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J Eur Acad Dermatol Venereol Histology of Skin Lesions Establishes That the Vesicular Rash Associated With COVID-19 Is Not "Varicella-Like"

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  • J Eur Acad Dermatol Venereol Histology of Skin Lesions Establishes That the Vesicular Rash Associated With COVID-19 Is Not "Varicella-Like"


    J Eur Acad Dermatol Venereol


    . 2020 Jun 5.
    doi: 10.1111/jdv.16706. Online ahead of print.
    Histology of Skin Lesions Establishes That the Vesicular Rash Associated With COVID-19 Is Not "Varicella-Like"


    A Mah? 1 , E Birckel 1 , C Merklen 1 , P Lef?bvre 1 , C Hannedouche 1 , M Jost 1 , L Droy-Dupr? 1



    Affiliations

    Abstract

    Several articles recently reported a "varicella-like" rash in patients with COVID-19 [1,2]. We observed similar cases at our institution. However, although we agree that the clinical picture is original, we reject that "varicella-like" denomination since clinical presentation, as well as some histologic features that we wish to report here for the first time, make it clearly different from varicella. Three patients with a vesicular rash associated with COVID-19 (RT-PCR test on a nasopharyngeal swab specimen positive for SARS-CoV-2 ARN) were seen at our institution in April, 2020. A biopsy of a vesicle was performed in each. Multiple levels with H&E stain were done; the slides were reviewed independently by two pathologists; only concordant data were validated. A test for SARS-CoV-2 was performed on a vesicle in two patients, and a direct immunofluorescence test on perilesional skin in one.

    Keywords: Covid-19; SARS-CoV-2; acantholysis; coronavirus; skin rash; varicella.

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