Cutaneous Vasculitis As a Covid-19 Manifestation: A Cross-Sectional Study With Detailed Histopathological Evaluation Publisher



R Diab REEM ; A Rakhshan AZADEH ; M Shahididadras MOHAMMAD ; S Salarinejad SAREH ; A Kaddah ALI ; Z Razaghi ZAHRA ; M Akhdar MARWA ; R Sadoughifar ROXANNA ; F Abdollahimajd FAHIMEH
Source: JEADV Clinical Practice Published:2025

Abstract

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. © 2025 Elsevier B.V., All rights reserved.