ASSOCIATION OF PULMONARY AND CUTANEOUS CHANGES IN COVID-19-RELATED CONDITIONS

The study of skin manifestations in COVID-19 is relevant due to the possibility of their appearance before the onset of the typical pattern of respiratory lesions, and the typicality of this pattern has changed noticeably with the emergence of new strains of the virus (nosomorphosis), therefore skin manifestations have both early diagnostic and possible prognostic value.

The aim of our study was to identify the relationship between the course of SARS-CoV-2 and its specific features of skin manifestations during the COVID-19 pandemic.

A retrospective study of data from patients with maculopapular lesions who had COVID-19 was conducted. Among all the skin manifestations of COVID, we selected maculopapular lesions for a more detailed study, as one of the most frequent dermatological pathological processes in this disease. Based on the assessment of the area of the lesion and symptoms (the nature of itching, dryness, pain or other accompanying discomfort that interferes with normal activity, sleep; skin peeling), the degree of the course was assessed as mild, moderate, severe. The severe form of the acute respiratory syndrome of the coronavirus 2 (SARS-CoV-2) was diagnosed based on a complex of clinical and laboratory data obtained from the medical histories of persons undergoing examination. Among the clinical and laboratory data, we selected C-reactive protein (CRP - a blood plasma protein belonging to the group of acute phase proteins, the concentration of which increases during inflammation), D-dimer (a protein fragment that is formed during the dissolution of a blood clot that occurs during blood clotting), procalcitonin (a precursor of calcitonin, which is involved in calcium metabolism and maintains its constant level in the blood) and blood oxygen saturation level.

It has been established that moderate and severe SARS-CoV-2 is characterized by skin lesions in the form of maculopapular lesions. Typical are itching, dryness, painful or other accompanying discomfort, skin peeling. In most patients with rash (198 patients (65.8%)) it was a generalized process, more prominent on extremities. Bilateral jawline and periauricular area were affected in 234 (77.7%) patients. In 204 (67.8%) patients, rashes were observed on the abdomen. The average duration of the rash was 10.4±2.21 days.

Among the studied signs, a strong correlation was found between the area of alveolar cell desquamation in the lungs and such changes as the area of skin lesions, skin peeling (r=0.73 and r=0.74, respectively), which could be established in deceased individuals. A high dependence of the area of skin lesions on the level of D-dimer (r=0.71) and procalcitonin (r=0.70) was also found.