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    Research Letter
    August 5, 2020

    Livedoid and Purpuric Skin Eruptions Associated With Coagulopathy in Severe COVID-19

    Author Affiliations
    • 1Department of Dermatology, NewYork-Presbyterian/Weill Cornell Medical College, New York
    • 2Division of Hematology and Oncology, Department of Medicine, NewYork-Presbyterian/Weill Cornell Medical College, New York
    • 3Department of Pathology and Laboratory Medicine, NewYork-Presbyterian/Weill Cornell Medical College, New York
    JAMA Dermatol. 2020;156(9):1022-1024. doi:10.1001/jamadermatol.2020.2800

    As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection spreads globally, dermatologists are recognizing a variety of cutaneous manifestations in patients with coronavirus disease 2019 (COVID-19). A recent Spanish report1 categorized skin findings in 375 patients with suspected and confirmed COVID-19, including livedoid and necrotic eruptions, which were noted in patients with more severe disease. The authors suggested that these skin manifestations may be associated with occlusive vascular disease.

    In this case series, we describe the experience of 4 patients from 2 academic hospitals in New York City from March 13 to April 3, 2020, who presented with severe COVID-19 (confirmed by SARS-CoV-2 real-time polymerase chain reaction using Panther Fusion or Roche Cobas tests) and acute respiratory distress syndrome requiring intubation. The patients had skin findings of acral fixed livedo racemosa and retiform purpura, for which the dermatology department was consulted. This study was deemed exempt from formal institutional review board approval by NewYork-Presbyterian/Weill Cornell Medical College because it is a report of clinical care and is not considered human participants research. Written informed consent for skin biopsy was obtained from health care proxies because all patients were intubated and required sedation.