COVID-19 Cutaneous Manifestations in Brazil

This is a cross-sectional, retrospective, and descriptive study. Data was gathered from all patients admitted to the emergency department of Sírio-Libanês Hospital (São Paulo, Brazil) presenting with COVID-19 symptoms and cutaneous manifestations, between February and June 2020. Individuals who did not require hospitalization, and showing mild to moderate COVID-19 symptoms, were evaluated by a dermatologist only during the period of care in the emergency department. Patients requiring hospitalization were followed up by physicians from the dermatology team throughout the full length of in-hospital time. Whenever consent was given, skin lesions were photographed without any identification of the specific patient. Cases were selected according to the following criteria: 1) Subjects with COVID-19 symptoms, regardless of severity, 2) A positive nose swab (PCR test) for COVID-19; 3) Presence of skin lesions of recent onset (previous 2 weeks) documented by photo, at the time of the clinical evaluation in the emergency department, or during the hospitalization period. Skin biopsy was not performed routinely, being utilized only in cases demanding additional anatomopathological examination for diagnostic elucidation, abiding by institutional norms of consent agreed by the patient. Information originated from medical records included age at disease onset, gender, clinical features of COVID-19, and relevant medical history. The cutaneous manifestations were described by dermatologists according to the patterns of skin lesions. It was also recorded the topography, and the time of onset in relation to the COVID-19 symptoms, as well as the symptoms associated with the dermatological findings. Prognostic factors of possible worse outcomes were also analyzed in hospitalized patients, such as the need for non-invasive ventilation, intubation, dialysis, Extracorporeal Membrane Oxygenation (ECMO), and death.
Microsoft Excel® was used as the data sheet template, allowing analysis for descriptive statistics. The continuous variables were presented as mean, median, minimum, and maximum values, and Standard Deviation (SD); while the categorical variables were presented as absolute (n) and relative (%) frequencies. Statistical analysis was performed using IBM SPSS Statistics Version 24 and statistical significance was set at 5% (p < 0.05). The inferential analyzes used in order to confirm or refute evidence found in the descriptive analysis were t-Student for independent samples, Mann-Whitney, Analysis of Variance (ANOVA) with one factor Fixed, Kruskal-Wallis, Pearson's Chi-Square and Fisher's Exact or its extension.
This study was approved by the Ethics Committee of Sírio-Libanês Hospital, under the number 32840120.4.0000.5461, and written informed consent was obtained from all the participants.