DermWire Exclusive:  Inside the COVID-19 Outbreak in Italy with Sebastiano Recalcati image

Dr. Sebastiano Recalcati, a dermatologist in Lombardy, Italy, was one of many doctors called to the frontlines in that country when COVID-19 ravaged the region. He published his observations in the Journal of the European Academy of Dermatology Venereology. Dr. Recalcati spoke to DermWire and Practical Dermatology® magazine about skin manifestations seen in COVID-19 patients. He also spoke of ongoing observations of skin manifestations in younger COVID-19 patients. These findings will help shed light on the pathogenesis of this novel respiratory virus and may guide dermatologists from other countries that are behind Italy in terms of managing the outbreak.

PD: WHY IS THIS TOPIC IMPORTANT TO STUDY?

Dr. Sebastiano Recalcati: There are no data in the literature so far about skin manifestations in COVID-19. I live in Lombardy, Italy, and this is one of the most involved regions in the world. Despite extraordinary restriction measures, many health workers were affected and due to this condition a strong effort was asked [of all] physicians and nurses. Dermatologists were involved in front line as well, especially in the triage stations and in the medical wards with positive cases because of the lack of medical doctors. As dermatologists we tried to analyze the cutaneous involvement in COVID-19 patients hospitalized in Lecco, Lombardy. Our observations could help physicians to consider and suspect a COVID-19-related exanthem in the differential diagnosis of a rash, particularly if associated with fever and dyspnea, to make a proper diagnosis and to perform suitable restrictions measures.

 PD: DESCRIBE THE RESEARCH AND YOUR FINDINGS.

Dr. Recalcati: We looked at what was going on with the skin in 148 inpatients with COVID-19. We excluded 60 who had started new drugs within 15 days to rule out acute drug reactions. Of the 88 COVID-19 patients, 20.4 percent developed skin manifestations. Eight of the 18 (44 percent) had skin eruptions at symptom onset, and the rest after hospitalization. Fourteen (78 percent) had erythematous rashes, three had widespread urticaria, and one had chickenpox-like vesicles. The most commonly affected area was the trunk. Itching was mild or absent, and lesions usually healed up in a few days. Apparently, skin manifestations did not correlate with disease severity. These skin manifestations were similar to cutaneous involvement occurring during common viral infections.

PD: WHAT IS THE NEXT STEP?

Dr. Recalcati: We are focusing now on the pediatric and young adult population. From the end of March we started observing several acral frostbite-like lesions, mainly in children, and we are trying to understand and interpret them. A paper is already under review. Moreover, recently the scientific community is focusing on the pathogenetic role of coagulation cascade and vascular involvement in COVID-19, so we are concentrating now on cutaneous vascular lesions. We found interesting histological findings and maybe we could add something to the disease’s pathogenesis. Lastly I will say that I appreciate a lot the global efforts of the physician community to share data and to try to better understand COVID-19 features. This is the way hopefully we will win this “war."