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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

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
1.
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. PubMedGoogle Scholar
2.
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 PubMedGoogle ScholarCrossref
3.
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. PubMedGoogle Scholar
4.
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 PubMedGoogle ScholarCrossref
5.
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. PubMedGoogle Scholar
6.
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 PubMedGoogle ScholarCrossref
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