Original article
Eruptions and related clinical course among 296 hospitalized adults with confirmed COVID-19

https://doi.org/10.1016/j.jaad.2020.12.046Get rights and content

Background

Limited information exists on mucocutaneous disease and its relation to course of COVID-19.

Objective

To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19.

Methods

Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020.

Results

Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance.

Limitations

Skin biopsies were not performed.

Conclusions

Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course.

Key words

adults
COVID-19
eruption
hospitalized
morbilliform
mucocutaneous
necrosis
Northwell
purpura
rash
SarsCoV-2
ulcer

Abbreviations used

AKI
acute kidney injury
BMI
body mass index
CI
confidence interval
IQR
interquartile range

Cited by (0)

Funding Sources: None.

IRB approval status: This investigation was approved by the Human Subjects Committee at the Feinstein Institute for Medical Research at the Northwell Health.

Reprints not available from the authors.

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