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• W3085656237 abstract "To the Editor: We read with interest the letters from the New York City report regarding the absence of COVID toe lesions on their patients and the recommendation of caution when concluding that cutaneous findings are specifically due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1Deutsch A. Blasiak R. Keyes A. et al.COVID toes: phenomenon or epiphenomenon?.J Am Acad Dermatol. 2020; 83: e347-e348Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar,2Vesely M.D. Perkins S.H. Caution in the time of rashes and COVID-19.J Am Acad Dermatol. 2020; 83: e321-e322Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Since the global pandemic of SARS-CoV-2, the University of São Paulo Medical School Hospital—a reference center and one of the largest university hospitals in Latin America—reorganized its structure, offering about 300 intensive care units and 500 nursery beds fully dedicated to SARS-CoV-2. Five staff members of the Dermatology Department were exclusively assigned to assist the admitted patients who presented with dermatologic lesions. As of May 2020, Brazil, especially the city of São Paulo, became one of the new epicenters of the pandemic. By July 31, the state of São Paulo had a total of 542,304 confirmed cases and 22,997 deaths. From March 31 to July 31, 2020, 3982 patients were hospitalized with severe pulmonary manifestations of the disease, either in intensive care units or nursery beds. The dermatology team was called to visit a total of 98 patients, and the diagnosis of SARS-CoV-2 was confirmed either by polymerase chain reaction or serology in 86 of them. Patients were always evaluated in person by at least 2 experienced dermatologists at every visit. To our surprise, despite the reports of diverse cutaneous manifestations related to SARS-CoV-2, among the 86 patients with confirmed COVID-19, it was not possible to attribute with certainty that any cutaneous lesions had a direct correlation to the SARS-CoV-2 infection.3Marzano A.V. Cassano N. Genovese G. Moltrasio C. Vena G.A. Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue.Br J Dermatol. 2020; 183: 431-442Crossref PubMed Scopus (133) Google Scholar,4Galván Casas C. Català A. Carretero Hernández G. et al.Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases.Br J Dermatol. 2020; 183: 71-77Crossref PubMed Scopus (861) Google Scholar The profile of dermatosis observed was similar to what was usually seen before the pandemic, with fungal infections being the most frequent cause, followed by drug eruptions and viral infections. Six patients with confirmed SARS-CoV-2 presented an exanthema that rapidly resolved and could arguably be related to the viral infection. All of them had received either antipyretics, anti-inflammatories, or antibiotics before or during their hospital stay, and the temporal relationship between the rash development and the use of those drugs led us to consider drug-induced exanthema to be a more likely hypothesis. This differentiation between viral or drug-induced exanthems is always challenging, even without the pandemic scenario. One patient presented with acral areas of erythema and a history of systemic lupus, leading us to the hypothesis of chilblains, instead of the recently described COVID toes. Therefore, because the pandemic is still ongoing, with new countries assuming the epicenter positions, and new data are being published by the day, we agree that every skin lesion should be suspected to be a virus-related manifestation. However, we also recommend caution when concluding that some cutaneous findings are specifically induced by the virus. Thus, we would like to share our experience as the largest reference center for this epidemic in Brazil: with an in-person evaluation of patients with laboratory and clinical confirmation of severe systemic COVID-19 manifestations, no specific SARS-CoV-2 cutaneous findings were reported. Caution in the time of rashes and COVID-19Journal of the American Academy of DermatologyVol. 83Issue 4PreviewTo the Editor: We applaud the authors of a recent report in JAAD1 who performed a systematic literature review of the highly variable cutaneous manifestations of coronavirus disease 2019 (COVID-19). Since the global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), dermatologists have mobilized to identify, catalog, and disseminate potential cutaneous manifestations of SARS-CoV-2 infection. Lack of widespread testing and potential limitations in assays that detect acute and previous infections underscore the utility of identifying skin manifestations of COVID-19. Full-Text PDF COVID toes: Phenomenon or epiphenomenon?Journal of the American Academy of DermatologyVol. 83Issue 5PreviewTo the Editor: As of June 15, there have been 206,606 cases and 22,103 deaths from COVID-19 in New York City.1 The boroughs of the Bronx, Queens, and Brooklyn, as well as Harlem in upper Manhattan, have been epicenters of disease since its emergence due to socioeconomic factors that dictate their populations' baseline health and limit the ability to maintain infection control measures. Accordingly, these areas account for 80.8% and 81.2% of cases and deaths from COVID-19 in New York City, respectively. Full-Text PDF The underrepresentation of “COVID toes” in skin of color: An example of racial bias or evidence of a tenuous disease association?Journal of the American Academy of DermatologyVol. 84Issue 2PreviewTo the Editor: We read with interest the article by Avancini et al1 describing the absence of cutaneous manifestations associated with coronavirus disease 2019 (COVID-19) in a large, dedicated severe acute respiratory syndrome coronavirus 2 hospital in Brazil. Of the 3982 patients hospitalized with COVID, dermatology was consulted for 98, with no “COVID toes” identified among them. Previously, Daneshjou et al2 published a series of 6 cases (1 positive for COVID) of this pernio-like condition in skin of color, citing a lack of representative imagery in dermatologic literature. Full-Text PDF" @default.
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• W3085656237 title "Absence of specific cutaneous manifestations of severe acute respiratory syndrome coronavirus 2 in a reference center in Brazil" @default.
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