key: cord-1051131-4j7gmkuz
authors: Català, A.; Galván Casas, C.; Carretero Hernández, G.; García‐Doval, I.
title: “Vesicular eruption in COVID‐19 – to exclude varicella”: reply from the authors
date: 2020-07-01
journal: Br J Dermatol
DOI: 10.1111/bjd.19350
sha: 9c9e40e823ff268c038a18a26fffe121d204c823
doc_id: 1051131
cord_uid: 4j7gmkuz

We and agree with Drs Lim and Tey on the need to exclude varicella in vesicular eruptions in patients with COVID‐19, as this diagnosis has important implications. Once that it is established that some patients with COVID‐19 can have a vesicular eruption, there is a need to further characterize this group of patients. The link of some of these lesions with herpesvirus infections is very likely. One patient was excluded from our study with a diagnosis of varicella or disseminated herpes zoster.

"Vesicular eruption in COVID-19 -to exclude varicella": reply from the authors Dear Editor, We and agree with Drs Lim and Tey on the need to exclude varicella in vesicular eruptions in patients with COVID-19, as this diagnosis has important implications.

Once that it is established that some patients with COVID-19 can have a vesicular eruption 1 , there is a need to further characterize this group of patients. The link of some of these lesions with herpesvirus infections is very likely. One patient was excluded from our study with a diagnosis of varicella or disseminated herpes zoster. The list of case reports or case series is growing fast 2 and other authors have shown that patients with COVID-19 can have a vesicular eruption with presence of several herpesvirus 3 .

Their images show haemorrhagic bullae of different sizes and with a diameter of more than 1 cm, larger than the eruption described in our paper 1 with many equal, 2-3 mm vesicles. As the paper by Drs Lim and Tey does not include pictures, we wonder if this could this be a sign suggesting herpesvirus infection (including varicella).

However, other reports have described a histologic pattern of acantholysis and dyskeratosis with a suprabasal unilocular vesicle, different to varicella histology, indicating that at least some patients can have a disease that is not varicella. The diagnosis of these eruptions includes pseudoherpetic Grover disease 4 , or they might be due to SARS-CoV-2 infection.

We suggest that further research should be done with consecutive patients, optimally including lymphocyte count, histology and/or Tzanck smear, and SARS-CoV-2 and herpesvirus detection in the vesicles, to better delineate the possible diagnoses for patients that show a vesicular eruption associated to COVID-19.

A. Català, 1 C. Galván Casas, 2 G. Carretero Hernández 3 and I. García-Doval 4

Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases

CEBD Coronavirus Dermatology Resource

Reply to "Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients": To consider varicella-like exanthem associated with COVID-19, virus varicella zoster and virus herpes simplex must be ruled out

Reply to "Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital