Cutaneous manifestations in COVID-19: Lessons learned from current evidence

Suchonwanit, Poonkiat; Leerunyakul, Kanchana; Kositkuljorn, Chaninan

doi:10.1016/j.jaad.2020.04.094

Cited by 109 publications

(138 citation statements)

References 4 publications

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“…The pathological mechanisms of skin lesions in COVID-19 patients remain poorly understood. Cutaneous manifestations in COVID-19 may be classified into two major groups regarding their pathomechanisms [ 62 ]: clinical features similar to viral exanthems (an immune response to viral nucleotides) cutaneous eruptions secondary to systemic consequences caused by COVID-19 (especially vasculitis and thrombotic vasculopathy). …”

Section: Resultsmentioning

confidence: 99%

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

2020

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In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions—and in severe cases, microvascular injury and thrombosis—associated with COVID-19, and provide important clues to their pathological mechanisms.

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Section: Resultsmentioning

confidence: 99%

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

2020

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“…The first is the immune response to the viral infection, manifesting with morbilliform rash, petechial rash, erythematous‐to‐purpuric coalescing macules, widespread urticaria, and varicella‐like vesicles. The other one is associated with vasculopathy, manifesting with peripheral cyanosis with bullae and dry gangrene, transient unilateral livedo reticularis, and red papules on fingers resembling chilblains 6 . When evaluating cutaneous lesions in patients with COVID‐19 infection, drug eruptions should be firstly considered in the differential diagnosis.…”

Section: Figurementioning

confidence: 99%

A unilateral purpuric rash in a patient with COVID ‐19 infection

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2020

Dermatologic Therapy

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Dear Editor, Coronavirus disease (COVID-19) of 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared as a pandemic by the World Health Organization on March 11, 2020. Currently, it continues to exist as a global problem. 1 While screening the people contacted with a patient diagnosed as COVID-19 infection, we identified a 58-year-old male with a positive polymerase chain reaction (PCR) for SARS-CoV-2. At the time of diagnosis, the patient did not have any infection-related complaints. However, the computed tomography scan of the chest was typical of COVID-19. Ground glass opacities were observed in both lung parenchyma. On

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“…Although urticarial rash is the most common skin manifestation described in COVID-19 infection, cases can be classified into two groups: those related to the virus and those associated with complications and management. 5 Comment on 'Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital'. Pseudoherpetic Grover disease seems to occur in patients with COVID-19 infection doi: 10.1111/ced.14305…”

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confidence: 99%