key: cord-0726601-oi0xnmm1
authors: Jacquin-Porretaz, C.; Ducournau, A.; Dupond, A.-S.; Nardin, C.; Aubin, F.; Courtieu, C.
title: Cutaneous manifestations of COVID-19 in the Franche-Comté region of France: a monocentric study
date: 2021-01-09
journal: Ann Dermatol Venereol
DOI: 10.1016/j.annder.2020.12.002
sha: ad7f882ca76cc9c4859f7b20ddbc0ddbeeb34c09
doc_id: 726601
cord_uid: oi0xnmm1

nan

. The most frequent cutaneous manifestation described during the COVID-19 outbreak was pseudo-chilblain, reported in 19 patients (49%) with no previous history of chilblains. Mean age was 35 +/-24 years. Pseudo-chilblain was associated with general symptoms in 12 patients (63%) and remained isolated in 7 patients (37%). The average time from onset of general symptoms to cutaneous manifestations was 9 ± 9 days. Vesicular rash (15%) was the third cutaneous manifestation and was seen predominantly on the extremities. Mean patient age was 44 ± 27 years. Most patients (n= 5, 83%) presented at least one non-dermatological symptom. The average time between the onset of COVID-19 symptoms and vesicular rash was longer than 3 weeks (22 ± 26 days). One patient had pseudo-chilblain associated with a vesicular eruption. SARS-CoV-2 PCR testing was performed in 3 cases and was positive for 2 patients. SARS-CoV2 serology testing was also carried out in 3 patients and was positive in one patient.

Five patients (13%) presented with a photo-distributed rash. No new drug intake or cutaneous application of topical products was reported. Photo tests were not performed.

The results of our study in Franche-Comté match preliminary data gathered in Europe, notably in Spain and Italy [1, 2] . Pseudo-chilblain manifestations were predominant and occurred in young patients having no pre-existing peripheral vascular disease and no previous exposure to cold. In these patients, COVID-19 disease was mild to moderate. Seven patients had no manifestations other than pseudo-chilblain. Blood tests were reassuring; no vasculitis was seen on skin biopsies. SARS-CoV2 swabs were negative in all cases except for one case associated with a photo-distributed rash. These manifestations of late onset (+9 days) and Non-specific rashes such as maculopapular, vesicular, photo-distributed and urticarial rashes appear later than pseudo-chilblain and in older patients (> 40 years). They are always accompanied by general symptoms and constitute a differential diagnosis.

Finally, maculopapular rashes appear to be restricted to contagious patients, prompting the use of personal protective equipment and isolation.

To conclude, the skin manifestations described during the COVID-19 outbreak are heterogenous. Further investigations are needed to better understand the mechanisms underlying the skin manifestations of COVID-19. 

Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients

Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies

Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on polymerase chain reaction