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Dermatology

Livedoid and Purpuric Skin Eruptions Associated With Coagulopathy in Severe COVID-19

Educational Objective
To understand the livedoid and purpuric skin eruptions associated with coagulopathy in severe COVID-19

1 Credit CME

JAMA Dermatology

Published Online: August 5, 2020

Research Letter

Article Information and Disclosures

Caren Droesch, MD¹;

Mytrang Hoang Do, BS¹;

Maria DeSancho, MD, MSc²;

Eun-Ju Lee, MD²;

Cynthia Magro, MD³;

Joanna Harp, MD¹

Author Affiliations

¹Department of Dermatology, NewYork-Presbyterian/Weill Cornell Medical College, New York
²Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian/Weill Cornell Medical College, New York
³Department of Pathology and Laboratory Medicine, NewYork-Presbyterian/Weill Cornell Medical College, New York

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As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads globally, dermatologists are recognizing a variety of cutaneous manifestations in patients with coronavirus disease 2019 (COVID-19). A recent Spanish report¹ categorized skin findings in 375 patients with suspected and confirmed COVID-19, including livedoid and necrotic eruptions, which were noted in patients with more severe disease. The authors suggested that these skin manifestations may be associated with occlusive vascular disease.

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Article Information

Accepted for Publication: June 1, 2020.

Published Online: August 5, 2020. doi:10.1001/jamadermatol.2020.2800

Correction: This article was corrected on September 23, 2020, to fix an error in the byline.

Corresponding Author: Joanna Harp, MD, Department of Dermatology, NewYork-Presbyterian/Weill Cornell Medical College, 1305 York Ave, 9th Floor, New York, NY 10021 (joh9090@med.cornell.edu).

Author Contributions: Drs Droesch and Harp had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Droesch, Magro, Harp.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Droesch, Do, Lee, Harp.

Critical revision of the manuscript for important intellectual content: Droesch, DeSancho, Lee, Magro, Harp.

Statistical analysis: Harp.

Administrative, technical, or material support: Magro, Harp.

Supervision: Magro, Harp.

Conflict of Interest Disclosures: Dr DeSancho reported serving on the Advisory Boards for Bio Products Laboratory and Sanofi-Genzyme. No other disclosures were reported.

References

Galván 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. Published online April 29, 2020. PubMed Google Scholar

Magro C , Mulvey JJ , Berlin D , et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020;220:1-13. doi:10.1016/j.trsl.2020.04.007 PubMed Google Scholar Crossref

Panigada M , Bottino N , Tagliabue P , et al. Hypercoagulability of COVID-19 patients in intensive care unit: a report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. Published online April 17, 2020. PubMed Google Scholar

Klok FA , Kruip MJHA , van der Meer NJM , et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-147. doi:10.1016/j.thromres.2020.04.013 PubMed Google Scholar Crossref

Yin S , Huang M , Li D , Tang N . Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. J Thromb Thrombolysis. Published online April 3, 2020. PubMed Google Scholar

Thachil J , Tang N , Gando S , et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-1026. doi:10.1111/jth.14810 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.