation between the severity of the skin manifestation and that of Sars-CoV-2 disease. Rather, a correlation exists between increasing age and increasing the severity of the disease ".
For the expert, it is therefore necessary to pay particular attention to precise signals that appear on the skin: an apparent urticaria, a very extensive erythema, sudden vasculitis, bruising and chilblains are all possible indicators of the disease that must lead us to take a swab. "Since the beginning of the Covid-19 pandemic – comments Ketty Peris, President of SIDeMaST and Director of the U.O.C. of Dermatology of the Gemelli Polyclinic in Rome – SIDeMaST has been active by carrying out various scientific studies focused on skin diseases and Sars-CoV-2 infection and carrying out numerous support activities for patients suffering from skin diseases ".
“The study coordinated by Professor Marzano is particularly interesting because it confirms that the skin can be a sign of a Sars-CoV-2 infection. For this reason, it is essential to check our skin even more, because it could warn us and warn us in advance about what is happening in our body, giving us the opportunity to move in advance and help us make an early diagnosis of the disease and also avoid possible further infections ".