Cutaneous Vasculitis as a Covid‐19 Manifestation: A Cross‐Sectional Study With Detailed Histopathological Evaluation

Background Although coronavirus disease 2019 (Covid‐19) primarily affects the lungs, dermatologic lesions can present as one of the extrapulmonary manifestations. Multiple cutaneous manifestations have been linked with Covid‐19, including urticaria, maculopapular rash, vesicular rash, petechiae, perniosis, livedo racemosa, distal ischaemia and necrosis. Cutaneous vasculitis is another possible symptom, ranging from mild or asymptomatic to fulminant. Objectives To examine the histopathological characteristics, treatment responses and clinical outcomes of Covid‐19‐associated cutaneous vasculitis and to identify specific markers that can assist dermatologists in diagnosing and managing these lesions. Methods Patients presenting with typical cutaneous vasculitic manifestations were selected. Covid‐19 was confirmed by RT‐PCR for SARS‐CoV‐2 from a nasopharyngeal or throat swab. Skin biopsy specimens were obtained from 33 eligible patients and reviewed by an experienced dermatopathologist. We present detailed histopathology, treatment and clinical follow‐up. Results The most prominent histopathological features for cutaneous vasculitis rashes associated with Covid‐19 included endothelial cell swelling, erythrocyte extravasation, vascular ectasia and a lymphocytic infiltrate with some neutrophils and eosinophils. There was a rapid improvement in patients' lesions upon initiation of prednisolone, which was used as a short‐term treatment. Conclusions This study will empower dermatologists with tools for the rapid evaluation of patients suspected of cutaneous vasculitis based on clinical presentations and specific histopathological manifestations associated with Covid‐19, which emerged recently.