The following is a summary of “Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity,” published in the March 2023 issue of Critical Care by Savage, et al.

For a retrospective observational cohort study, researchers sought to describe the patterns and presentations of violaceous discoloration that appeared to be related to the COVID-19 disease process.

Adults who were COVID-19 positive and had purpuric/violaceous lesions in pressure-adjacent areas of the gluteus without preexisting pressure injury were included in this study. The patients were admitted to an ICU at a single quaternary academic medical center between April 1 and May 15, 2020. Data were collected through a review of the electronic health record. The wounds were characterized based on their location, tissue type (violaceous, granulation, slough, eschar), wound margin (irregular, diffuse, nonlocalized), and peri-wound condition (intact).

A total of 26 patients were included in the study. The purpuric/violaceous wounds were predominantly observed in White individuals (92.3%), with a higher prevalence among men (88.0%). The age range of the patients was 60 to 89 years (76.9%), and a significant proportion had a body mass index of 30 kg/m2 or higher (46.1%). Most wounds were located in the sacrococcygeal region (42.3%) and fleshy gluteal regions (46.1%).

The wounds exhibited a heterogeneous appearance, characterized by poorly defined violaceous skin discoloration of acute onset. The patient population demonstrated clinical characteristics similar to acute skin failure, including concomitant organ failures and hemodynamic instability. Further studies involving larger populations and biopsies were needed to identify patterns associated with these dermatologic changes.