SLR - September 2021 - Amida Kuah

Prevalence of Mucocutaneous Manifestations, Oral and Palmoplantar Findings in 666 Patients with Covid-19 in A Field Hospital in Spain

Reference: Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Martin Rios MD, Herranz Mañas C, Artigas Almazan J, García Casasola G, Perez Castro E, Gallego Arenas A, Mayor Ibarguren A, Feito Rodríguez M, Lozano Masdemont B, Beato M, Ruiz Bravo E, Oliver P, Montero Vega MD, Herranz Pinto P. Prevalence of Mucocutaneous Manifestations, Oral and Palmoplantar Findings in 666 Patients with Covid-19 in A Field Hospital in Spain: oral and palmoplantar findings. Br J Dermatol. 2021 Jan;184(1):184-185. doi: 10.1111/bjd.19564. Epub 2020 Nov 2. PMID: 32969503; PMCID: PMC7537506.

Level of Evidence: IV

Scientific Literature Review

Reviewed By: Amida Kuah, DPM
Residency Program: Ascension St. John – Detroit, MI

Podiatric Relevance: The ongoing novel COVID-19 pandemic has had a colossal impact upon the medical community. This article presents a population of 666 patients in a field hospital in Spain that documented the myriad of cutaneous manifestations of COVID-19 on the feet as well as other parts of the body. With the novelty of this disease and its high rates of infection, it is important for podiatric physicians to be able to identify pathological manifestations of COVID-19 symptoms in the feet.

Methods: Between April 10th to April 25th of 2020, a temporary field hospital was erected during the pandemic peak in Madrid, Spain. A total of 666 patients at this site who tested positive for COVID-19 via PCR or presented with bilateral pneumonia were included in this study. A team of dermatologists were onsite to evaluate, document, and treat cutaneous findings in these patients.

Results: The authors found that 121 (39.8 percent) patients had presented with palmoplantar dermatological pathologies. Of these cutaneous manifestations, 77 patients (25.3 percent) presented with diffuse desquamation of the skin which were mainly localized to weight bearing areas and occasionally associated with pruritus. Fungal cultures were performed to rule out superficial mycosis. It was also observed that 46 (15.1 percent) of patients had presented with reddish-to-brown acral macules on the palms and soles. Histopathological analysis of the acral macules showed mild-to-moderate lymphocytic infiltrates surround the blood vessels and eccrine sweat glands. Erythrodysesthesia was also reported in 7 percent of patients at the initial phase of the disease. Authors also observed 304 patients with mucocutaneous manifestations with and without palmoplantar dermatological changes.

Conclusions: Due to the novelty of the COVID-19 virus, there is limited literature in regards to cutaneous manifestations of the disease. This large retrospective cohort study found that dermatological palmoplantar involvement was a frequent manifestation of COVID-19 symptoms in the population studied. Although this study was limited by the parameters of mass patient treatment in a global pandemic, it provides crucial data regarding symptomatic presentation of this novel disease. Authors concluded that redness and swelling of the hands and feet, fine palmoplantar desquamation and reddish-to-brown macules may be used to aid physicians in diagnosing COVID-19 infection. While the majority of these manifestations described in this study appear to be self-limiting, it is important for podiatric physicians to be able identify these dermatological changes as having a strong association with COVID-19 during the current pandemic.

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