JAMA Dermatology

  • A new paper describes four coronavirus patients with severe disease who experienced skin discoloration and lesions and accompanying blood clots.
  • Other studies and anecdotes suggest the virus commonly affects the skin and may be linked to blood clots.
  • The findings add to a growing list of complications of the coronavirus, which seems to be able to affect any organ.
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Patients with severe coronavirus may experience rashes and lesions indicative of underlying blood clots, a new report suggests.

In the paper, published in JAMA Dermatology Wednesday, researchers described four New York City patients who were intubated with severe coronavirus and had skin complications.

All experienced "acral fixed livedo racemosa," or discolored, sometimes broken skin on the extremities, and "retiform purpura," or uneven skin lesions caused when red blood cells leak into the skin, according to the researchers from from NewYork-Presbyterian/Weill Cornell Medical College.

The two complications are "hallmark manifestations" of skin blood clots, they wrote.

Indeed, even though all patients received therapy to help prevent blood clots when they were admitted, all developed clots in their skin and were thought to have pulmonary embolisms, or an artery blockage in the lung.

It's unclear if or when the patients were discharged.

The researchers weren't able to identify exactly when the rashes first appeared and didn't use the type of imaging they'd like in order to spare staff exposure.

But the findings are a lesson to other healthcare professionals to take skin manifestations as a potential sign of abnormal underlying blood clots, which can lead to strokes, heart attacks, pulmonary embolisms, and other potentially fatal complications.

The list of coronavirus manifestations continues to grow

The paper is far from the first to note the coronavirus may cause complications in the skin, with patients reporting "COVID toes," or purple, swollen toes that look like they've been frostbitten, early on.

In a Facebook group for coronavirus patients and survivors, people have reported fluid-filled blisters, full-body rashes, hives, red and purple spots, patches of skin that burn, chicken-pox like bumps, and more.

In some of these cases, the skin changes may be due to blood clotting in the skin's small blood vessels.

The skin is just one of the organs that can populate with blood clots, a common denominator among some of the most poorly understood and dangerous coronavirus symptoms.

In fact, blood clots were found in "almost every organ" of coronavirus patients' autopsies, a NYU pathologist said.

Skin abnormalities are among the growing list of non-respiratory ways the coronavirus seems to manifest

Doctors are increasingly understanding that the coronavirus is far from "only" a respiratory condition.

While the Centers for Disease Control and Prevention's list of potential symptoms slowly grows, including issues like hair loss and clogged ears, a recent survey of more than 1,500 patients found hundreds reporting other complications ranging from dizziness to flashes of light in vision to weight gain to nerve sensations.

The wide-ranging ways the disease appears to manifest starkly sets it apart from any other virus Dr. Anthony Fauci has seen in his 40 years, the infectious disease expert said in a webinar hosted by US News & World Report last week.

"I've never seen anything that has such a broad range of manifestations from a certain percentage of people," he said, noting that up to 40% have no symptoms, many have minor symptoms, some get hospitalised, and some die.

"You go from nothing to death," he said. "It's very, very unusual."

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