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Abstract：
The microbiological diagnosis of skin lesions related to COVID-19 is not well known.
Perform a microbiological diagnosis in COVID19-related cutaneous manifestations.
A cross-sectional study was performed with 64 patients with cutaneous manifestations associated with COVID-19 who underwent serological and nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2.
Out of the 64 patients, 6 patients had positive RT-PCR, with all of them developing SARS-CoV-2 IgG and 4 of them had positive IgM + IgA. Of the 58 patients with negative RT-PCR, 8 cases had positive IgM + IgA and only one of them had IgG seroconversion. Therefore, the infection was demonstrated in 7 cases (10.9%) and was doubtful in 7 other cases (10.9%) who presented negative RT-PCR and presence of IgA + IgM without subsequent seroconversion of IgG. Fifty patients (78.1%) had negative serological tests. The most frequent cutaneous pattern was pseudo-chilblain (48.4%) followed by maculo-papular pattern (26.6%), urticarial lesions (10.9%), vesicular eruptions (6.3%) and livedoid pattern (4.7%). The maculo-papular pattern showed the highest positivity in RT-PCR (3 cases; 17.6%) and serologies (4 cases; 23.5%). Skin lesions developed after the systemic symptoms in most patients (19 cases; 61.3%).
Microbiological confirmation tests may not be an effective diagnostic technique for COVID-related cutaneous manifestations or that attributed lesions are not related to COVID-19. Confounding factors such as adverse drug reaction, serological cross-reactions with other viruses, the low production of antibodies in asymptomatic or mild forms of COVID-19 or its rapid disappearance, increase diagnostic uncertainty.
Perform a microbiological diagnosis in COVID19-related cutaneous manifestations.
A cross-sectional study was performed with 64 patients with cutaneous manifestations associated with COVID-19 who underwent serological and nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2.
Out of the 64 patients, 6 patients had positive RT-PCR, with all of them developing SARS-CoV-2 IgG and 4 of them had positive IgM + IgA. Of the 58 patients with negative RT-PCR, 8 cases had positive IgM + IgA and only one of them had IgG seroconversion. Therefore, the infection was demonstrated in 7 cases (10.9%) and was doubtful in 7 other cases (10.9%) who presented negative RT-PCR and presence of IgA + IgM without subsequent seroconversion of IgG. Fifty patients (78.1%) had negative serological tests. The most frequent cutaneous pattern was pseudo-chilblain (48.4%) followed by maculo-papular pattern (26.6%), urticarial lesions (10.9%), vesicular eruptions (6.3%) and livedoid pattern (4.7%). The maculo-papular pattern showed the highest positivity in RT-PCR (3 cases; 17.6%) and serologies (4 cases; 23.5%). Skin lesions developed after the systemic symptoms in most patients (19 cases; 61.3%).
Microbiological confirmation tests may not be an effective diagnostic technique for COVID-related cutaneous manifestations or that attributed lesions are not related to COVID-19. Confounding factors such as adverse drug reaction, serological cross-reactions with other viruses, the low production of antibodies in asymptomatic or mild forms of COVID-19 or its rapid disappearance, increase diagnostic uncertainty.
摘要：
与COVID-19相关的皮肤病变的微生物学诊断尚不清楚。
对COVID19相关的皮肤表现进行微生物学诊断。
对64例与COVID-19相关的皮肤表现患者进行了横断面研究，这些患者接受了SARS-CoV-2的血清学和鼻咽逆转录聚合酶链反应（RT-PCR）。
在64名患者中,6例患者RT-PCR阳性,所有患者均发展为SARS-CoV-2IgG，其中4例IgMIgA阳性。在58例RT-PCR阴性的患者中，8例IgM+IgA阳性，仅1例IgG血清转换。因此,7例(10.9%)出现感染,其他7例(10.9%)出现RT-PCR阴性,IgA+IgM存在,但随后IgG无血清转换.50例患者（78.1％）的血清学检查呈阴性。最常见的皮肤模式是假性冻疮（48.4％），其次是黄斑丘疹（26.6％），荨麻疹病变（10.9%），水泡疹（6.3％）和livedoid模式（4.7％）。黄斑丘疹型在RT-PCR（3例；17.6％）和血清学（4例；23.5％）中阳性最高。大多数患者（19例；61.3％）在全身症状后出现皮肤病变。
微生物确认试验可能不是COVID相关皮肤表现或与COVID-19无关的归因于病变的有效诊断技术。药物不良反应等混杂因素，与其他病毒的血清学交叉反应，无症状或轻度形式的COVID-19抗体产量低或迅速消失，增加诊断的不确定性。
对COVID19相关的皮肤表现进行微生物学诊断。
对64例与COVID-19相关的皮肤表现患者进行了横断面研究，这些患者接受了SARS-CoV-2的血清学和鼻咽逆转录聚合酶链反应（RT-PCR）。
在64名患者中,6例患者RT-PCR阳性,所有患者均发展为SARS-CoV-2IgG，其中4例IgMIgA阳性。在58例RT-PCR阴性的患者中，8例IgM+IgA阳性，仅1例IgG血清转换。因此,7例(10.9%)出现感染,其他7例(10.9%)出现RT-PCR阴性,IgA+IgM存在,但随后IgG无血清转换.50例患者（78.1％）的血清学检查呈阴性。最常见的皮肤模式是假性冻疮（48.4％），其次是黄斑丘疹（26.6％），荨麻疹病变（10.9%），水泡疹（6.3％）和livedoid模式（4.7％）。黄斑丘疹型在RT-PCR（3例；17.6％）和血清学（4例；23.5％）中阳性最高。大多数患者（19例；61.3％）在全身症状后出现皮肤病变。
微生物确认试验可能不是COVID相关皮肤表现或与COVID-19无关的归因于病变的有效诊断技术。药物不良反应等混杂因素，与其他病毒的血清学交叉反应，无症状或轻度形式的COVID-19抗体产量低或迅速消失，增加诊断的不确定性。
