Division of Dermatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Division of Infectious Diseases, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Hong Kong Med J. 2023 Oct;29(5):421-431. doi: 10.12809/hkmj2210199. Epub 2023 Oct 19.
Various cutaneous manifestations have been reported as symptoms of coronavirus disease 2019 (COVID-19), which may facilitate early clinical diagnosis and management. This study explored the incidence of cutaneous manifestations among hospitalised patients with COVID-19 and investigated its relationships with viral load, co-morbidities, and outcomes.
This retrospective study included adult patients admitted to a tertiary hospital for COVID-19 from July to September 2020. Clinical information, co-morbidities, viral load (cycle threshold [Ct] value), and outcomes were analysed.
In total, 219 patients with confirmed COVID-19 were included. Twenty patients presented with new onset of rash. The incidence of new rash was 9.1% (95% confidence interval=6.25%-14.4%). The most common manifestations were maculopapular exanthem (n=6, 42.9%, median Ct value: 24.8), followed by livedo reticularis (n=4, 28.6%, median Ct value: 21.3), varicella-like lesions (n=2, 14.3%, median Ct value: 19.3), urticaria (n=1, 7.1%, median Ct value: 14.4), and acral chilblain and petechiae (n=1, 7.1%, median Ct value: 33.1). The median Ct values for patients with and without rash were 22.9 and 24.1, respectively (P=0.58). There were no significant differences in mortality or hospital stay between patients with and without rash. Patients with rash were more likely to display fever on admission (P<0.01). Regardless of cutaneous manifestations, patients with older age, hypertension, and chronic kidney disease stage ≥3 had significantly higher viral load and mortality (P<0.05).
This study revealed no associations between cutaneous manifestation and viral load or clinical outcomes. Older patients with multiple co-morbidities have risks of high viral load and mortality; they should be closely monitored.
各种皮肤表现已被报道为 2019 年冠状病毒病（COVID-19）的症状，这可能有助于早期临床诊断和管理。本研究探讨了住院 COVID-19 患者皮肤表现的发生率，并研究了其与病毒载量、合并症和结局的关系。
本回顾性研究纳入了 2020 年 7 月至 9 月期间因 COVID-19 入住一家三级医院的成年患者。分析了临床信息、合并症、病毒载量（循环阈值[Ct]值）和结局。
共纳入 219 例确诊 COVID-19 的患者。20 例患者出现新发皮疹。新发皮疹的发生率为 9.1%（95%置信区间=6.25%-14.4%）。最常见的表现为斑丘疹性发疹（n=6，42.9%，中位数 Ct 值：24.8），其次为网状青斑（n=4，28.6%，中位数 Ct 值：21.3）、水痘样皮损（n=2，14.3%，中位数 Ct 值：19.3）、荨麻疹（n=1，7.1%，中位数 Ct 值：14.4）和肢端冻疮样皮损和瘀点（n=1，7.1%，中位数 Ct 值：33.1）。有皮疹和无皮疹患者的中位数 Ct 值分别为 22.9 和 24.1（P=0.58）。有皮疹和无皮疹患者的死亡率或住院时间无显著差异。有皮疹的患者入院时更可能发热（P<0.01）。无论有无皮肤表现，年龄较大、患有高血压和慢性肾脏病 3 期及以上的患者病毒载量和死亡率均显著较高（P<0.05）。
本研究显示皮肤表现与病毒载量或临床结局之间无关联。有多种合并症的老年患者病毒载量和死亡率较高，应密切监测。
