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Of 21 consecutive patients presenting with COVID-19 and skin rash at this tertiary care hospital, 29% (n=6) were found to also have enanthem that was macular (n=1), petechial (n=2), or macular with petechia (n=3). Enanthem was located on the palate in all patients. Enanthem was seen in 1 patient with papulovesicular rash, 2 patients with purpuric periflexural dermatitis, and 3 patients with erythema multiforme–like eruption. No patients with maculopapular or urticarial rash were observed to have coexisting enanthem.
A petechial enanthem on the palate may help suggest viral etiology of dermatitis in patients with exanthem and suspected COVID-19.
– Caroline K. Crabtree, MD
This abstract is available on the publisher's site.
Recalcati1 recently reported skin manifestations in 18 patients in Italy with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, or coronavirus disease 2019 (COVID-19), describing “erythematous rash,” “widespread urticaria,” and “chickenpox-like vesicles.” Additional reports have described other rashes, including petechial and purpuric changes,2 transient livedo reticularis,3 and acro-ischemic lesions.4 Whether these manifestations are directly related to COVID-19 remains unclear, since both viral infections and adverse drug reactions are frequent causes of exanthems. An important clue to distinguish between both entities is the presence of enanthem (oral cavity lesions).5 However, owing to safety concerns, many patients with suspected or confirmed COVID-19 do not have their oral cavity examined. Herein we describe variants of enanthem in a series of patients with COVID-19.