A systematic review on treatment‐related mucocutaneous reactions in COVID ‐19 patients

Abstract

Most of drugs could have certain mucocutaneous reactions and COVID‐19 drugs are not an exception that we focused. We systematically reviewed databases until August 15, 2020 and among initial 851 articles, 30 articles entered this study (20 case reports, 4 cohorts, and 6 controlled clinical trials). The types of reactions included AGEP, morbiliform drug eruptions, vasculitis, DRESS syndrome, urticarial vasculitis, and so on. The treatments have been used before side effects occur, included: antimalarial, anti‐viral, antibiotics, tocilizumab, enoxaparin and and so on. In pandemic, we found 0.004% to 4.15% of definite drug‐induced mucocutaneous reactions. The interval between drug usage and the eruption varied about few hours to 1 month; tightly dependent to the type of drug and hydroxychloroqine seems to be the drug with highest mean interval. Antivirals, antimalarials, azithromycin, and tocilizumab are most responsive drugs for adverse drug reactions, but antivirals especially in combination with antimalarial drugs are in the first step. Types of skin reactions are usually morbilliform/exanthematous maculopapular rashes or urticarial eruptions, which mostly may manage by steroids during few days. In the setting of HCQ, specific reactions like AGEP should be considered. Lopinavir/ritonavir is the most prevalent used drug among antivirals with the highest skin adverse reaction; ribarivin and remdisivir also could induce cutaneous drug reactions but favipiravir has no or less adverse effects. Logically the rate of dermatologic adverse effects among anivirals may relate to their frequency of usage. Rarely, potentially life‐threatening reactions may occur. Better management strategies could achieve by knowing more about drug‐induced mucocutaneous presentations of COVID‐19.

COVID-19 and the clinical course of rheumatic manifestations

“…There are two published cases of urticarial vasculitis [66]. However, a couple of systematic reviews have pointed out that most cutaneous manifestations could be traced to various drugs the patients were on [67,68]. The cause of purpura could be traced to thrombosis in several cases, and these would usually appear early in the disease onset.…”

Intense Impact of Health Alert Due to COVID-19 on Adherence of Moderate to Severe Psoriasis Patients to Hospital Therapy

“…Finally, we fully agree with the idea of taking a nonjudgmental approach to adherence (4) and we have maintained open access to patients to explain the facts about their treatment; however, nowadays evidence showed us not to discontinue immunomodulate therapy (15)(16)(17). This shared information helped prevent uncontrolled discontinuation of medications that can cause psoriasis flare-ups, thus reducing unnecessary patient visits to the hospital.…”

Skin manifestations as potential symptoms of diffuse vascular injury in critical COVID‐19 patients

“…The authors of this study have concentrated on various aspects of COVID‐19, especially dermatologic concerns 77–83 . We believe that vascular injuries may be one of the key pathomechanisms of COVID‐19 in various vital organs; awareness of dermatologic manifestation may offer an approach to earlier diagnosis and more rapid therapeutic approaches toward similar systemic events.…”