From diverse clinical manifestations of a new koronavirusny infection it is especially distinguished damages of skin. These defeats attracted attention since the beginning of epidemic, and, according to some specialists, damage of skin can be an initial symptom of COVID-19.
Carrying out careful differential diagnostics for the purpose of differentiation of damage of skin at a new koronavirusny infection from other damages of skin is required. Also it is necessary to remember that skin pathology can separately act from a koronavirusny infection as accompanying.
Damages of skin at a koronavirusny infection can have various character. Specialists allocate several groups of damages of skin at COVID-19.
The first group is provided by angiites, that is defeat of vessels with skin manifestations. Usually similar defeats have the infectious and allergic nature and can often be at various viral infections. For example, at an acute respiratory viral infection rather frequent phenomenon is the acute knotty erythema. Considering that the koronavirusny infection often proceeds with considerable involvement in process of a system of immunity, the cell-bound immune complexes circulating in blood in combination with viral antigens can cause damage to walls of small vessels, including skin. Clinically it can be shown by appearance of vascular rash. It should be noted that rather specific phenomenon for a new koronavirusny infection are so-called akrovaskulita (defeat of vessels of distal departments of extremities). There is an opinion that similar distribution arises owing to a hypoxia of peripheral fabrics because of damage of lungs.
Carry papular and squamous rashes to the second type of damages of skin and pink deprive. These damages of skin also belong to the category infectious and allergic and also often are associated with a new koronavirusny infection. At the same time pink deprive, arising at a koronavirusny infection, has feature in the form of lack of a parental element (the largest first element) which is observed at a disease on classical type.
The third type is provided by infectious eritema and korepodobny rashes. As at other viral infections (for example, measles), and at COVID-19 similar rashes have similar characteristics, that is are classical infectious ekzantema.
The fourth type is provided by the papulo-vesicular rashes reminding a heat rash. Such rashes can arise against the background of the subfebrile body temperature and the increased sweating connected with it. One of the signs typical for a koronavirusny infection, the prevalence of defeats is that distinguishes this rash from a classical miliariya.
Toksikodermiya represent the fifth type of rashes at a koronavirusny infection and are connected not directly with it, and with various skin reactions to medicines. Antibacterial, antiviral drugs, hydroxychloroquine — all of them can cause allergic reactions from skin.
The sixth type of rashes (urtikarny rash or small tortoiseshell) can also have the reason intolerance the patient of this or that medicine accepted by it. Besides, the small tortoiseshell can act as one of the first symptoms of a koronavirusny infection or to be a harbinger of the beginning of a clinical picture of a disease. By analogy with the first type of rashes (angiites) its mainly akralny arrangement is also characteristic of urtikarny rash at a koronavirusny infection.
The last, seventh type of damages of skin at a koronavirusny infection is provided by trophic changes of facial tissues and usually caused by long stay of the patient in a pron-position. It is known that use of a similar position (on a stomach) at patients promotes oxygenation improvement therefore it is widely used in clinical practice. Artificial defeats act as a consequence of long stay of patients in such situation.
As we see, damages of skin at a new koronavirusny infection have various character and can be not always connected with influence of a virus. If the doctor of the general profile experiences difficulties in the correct interpretation of skin changes and definition of type of rash, he can invite to consultation of the specialist dermatologist who will help to define rash type, to establish its reason and to recommend medical actions.