COMMENT
Skin vascular symptoms have been reported in patients with COVID-19 disease1. The occurrence of livedo, necrotic or non-necrotic purpuras is explained by the infection-related coagulopathy1. Our patient presented Lichen Aureus (LA) in association with a mild form of COVID-19 disease. LA is a rare, localized variant of pigmented purpuric dermatoses (PPDs) characterized by the sudden onset of unilateral, well circumscribed, rust-colored patches, usually on the lower legs, with particular dermoscopic features, as was seen in our case2,3. PPDs are also known as capillaritis. Their precise cause remains unclear. Several cofactors including venous hypertension, capillary fragility, infections and drugs intake were suggested2. One case of PPD was described as Schamberg purpura in a 13-year-old child with mild COVID-19 infection4. We think, in our case, LA may be considered as a vascular skin manifestation associated with COVID-19. However, the severe acute respiratory syndrome coronavirus-2 may lead to excessive activation of inflammatory mediators creating a “cytokine storm” which may cause damage to the endothelium in addition to changes in the cellular component of immunity with activation of the complement system1,4. Thus, alteration of endothelial cells function, causing red blood cells to leak through the vessel walls, may be responsible in this case of triggering a cell-mediated hypersensitivity reaction4,5. Therefore, in our case, cell-mediated immune response seems to have probably a role in the onset of LA few days after first COVID-19 systemic symptoms.
In conclusion, our observation and the case about Schamberg disease previously described suggest PPD as non-specific findings of SARS-CoV-2 infection4. Although the relationship is not fully elucidated, the knowledge of such cutaneous manifestations is worthwhile to mention in order to help improve disease recognition and care.