Cutaneous manifestations of COVID-19: Report of three cases and a review of literature

Sachdeva, Muskaan; Gianotti, Raffaele; Shah, Monica; Bradanini, Lucia; Tosi, Diego; Veraldi, Stefano; Ziv, Michael; Leshem, Eyal; Dodiuk‐Gad, Roni P.

doi:10.1016/j.jdermsci.2020.04.011

Cited by 294 publications

(423 citation statements)

References 27 publications

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“…Cutaneous manifestations are related not only to SARS-CoV-2 infection, but also to several other infectious diseases, such as toxic shock syndrome, meningococcemia, rickettsial diseases, measles, and scarlet fever. 76 In the present study, 19 manifestations of dermatologic symptoms were observed, including skin rash, mottling, exanthema, erythema, periorbital erythema, and peritoneal or facial desquamation. These skin changes are rarely observed, but they can still go unnoticed due to lack of attention, which raises concern about COVID-19 transmission by misdiagnosed asymptomatic children.…”

Section: Resultsmentioning

confidence: 48%

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Pousa¹,

Mendonça²,

Oliveira³

et al. 2021

Jornal de Pediatria

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Objective The aim of this review was to summarize the most common extrapulmonary manifestations in pediatric patients with COVID-19, as well as to discuss clinical, epidemiological, and pathophysiological aspects of these clinical presentations in children. Source of data An extensive search of literature was performed in order to identify pediatric cases with extrapulmonary manifestations between January 1, 2020 and June 21, 2020. Generic keywords, such as “Novel coronavirus” or “Novel coronavirus 2019” or “2019 nCoV” or “COVID-19” or “SARS-CoV-2” were searched on PubMed database, associated either with age filters or generic pediatric terms. Summary of findings A total of 28 articles, including 199 patients, were considered suitable to review and data extraction. The main findings were summarized in tables. The main non-pulmonary manifestations in pediatric patients, in decreasing order of frequency, were gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, cutaneous, hepatic, ocular, olfactory, and gustatory. Multisystem impairment and Kawasaki-like disease were also described. Conclusions Differences in immune response of children and variations of tissue expression of angiotensin converting enzyme 2, the virus receptor, are likely to influence clinical, epidemiological, and pathophysiological patterns of the disease.

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Section: Resultsmentioning

confidence: 48%

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Pousa¹,

Mendonça²,

Oliveira³

et al. 2021

Jornal de Pediatria

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“…COVID‐19 has a wide range of primary symptoms, including fever, cough, malaise and digestive symptoms; however, the frequency of cutaneous manifestations is comparatively lower 1,2 . Various types of cutaneous manifestations have been reported, including erythema, urticaria, purpura, reticular and frostbite 3 . There are, however, few reports of COVID‐19 patients with erythema that include detailed information such as symptom progression.…”

Section: Introductionmentioning

confidence: 99%

Three cases of COVID‐19 patients presenting with erythema

Tamai¹,

Maekawa²,

Goto³

et al. 2020

The Journal of Dermatology

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Individuals infected with the novel coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2]) who develop coronavirus disease 2019 (COVID-19) experience many symptoms; however, cutaneous manifestations are relatively rare. The authors encountered three patients with COVID-19 who presented with erythema and suspected viral rash. In all cases, erythema appeared after the onset of the initial symptoms of COVID-19. Erythema was considered to be caused by COVID-19 and not a drug-induced eruption because, in all cases, erythema was relieved merely by external medicine and oral antihistamines, without discontinuing the original medication. The authors' hospital accepted 69 COVID-19 patients between 22 February 2020 and 31 May 2020 and, of these, three (4.3%) exhibited eruptions, and all cases presented erythema. Except for seven patients who exhibited positive nasopharyngeal swab tests for SARS-CoV-2 RNA but no symptoms, three (4.8%) of the remaining 62 patients exhibited erythema. Although various types of eruptions have been reported in patients with COVID-19, erythema was the only type in our patients. Erythema in the three patients exhibited many similarities to that previously reported in COVID-19 patients, particularly in the manner it appeared and disappeared. For these reasons, these three cases were considered typical examples of erythema in patients with COVID-19. Considering previous studies and the three cases reported here, there is a high probability that SARS-CoV-2 can cause erythema.

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“…30 The single case of a VR reported by Sachdeva et al was described as resembling Grover's Disease. 31 Piccolo et al observed two different lesion patterns for PC: erythematous-edematous types and blistering types. A few articles also described skin biopsy ndings, which almost uniformly revealed a perivascular mononuclear/lymphocytic in ltrate with occasional small vessel thrombosis.…”

Section: Id Studymentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: A Systematic Review

Daneshgaran

Dubin

Gould

2020

Preprint

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Background: The COVID-19 pandemic has affected 4.5 million people and killed over 300,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported.Objective: The aim of this review was to collate and categorize the dermatologic findings reported in COVID-19 patients and identify specific lesions that may facilitate diagnosis and prognostication.Methods: A systematic review of the PubMed database was conducted on May 14th, 2020 using the search terms “Covid-19 skin,” “Covid-19 rash,” “Covid-19 exanthem,” and “Covid-19 chilblains.” Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.Results: The literature search identified 115 records, of which 34 publications describing 996 dermatologic patients were included. Case reports (n=15), case series (n=10) and observational studies (n=7) were the most common publication types. Pseudo-chilblains (PC) was the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, MA, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes (EMR) affected 21.3% of patients, most frequently impacting middle-aged adults (MA 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes (VR) affected 13.0% of patients, appearing in middle-aged adults (MA 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes (UR) affected 10.9% of patients, appearing in adults (MA 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo/purpura/necrosis (LPN) were uncommon (4% of cases), appearing in elderly patients (MA 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions (EME), although infrequent (3.7% of cases), affected mostly children (MA 12.2 years).Conclusions: VR may suggest an initial diagnosis of COVID-19, PC may be most appropriate for epidemiological uses, and LPN may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all health care professionals be well-versed in these increasingly common cutaneous manifestations of COVID-19.

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Cutaneous manifestations of COVID-19: Report of three cases and a review of literature

Cited by 294 publications

References 27 publications

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Three cases of COVID‐19 patients presenting with erythema

Cutaneous Manifestations of COVID-19: A Systematic Review

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