背景:2019年冠状病毒病(COVID-19)影响不同的器官系统,包括皮肤。缺乏对中国门诊和住院患者皮肤表现的回顾性分析。该研究旨在分析COVID-19患者的皮肤表现以及先前皮肤病的复发或加重。
方法:于2022年11月至2023年7月在中国东部某大学医院进行了回顾性横断面研究。它涉及逆转录聚合酶链反应(RT-PCR)阳性的COVID-19患者,记录各种皮肤表现以及先前存在的皮肤状况的复发或加重。评估皮肤损伤的模式和其他变量。
结果:该研究包括303名患者,男性127人,女性176人。斑丘疹是主要的新皮肤表现(54.92%),主要是中年人。其他发现包括荨麻疹(16.39%),带状疱疹(11.89%),和单纯疱疹(4.10%),泡状皮疹(2.46%),紫癜(2.05%),多形性红斑(1.64%),网状网(0.41%)等。严重疾病与带状疱疹和网状livedo相关。严重的COVID-19病例与水疱皮疹有关,紫癜,和多形性红斑.感染后皮肤病变出现的平均时间从脂溢性皮炎的3天到带状疱疹的17.48天不等。血管表现与D-二聚体水平升高相关。共报告59例(19.47%)感染COVID-19后皮肤疾病复发或加重,以皮炎最为常见,其次是痤疮和毛囊炎,牛皮癣,荨麻疹,大疱性类天疱疮,天疱疮,体癣和雄激素性脱发。
结论:本研究中描述的皮肤表型扩大了与COVID-19相关的皮肤病谱。过度活跃的免疫反应可能导致皮肤表现,补体激活,和微血管损伤。带状疱疹通常发生在免疫系统较弱或更严重疾病的老年COVID-19患者中。紫癜和网状livedo,虽然罕见,可能表明疾病的严重程度。通过皮肤表现可以预测不同严重程度的COVID-19的病程。认识到这些皮肤表现可以帮助预测COVID-19的严重程度,并指导皮肤科医生管理大流行反应。
BACKGROUND: Coronavirus disease 2019 (COVID-19) affects different organ systems, including the skin. A retrospective analysis of skin manifestations in Chinese outpatient and inpatient settings is lacking. The study aims to analyze cutaneous manifestations in COVID-19 patients and the recurrence or aggravation of previous skin diseases.
METHODS: A retrospective cross-sectional study was conducted from November 2022 to July 2023 in a university hospital in eastern
China. It involved reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 patients, documenting various skin manifestations and the recurrence or aggravation of pre-existing skin conditions. The pattern of skin lesions and other variables were assessed.
RESULTS: The study included 303 patients, with 127 males and 176 females. Maculopapular rash was the predominant new cutaneous manifestation (54.92%), mainly in middle-aged individuals. Other findings included urticaria (16.39%), herpes zoster (11.89%), and herpes simplex (4.10%), vesicular rashes (2.46%), purpura (2.05%), erythema multiforme (1.64%), livedo reticularis (0.41%) and so on. Severe disease was associated with herpes zoster and livedo reticularis. Critical COVID-19 cases were linked to vesicular rashes, purpura, and erythema multiforme. The mean time for skin lesion emergence post-infection varied from 3 days for seborrheic dermatitis to 17.48 days for herpes zoster. Vasculitic manifestations correlated with elevated D-dimer levels. A total of 59 cases (19.47%) of recurrent or aggravated skin diseases were reported following infection with COVID-19, with dermatitis being the most common, followed by acne and folliculitis, psoriasis, urticaria, bullous pemphigoid, pemphigus, tinea corporis and androgenetic alopecia.
CONCLUSIONS: The cutaneous phenotypes delineated in this study expand the dermatologic spectrum associated with COVID-19. Cutaneous manifestations may result from overactive immune responses, complement activation, and microvascular damage. Herpes zoster typically occurs in elderly COVID-19 patients with weaker immune systems or more severe diseases. Purpura and livedo reticularis, although rare, may indicate disease severity. It is possible to predict the course of COVID-19 with different severity through cutaneous manifestations. Recognizing these skin manifestations could aid in predicting COVID-19 severity and guide dermatologists in managing the pandemic response.