Cutaneous manifestations of COVID‐19 and COVID‐19 vaccination

Abstract

In December 2019, a new infectious pathogen named severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was identified in Wuhan, China. Transmitted through respiratory droplets, SARS‐CoV‐2 is the causative pathogen of coronavirus disease 2019 (COVID‐19). Although this new COVID‐19 infection is known to cause primarily interstitial pneumonia and respiratory failure, it is often associated with cutaneous manifestations as well. These manifestations with COVID‐19 can be classified into seven categories: (i) chilblain‐like skin eruption (e.g., COVID toes), (ii) urticaria‐like skin eruption, (iii) maculopapular lesions, (iv) vesicular eruptions, (v) purpura, (vi) livedo reticularis and necrotic lesions, (vii) urticarial vasculitis, and others such as alopecia and herpes zoster. The pathogenesis of skin eruptions can be broadly divided into vasculitic and inflammatory skin eruptions. Various cutaneous adverse reactions have also been observed after COVID‐19 mRNA vaccination. The major cutaneous adverse reactions are type I hypersensitivity (urticaria and anaphylaxis) and type IV hypersensitivity (COVID arm and erythema multiform). Autoimmune‐mediated reactions including bullous pemphigus, vasculitis, vitiligo, and alopecia areata have also been reported. Several cases with chilblain‐like lesions and herpes zoster after COVID‐19 mRNA vaccination have been published. Various skin diseases associated with COVID‐19 and COVID‐19 vaccination have been reported, and the mechanism has been partly elucidated. In the process, for example, some papers have reported that it is not related to COVID‐19 infection, although it was initially called COVID‐toe and considered a COVID‐19‐associated cutaneous eruption. In fact, some COVID‐19‐associated skin reactions are indistinguishable from drug eruptions. In the future, the mechanisms of COVID‐19‐ or COVID‐19 vaccine‐associated skin reactions need to be elucidated and verification of causal relationships is required.

Unraveling the debate: Can the skin manifestations of SARS‐CoV‐2 infection and vaccination be explained by the reactivation of herpes virus?

“…These articles offer different classifications and pathophysiological explanations for the nature of the lesions, but mostly conclude that additional research is needed to settle the conundrum. [11][12][13] Recently, many support the claim that cutaneous manifestations of COVID-19 are severity-dependent and perhaps reflect a type IV immune response, 14 while others have suggested an apparent association with Herpesviridae. 15,16 Whether the SARS-CoV-2 mRNA vaccination (henceforth, the mRNA vaccine) contributes to herpes reactivation is an ongoing debate, despite the large amount of structured data.…”

“…13,16 Regarding the mRNA vaccine, the working hypothesis was that there is an increased incidence of herpetic reactivation following vaccination via a yet unknown mechanism. 14…”

“…Recently, many support the claim that cutaneous manifestations of COVID‐19 are severity‐dependent and perhaps reflect a type IV immune response, 14 while others have suggested an apparent association with Herpesviridae 15,16 …”

The association of hair loss and coronavirus infection COVID-19 – facts and hypotheses

“…Проявлениями COVID-19 прежде всего является интерстициальная пневмония и дыхательная недостаточность, у ряда пациентов наблюдается вовлечение желудочно-кишечного тракта, нервной системы, системы крови, а также кожи [2]. Высыпания на коже возникают не менее чем у 20% больных и характеризуются выраженной вариабельностью [3,4] На основании особенностей клинических и гистологических проявлений высыпаний на коже выделяют несколько паттернов поражения кожи, которые включают уртикарную сыпь, сливную эритематозную/макулопапулезную/кореподобную сыпь, папуло-везикулярную экзантему, акральный паттерн, подобный обморожению, паттерн, подобный ретикулярному или рацимозному ливедо, а также высыпания по типу геморрагического васкулита [4,5].…”

“…Что касается кожных проявлений COVID-19, то до сих пор обсуждается вопрос, являются ли они прямым следствием повреждаю щего действия SARS-CoV-2 или результатом тромбогенных и иммунных нарушений, вызванных инфекцией. Гиперкоагуляция и повреждение сосудов часто наблюдаются в коже у пациентов с дерматологическими проявлениями заболевания и обусловлены воспалением, индуцированным поражением SARS-CoV-2 эндотелиальных клеток сосудов кожи или клеток иммунной системы [4,9]. При этом кожные проявления COVID-19 могут быть потенциальными маркерами тяжести и характера течения инфекции, а также создавать предпосылки к пониманию патогенеза заболевания.…”