On April 22 it was published in Dermosyphilographic acts an investigation led by Dr. Jorge Romaní (Parc Taulí Dermatology Service) on a hitherto atypical clinical picture of perniotic and acral lesions, and its probable link with COVID-19.
Due, among other things, to this article, a multicenter rapid prospective nationwide consensus study was initiated with 375 cases. The resulting article was published on April 29 in British Journal of Dermatology, the 3rd most impactful journal in the field of dermatology according to the JCR Impact Factor. Once again, Dr. Rosemary, who tells us what this study has consisted of and how important it can be for COVID-19 research.
Where did this first study on the clinical picture of perniotic and acral lesions come from?
(Jorge Romaní). During the first weeks of the pandemic, an alarm appeared in the media for a type of injury observed mainly in children, and reminiscent of vines (perniosis). It was atypical, as temperatures were not low, and these lesions did not exactly correspond to classical perniosis either. Without too much initial scientific evidence, they were associated with COVID infection, but an alarm was set off that disrupted pediatric emergency services, with frightened families calling for a diagnostic test. Interestingly, the vast majority had negative PCR and had not shown any symptoms of coronavirus infection.
The dermatologists and infectologists of Parc Taulí decided to collect and study a series of patients, and we asked for the collaboration of Dra. Baselga and his team of dermatologists from the Sant Joan de Déu hospital who contributed their cases. As I was also involved in the clinical trial led by Oriol Mitjà, his team provided the rapid tests to try to detect serology.
In the supplementary material some images of the analyzed lesions can be seen. What have been the results obtained?
(JR) It is an atypical fact in scientific publication, but the editors of the British Journal of Dermatology agreed to publish as supplementary material ALL the images in the study. It is a veritable dermatological atlas of the cutaneous manifestations of the pandemic. The work describes five dermatological patterns, which are recognizable by any dermatologist (vesicular, papular macular, urticariform, livedo-necrotic and acral-perniotic):
Following the latest article published in the BJD: Can it be diagnosed at what stage of COVID-19 the patient is through a skin analysis?
(JR) Each of the patterns may appear at a different time point from COVID infection and is related to a different prognosis of the disease. Thus, vesicular lesions appear during the first weeks, or perniotics manifest late, up to two months after contact with the virus, and represent an excellent prognosis, often with an infection passed unnoticed.
What impact can the overall study have on combating COVID-19?
(JR) If skin lesions are scanned by a trained observer, from them one can come not only to suspect the infection, but even to know at what time the patient has had contact with the virus, and the prognosis associated.
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