Histology of skin lesions establishes that the vesicular rash associated with COVID‐19 is not “varicella‐like”

Mahé, A.; Birckel, E.; Merklen, C.; Lefèbvre, P.; Hannedouche, C.; Jost, M.; Droy‐Dupré, L.

Several articles recently reported a “varicella‐like” rash in patients with COVID‐19 [1,2]. We observed similar cases at our institution. However, although we agree that the clinical picture is original, we reject that “varicella‐like” denomination since clinical presentation, as well as some histologic features that we wish to report here for the first time, make it clearly different from varicella. Three patients with a vesicular rash associated with COVID‐19 (RT‐PCR test on a nasopharyngeal swab specimen positive for SARS‐CoV‐2 ARN) were seen at our institution in April, 2020. A biopsy of a vesicle was performed in each. Multiple levels with H&E stain were done; the slides were reviewed independently by two pathologists; only concordant data were validated. A test for SARS‐CoV‐2 was performed on a vesicle in two patients, and a direct immunofluorescence test on perilesional skin in one.