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.