METHODS: We compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies.
RESULTS: After a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism. IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated.
CONCLUSIONS: Despite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions.
结果:经过对病例的仔细审查,发现15例与COVID-19无关的皮肤病,而其余病变可根据其临床特征分类为水疱(4),斑丘疹(41),荨麻疹状(9),livedo和坏死(10)和pernio样(5)。尽管组织病理学特征与先前报道的结果相似,我们发现了两个以前未报告的发现,斑丘疹伴鳞状小汗腺增生和嗜中性粒细胞上皮性增生。IHC在某些情况下显示内皮和表皮染色,但所有测试病例的RT-PCR均为阴性。因此,无法证明病毒的直接参与。
结论:尽管出现了一系列最大的确诊COVID-19患者,其组织病理学研究为皮肤表现,病毒的直接参与很难确定.血管扩张和荨麻疹样病变似乎与病毒感染更明显相关,尽管IHC或RT-PCR阴性结果未能证明病毒存在.这些发现,与其他皮肤病学领域一样,强调需要进行临床病理相关性研究,以增加对病毒累及COVID-19皮肤相关病变的认识。