Research Letter
Dermatological manifestations and its association with SARS-CoV-2: a descriptive cross-sectional study from Guatemala
Azucena Hernández Rousselin
Corresponding author
Department of Internal Medicine, Dermatology Unit, Hospital Roosevelt, Guatemala, Guatemala
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There are a few reports regarding cutaneous manifestations; reported findings were: rash, urticaria, chickenpox-like vesicles, livedo reticularis, herpetiform lesions, and chilblains.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> A descriptive cross-sectional study was carried out at Roosevelt Hospital of Guatemala, a first-level infirmary located in the capital city. The sample was determined based on the reported prevalence, which ranges from 1.5%, 7.8% to 20%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> An expected percentage of 9% was estimated, with a sampling error of 4% and a confidence level of 95%. A total of 202 patients were included, 77 women (38.1) and 125 (61.9%) men. The age ranged from 12 to 82 years, with a mean of 48.9. The most frequent comorbidities were diabetes (63; 31.2%), hypertension (41; 20.3%), chronic kidney disease (nine; 4.5%), and obesity (14; 6.9%). It was found that 12 patients had skin manifestations, of which five (2.5%) were directly associated with SARS-CoV2 (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>), and seven (3.5%) a circumstantial relationship with it. In the group of patients with direct association, there was no other explanation for the dermatological injury. One patient had reactive arthritis in the knee (this patient had sterile synovial fluid culture and no other associated infection), one patient had urticariform reaction, one patient had erythematous rash (they only received acetaminophen), and two patients had livedo reticular in the legs. The circumstantial association is based on the fact that there are injuries related to the treatment or immunological state of the patient. Three patients who were in prone position to improve oxygenation presented vascular macules on their knees; a biopsy was taken to rule out vasculitis, and only extravasated erythrocytes were found. Two patients presented monomorphic papules on the chest and forehead, but were receiving methylprednisolone, and the condition was diagnosed as steroid acne. Two immunosuppressed patients (HIV-positive and chronic kidney disease) presented vesicles on an erythematous base; the distribution in one case was dermatomal and in the other the lesions were grouped. These findings are clinically consistent with the Herpesviridae family viruses. In the literature, vesicular lesions similar to varicella are reported, with a more dispersed and diffuse distribution and located on the trunk.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> Thus, the clinical and evolution characteristics can help to differentiate this particular injury. A polymerase chain reaction test of a sample of the lesion is very useful in the identification of the causative virus.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of skin lesions observed in the present study was much lower than that found by Recalcati, but similar to that reported by Tammaro.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The skin manifestations found in this study are similar to those caused by other viruses, and it cannot be concluded that there is a pathognomonic skin lesion of SARS-CoV-2.</p><p id="par0020" class="elsevierStylePara elsevierViewall">As previously reported, no correlation with disease severity was observed.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> The deficit in the immune system can cause other infections, and the established therapy can also cause skin lesions; therefore, it is essential to carry out detailed studies in each case to make a better differential diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author contribution</span><p id="par0030" class="elsevierStylePara elsevierViewall">Azucena Hernández Rousselin: Approval of the final version; study conception and planning; writing of the manuscript; data collection, analysis and interpretation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Author contribution" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-07-14" "fechaAceptado" => "2020-08-20" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Hernández Rousselin A. Dermatological manifestations and its association with SARS-CoV-2: a descriptive cross-sectional study from Guatemala. An Bras Dermatol. 2021;96:106–7.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Department of Internal Medicine, Hospital Roosevelt, Guatemala, Guatemala.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 750 "Tamanyo" => 51613 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Livedo reticular.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 601 "Ancho" => 750 "Tamanyo" => 31144 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Reactive arthritis.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 416 "Ancho" => 900 "Tamanyo" => 29921 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Urticariform reaction.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous manifestations in COVID-19: a first perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. 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| 2024 August | 283 | 118 | 401 |
| 2024 July | 288 | 120 | 408 |
| 2024 June | 249 | 72 | 321 |
| 2024 May | 148 | 67 | 215 |
| 2024 April | 132 | 79 | 211 |
| 2024 March | 122 | 75 | 197 |
| 2024 February | 159 | 77 | 236 |
| 2024 January | 84 | 54 | 138 |
| 2023 December | 73 | 61 | 134 |
| 2023 November | 120 | 100 | 220 |
| 2023 October | 88 | 93 | 181 |
| 2023 September | 115 | 93 | 208 |
| 2023 August | 76 | 34 | 110 |
| 2023 July | 85 | 50 | 135 |
| 2023 June | 66 | 34 | 100 |
| 2023 May | 60 | 22 | 82 |
| 2023 April | 47 | 14 | 61 |
| 2023 March | 69 | 57 | 126 |
| 2023 February | 47 | 29 | 76 |
| 2023 January | 62 | 52 | 114 |
| 2022 December | 61 | 38 | 99 |
| 2022 November | 70 | 54 | 124 |
| 2022 October | 75 | 53 | 128 |
| 2022 September | 57 | 68 | 125 |
| 2022 August | 55 | 53 | 108 |
| 2022 July | 52 | 69 | 121 |
| 2022 June | 68 | 67 | 135 |
| 2022 May | 50 | 49 | 99 |
| 2022 April | 69 | 63 | 132 |
| 2022 March | 67 | 90 | 157 |
| 2022 February | 39 | 41 | 80 |
| 2022 January | 98 | 91 | 189 |
| 2021 December | 68 | 63 | 131 |
| 2021 November | 61 | 61 | 122 |
| 2021 October | 53 | 82 | 135 |
| 2021 September | 50 | 80 | 130 |
| 2021 August | 48 | 58 | 106 |
| 2021 July | 38 | 49 | 87 |
| 2021 June | 36 | 55 | 91 |
| 2021 May | 96 | 107 | 203 |
| 2021 April | 164 | 257 | 421 |
| 2021 March | 135 | 104 | 239 |
| 2021 February | 54 | 33 | 87 |
| 2021 January | 42 | 11 | 53 |
| 2020 December | 13 | 13 | 26 |
| 2020 November | 2 | 3 | 5 |
Show all
