Cutaneous manifestations in SARS‐CoV‐2 infection (COVID‐19): a French experience and a systematic review of the literature

Abstract

Skin manifestations have been increasingly reported in the setting of COVID‐19. However, their incidence and presentation are debated, and the role, direct or undirect, of SARS‐CoV‐2 in their pathogenesis has yet to be determined. In this work, we aimed to analyze our experience in a French referral center and to perform a systematic review of the literature to evaluate the incidence and prognosis of cutaneous lesions observed in COVID‐19 patients. Cutaneous manifestations were assessed in COVID‐19 patients admitted to Cochin Hospital (Paris, France) between March 16 th and April 27 th 2020. 759 confirmed moderate‐to‐severe COVID‐19 cases were diagnosed in our institution. Eight patients (1%, 6 males, 2 females, mean age 55.6) presented with skin lesions, mainly disseminated maculo‐papular exanthema, but also digitate papulo‐squamous rash (reported in 1 ), herpes recurrence, papulo‐vesicular rash and Grover’s disease. The mean delay between respiratory/systemic and dermatological signs was 13 days.

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

“…COVID-19-associated cutaneous manifestations have been increasingly reported in the last few months, garnering attention both from the international scientific community and from the media. A few months after the outbreak of the pandemic, many narrative and systematic reviews concerning the dermatological manifestations of COVID-19 have been published [2, 3, 6, 88-91]. A summary of clinical features, histopathological findings, severity of COVID-19 systemic symptoms and therapeutic options of COVID-19-related skin manifestations has been provided in Table 2.…”

“…Whilst the COVID-19-associated cutaneous manifestations have been increasingly reported, their exact incidence has yet to be estimated, their pathophysiological mechanisms are largely unknown, and the role, direct or indirect, of SARS-CoV-2 in their pathogenesis is still debated. Furthermore, evidence is accumulating that skin manifestations associated with COVID-19 are extremely polymorphic [3]. In this regard, our group proposed the following six main clinical patterns of COVID-19-associated cutaneous manifestations in a recently published review article: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric “vasculitic” pattern (shown in Fig.…”

Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns

“…From the initial 942 contributions, 262 papers were collected, but further screening excluded 178 of them, because the histopathologic features were not addressed or only marginally studied. Of the 84 contributions accepted for our analysis, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14. , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , …”

“…A recent systematic review indicates a worldwide incidence of skin involvement around 1% to 2%, whereas the prevalence ranges from 0.2% in a cohort of Chinese patients to 20.4% in an Italian study. 4 , 5 , 6 Some cutaneous manifestations arise before the onset of respiratory signs and clinical manifestations, suggesting their role in diagnosis and prognosis. According to the recent classification, 7 based on a Spanish prospective nationwide consensus study of 375 cases, the most characteristic presentations are chilblain-like lesions, ischemic-livedoid/necrotic lesions, and varicelliform-like/vesicular eruptions.…”

Extending the range of symptoms in a Bayesian Network for the Predictive Diagnosis of COVID-19

“…It has been assumed that symptoms reported by participants testing negative for COVID-19 were circumstantial since the study was community outreach rather than in a clinical setting. Type of Rash data was taken from studies by Zhao et al, (2020) and Matar et al, (2020), whilst laboratory findings were mined from Zhang et al, (2020b); Tabata et al, (2020); Guan et al, (2020); de Jager et al, (2010); Wilkerson et al, (2020) and J. Xie et al, (2020).…”