When we talk about Sars-CoV-2 virus infection, we realize that symptoms and signs of infection they 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 demonstrates how even simple skin changes they 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 on Journal of the American Academy of Dermatology: six are, 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 of the University of Milan. And it highlights six ways of “presentation” of Covid-19 “on the skin”: you may have a clinical picture similar to urticaria, a rash that resembles that of measles in both the limbs and the trunk, a chickenpox-like skin reaction, 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 ulcer formation 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, respiratory distress, 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.
Parameters considered included sex, age at the time of disease onset, presence or absence of comorbidities, skin manifestations, presence or absence of mucosal lesions, duration of skin manifestations. And again, skin-related symptoms, systemic symptoms, duration of systemic symptoms, latency between skin manifestations and systemic symptoms and severity of the disease.
The severity of the infection from Coronavirus was classified according to 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. In addition, 86 of 195 patients (43% with 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 most prevalent symptom among young people and were associated with an almost always asymptomatic manifestation of the virus, while all the other phenotypes were connected 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 disease severity ”.
For the expert it is therefore necessary to pay particular attention to the precise signals that appear on the skin: an apparent urticaria, a very extensive erythema, a sudden vasculitis, bruising and geloni all possible spies of the disease that must induce us to take a tampon must be considered. “Since the beginning of the Covid-19 pandemic – comments Ketty Peris, President of SIDeMaST and Director of the UOC of Dermatology at 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 with 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 “.
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