Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Abstract

Purpose of Review COVID-19 (coronavirus viral disease 2019), due to the novel SARS-CoV-2, may present with different types of cutaneous manifestations of varying pathophysiology. During the ongoing pandemic, publications reporting dermatologic findings in COVID-19 continue to emerge. Recent Findings Cutaneous vasculopathy and microthrombus-related changes including acral and sacral lesions, retiform purpura, livedo reticularis, and cutaneous vasculitis are notable findings in adult patients. Other exanthems include urticaria or angioedema, morbilliform/maculopapular exanthems, erythema multiforme, and vesicular eruptions. Increased recognition of these findings, especially those consistent with cutaneous microthrombi or vasculitis, is of particular importance. Additionally, occupational dermatologic disease related to extended personal protective equipment (PPE) use, such as skin damage and irritant or allergic contact dermatitis (ACD), represents another emerging problem amidst the pandemic. Summary In this review, we highlight the various cutaneous manifestations associated with COVID-19 in adult patients and occupational dermatitis in health care workers (HCWs) caring for this patient population. Keywords COVID-19. SARS-CoV-2. Cutaneous manifestations. Dermatologic. Rash. Contact dermatitis Abbreviations AAD American Academy of Dermatology ACD Allergic contact dermatitis ACE2 Angiotensin-converting enzyme 2 AD Atopic dermatitis AGEP Acute generalized exanthematous pustulosis ARDS Acute respiratory distress syndrome COVID-19 Coronarvirus viral disease 2019 CSSV Cutaneous small vessel vasculitis DIC Disseminated intravascular coagulation DiHS/DRESS Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms HCW Health care worker ICD Irritant contact dermatitis ITP Immune thrombocytopenic purpura PPE Personal protective equipment PT Patch test RT-PCR Reverse transcriptase polymerase chain reaction SARS-CoV-2 Severe acute respiratory distress syndrome coronavirus 2 SDRIFE Symmetrical drug-related intertriginous and flexural exanthema This article is part of the Topical Collection on Allergic Skin Diseases

Occupational Dermatoses Related to Personal Protective Equipment Used During the COVID-19 Pandemic

“…The composition of the facial PPE materials are important to consider in potential cases of occupational dermatitis. 19 ACD to facial PPE has been reported to textile dyes 39 , elastic bands 12 , metal wiring for nosepiece 40 , and formaldehyde 41 that may remain from the manufacturing process of the polypropylene shell. Wearing facial PPE for extended periods of time also increases risk of ICD, pressure induced dermatitis, and worsening of preexisting skin conditions such as acne and rosacea.…”

“… 12 , 40 , 44 Textile dyes in surgical or cloth masks have also been reported to lead to ACD. 39 Furthermore, formaldehyde used in the manufacturing of surgical masks and N95 respirators may still remain in the final product and have been reported to cause ACD. 41 , 45 , 18 , 14 Other preservatives with potential to induce ACD due to facial PPE include methyldibromoglutanitrile, 40 2-bromo-2-nitropropane-1,3-diol, 14 toluene-2,4-diisocyanate 18 , diaminodiphenylmethane 18 and hexamethylene diisocyanate.…”

Opportunities, Challenges and Pitfalls of Using Cannabidiol as an Adjuvant Drug in COVID-19

“…In addition, pathological changes in the renal [ 1 , 16 , 27 , 33 , 37 , 38 ], gastrointestinal, hepatic, pancreatic [ 1 , 16 , 27 , 31 , 39 , 40 ] and nervous systems [ 1 , 27 , 41 , 42 , 43 ] have been described. Disturbances of the eyes [ 1 , 44 ], endocrine [ 45 , 46 ] and reproductive functions [ 31 , 45 , 46 , 47 ], skeletal muscles [ 1 , 33 , 48 ] and skin [ 1 , 49 , 50 ] occur as well (for details, see Figure 2 ).…”

Pericardial Diseases in COVID19: a Contemporary Review

“…COVID19 primarily affects the lungs, and the severity of the disease ranges from mild respiratory symptoms to acute respiratory distress syndrome [ 2 ]. There is growing literature on the involvement of other organs, mainly the heart, kidneys, gastrointestinal tract, brain, and skin [ 3 , 4 ]. Cardiac manifestations of COVID19 include acute heart failure, myocarditis, acute coronary syndrome, Takotsubo cardiomyopathy, arrhythmias, pericardial involvement, and cardiac arrest [ 5 – 7 ].…”