Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients.
J Am Acad Dermatol. 2020 Apr 16;83(1):280-5. doi:10.1016/j.jaad.2020.04.044.
Reviewed by Dr Chia Hui Yi, National Skin Centre, Singapore
In this multicenter case series, the authors from eight Italian dermatology units describe a varicella-like papulovesicular exanthem as a rare but specific skin manifestation of COVID-19. There were 22 patients, mostly from Lombardy, Italy, who were positive for COVID-19 on nasopharyngeal swab and had no history of any new medications in the preceding 15 days. The median age was 60 years, and 72.7% of patients were male. They developed a scattered or diffuse papulovesicular varicella-like eruption, which generally manifested 3 days after onset of systemic symptoms with a median duration of 8 days. Typical features reported include frequent truncal distribution and mild or absent pruritus, which is unlike true varicella infection. Skin biopsies were performed in 7 patients with histological findings consistent with viral infection.
A limitation of this study is that SARS-CoV-2 RNA detection in lesional skin was not performed because of unavailability of the specific primer. This study adds to the emerging knowledge of skin manifestations in COVID-19.
Llamas-velasco et al1 in their reply letter raised the consideration of other herpesvirus infection and appropriate laboratory testing to exclude disseminated forms of other common viral infections.
Ortega-Quijano et al2 in their reply letter commented that while the small number of patients and methodology in this series are insufficient for calculation of specificity, the appearance of a viral exanthem, in particular a varicella-like eruption, raises its positive predictive value for COVID-19 during this pandemic.
1. Llamas-Velasco M, Rodríguez-Jiménez P, Chicharro P, De Argila D, Muñoz-Hernández P, Daudén E. 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. J Am Acad Dermatol. 2020 May 19:S0190-9622(20)30943-9. doi:10.1016/j.jaad.2020.04.180. 2. Ortega-Quijano D, Jimenez-Cauhe J, Burgos-Blasco P, Jimenez-Gomez N, Fernandez-Nieto D. Reply to “Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients”: Discussing specificity. J Am Acad Dermatol. 2020 May 4:S0190-9622(20)30778-7. doi: 10.1016/j.jaad.2020.04.156.