Common skin signs of COVID-19 in adults: An update

Abstract

A s experience with caring for patients with COVID-19 has accumulated since the onset of the pandemic, so has our understanding of its associated cutaneous manifestations and their clinical implications.It is benefi cial to watch for cutaneous manifestations of COVID-19, both in and out of the hospital. For example, a study of more than 330,000 community-based patients in the United Kingdom 1 found that patientreported skin rash was associated with positive COVID-19 testing and was more predictive than fever. Additionally, an analysis of 296 hospitalized patients with COVID-19 in the United States 2 found that mucocutaneous fi ndings were associated with the need for mechanical ventilation, even when adjusted for age, body mass index, and comorbidities.COVID-19-associated cutaneous abnormalities are often grouped into 5 major categories (Table 1) 3 : • Morbilliform rash (containing macules and papules, resembling measles) • Urticaria (itchy red welts) • Vesicles (small blisters) • Pseudo-chilblains (also known as "COVID toes," painful infl ammation of the digits in response to cold) • Vaso-occlusive lesions (due to thrombosis and occlusion of small arteries, with subsequent ischemia). ■ MORBILLIFORM RASH: THE MOST COMMON SKIN MANIFESTATIONMorbilliform eruptions are common in many viral illnesses and were reported in patients with COVID-19 early in the pandemic. 4,5 International registry data indicate that mor-REVIEW

COVID‐associated non‐vasculitic thrombotic retiform purpura of the face and extremities: A case report

“…In adults, it has been shown that these COVID‐associated vaso‐occlusive lesions occur predominantly in hospitalized patients 12,33 . The presence of a COVID‐associated rash in an adult suggested that our patient was at a higher risk for severe COVID‐19 illness.…”

“…[29][30][31][32] In adults, it has been shown that these COVIDassociated vaso-occlusive lesions occur predominantly in hospitalized patients. 12,33 The presence of a COVIDassociated rash in an adult suggested that our patient was at a higher risk for severe COVID-19 illness. Her previous immunization may have contributed to the hyperimmune and hyperthrombotic state that manifested with a purpuric rash that required immunomodulation with high dose corticosteroids, monoclonal antibody treatment, and specific antiviral therapy.…”

How to differentiate skin rash in covid, mononucleosis, chickenpox, sixth disease and measles

“…degeneration [11]. Although diffuse vesicular eruptions, with lesions developing simultaneously on the trunk and spreading distally with possible involvement of the palms and soles have been reported, localized forms with scattered lesions are the most frequent presentations [1,4,12]. Trunk is the most common affected area in these subtypes, yet extremities involvement is not uncommon [3].…”

Receptors and Cofactors That Contribute to SARS-CoV-2 Entry: Can Skin Be an Alternative Route of Entry?

“…Another nationwide study in Spain found that chilblain-like lesions were associated with less severe COVID-19 cases whereas livedoid and/or necrotic lesions were associated to more severe ones [ 130 ]. Clinical reports have accumulated and it is now admitted that the five most common cutaneous abnormalities that are associated with COVID-19 are morbilliform rash, urticaria, vesicles, pseudo-chilblains and vaso-occlusive lesions [ 131 ]. Some of these symptoms such as skin rash are associated with positive COVID-19 swab testing and a UK study of 330,000 patients found that it was more predictive of infection than fever [ 132 ].…”