Dermatologic findings in 2 patients with COVID-19

Rivera-Oyola, Ryan; Koschitzky, Merav; Printy, Rachel; Liu, Stephanie; Stanger, Roselyn; Golant, Alexandra; Lebwohl, Mark

doi:10.1016/j.jdcr.2020.04.027

Cited by 33 publications

(59 citation statements)

References 6 publications

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“…In addition, there are reports of the erythema multiforme type 7 . A search of the PubMed database retrieved only seven case reports describing COVID‐19 patients with an erythema that included basic patient information such as sex, age and time course of rash; 8–14 these reports are summarized in Table 1. The mean patient age was 47.1 years, with a range of 6–67 years.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“… 10,34‐56 These studies mainly reported maculopapular rash ( n = 11), urticaria ( n = 5), vesiculobullous lesions ( n = 1), chilblain‐like lesions ( n = 4), and livedo reticularis ( n = 2). Five articles reported dermatopathological findings in COVID‐19 patients 21,32,34,38,51 . The findings were epidermal cytopathic changes ( n = 4), interface dermatitis ( n = 2), dermal lymphocytic infiltrates ( n = 12), and thrombosis of dermal vessels ( n = 6) (Table.…”

Section: Resultsmentioning

confidence: 99%

The trend of cutaneous lesions during COVID‐19 pandemic: lessons from a meta‐analysis and systematic review

2020

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Background Besides predominant respiratory and gastrointestinal manifestations, reports on cutaneous manifestations in COVID-19 patients are being noted increasingly. Objectives To estimate the prevalence of cutaneous manifestations in COVID-19 patients. Methods This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A detailed literature search was done in PubMed and Embase from December 1, 2019, till May 1, 2020. Studies reporting cutaneous manifestations in COVID-19 patients were included. Irrespective of the heterogeneity of data, a random effects model with inverse-variance approach was used for pooling the prevalence using meta package in R version 3.6.2. Results Out of 15,143 articles, 2086 articles were selected for full-text read. Forty-three articles were selected for qualitative analysis, of which 10 articles (N = 1682) were included for meta-analysis. The pooled prevalence of overall cutaneous lesions was 5.69 (95% confidence interval [CI]: 1.87-15.98; I 2 88%). The pooled prevalence of other outcome parameters were as follows: viral exanthem-like presentation 4.15 (95% CI: 1.33-12.23; I 2 88%), maculopapular rash 3.81 (95% CI: 1.02-13.18; I 2 87%), vesiculobullous lesions 1.67 (95% CI: 0.70-3.96; I 2 0%). Conclusion The estimated prevalence of cutaneous manifestations in COVID-19 was 5.69%. Other manifestations were urticaria, chilblain-like lesions, livedo reticularis, and finger/toe gangrene. Although it is premature to conclude the prevalence of the cutaneous manifestations during this ongoing pandemic, our report may be a stimulating factor for the physicians to perform further vigilant streamlined reporting of cutaneous manifestations in COVID-19 patients to estimate the final prevalence. Epidermal cytopathic changes: ballooning or reticular degeneration of keratinocytes, dyskeratotic keratinocytes, and epidermal giant cells; Interface dermatitis: band-like or nodular inflammatory infiltrate involving papillary dermis and basement membrane with or without apoptosis or vacuolation of basal

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“…Regarding integumentary manifestations, clinical images or histopathological registers cannot be assessed for all cases reported so far. Authors have described these cutaneous lesions under distinct dermatological terms: (i) erythematous rash , [ 10,16] widespread urticaria [ 10,16,18,19] and chickenpox‐vesicles ; [ 10] (ii) “ mottling ”; [ 11] (iii) Dengue‐like purpuric exanthema ; [ 12] (iv) pneumonia with urticaria and pneumonia with atopic dermatitis ; [ 13] (v) urticarial eruption ; [ 8] (vi) acroischaemia of the finger/toe with cyanosis (blue toe syndrome) , dry gangrene with or without disseminated intravascular coagulation (DIC), [ 9] DIC‐like acral manifestations and severe perniosis ; [ 9,10] (vii) retiform purpura and livedo racemose ; [ 8,32,35] (viii) varicella‐like exanthema ; [ 8] (ix) chilblains‐like disease ; [ 8] (x) transitory unilateral livedo after sun exposure; [ 14] (xi) confluent erythematous‐yellowish papules in the heels; (xiii) acute flexural rash similar to Symmetrical Drug‐Related Intertriginous and Flexural Exanthema (SDRIFE); (xiv) purpuric skin rash with coalescing macules in the axillae ; [ 15] (xv) erythema multiforme‐like eruption; [ 8] (xvi) acute generalized exanthematous pustulosis (AGEP) with erythema multiforme‐like lesions ; [ 3,21,46] (xvii) drug‐induced vasculitis , [ 4] (xviii) oral and cutaneous vesiculobullous lesions ; [ 8,41] (xix) vascular acrosyndromes with indurated erythematous or violaceous plaques on heels and toes; [ 8] (xx) viral‐like morbilliform exanthema ; [ 7,8,27,28] (xxi) maculopapular eruptions , [ 8,22,29] (xxii) diffuse maculopapular eruption involving the trunk, similar to Grover disease ; [ 5] (xxiii) petechial skin eruption [ 6,16] and (xxiv) pruritic papular‐vesicular eruption surrounded by erythematous halos affecting trunk and limbs, suggestive of Herpes infection; [ 7,40] (xxv) necrosis ; [ 16,33] (xxvi) mucosal lesions ; [ 16,36‐39,43] (xxvii) perifollicular eruption ; [ 20,45] (xxviii) pruritic rash ; [ 23‐26,47] (xxix) lichenoid eruption ; […”

Section: What Has Been Reported About Cutaneous Lesions In Covid‐19 Pmentioning

confidence: 99%

“…Analysis of skin samples from patients with distinct COVID‐19 skin lesions may help establish the pathophysiology of cutaneous involvement, which appears to be less frequent than manifestations of the virus in other organs and tissues. A literature search in PubMed using the key terms “skin and COVID‐19” or “cutaneous and COVID‐19” identified descriptions of cutaneous manifestations in 89 articles, [ 3‐47] and almost 1150 patients registered with a variety of cutaneous lesions.…”

Section: Introductionmentioning

confidence: 99%

Potential interactions of SARS‐CoV‐2 with human cell receptors in the skin: Understanding the enigma for a lower frequency of skin lesions compared to other tissues

Criado

Pincelli

Criado

et al. 2020

Experimental Dermatology

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The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) represents a new public health problem, with a total of 10.577.263 documented COVID‐19 cases worldwide and 513.441 deaths up to the present date. Few cases of disease‐related cutaneous manifestations have been reported in the literature, and such manifestations are scarce. Integumentary manifestations from COVID‐19 include exanthemas and papular dermatoses, urticarial eruptions, atopic dermatitis, vesiculobullous lesions and skin signs of hypercoagulable states, such as acral ischaemia, livedo and retiform purpura. Most common extracutaneous manifestations from the disease include headache, cough, anosmia, ageusia, fever, dyspnoea, nausea, diarrhoea and cardiovascular events. The objectives of this review were to discuss the role of human cell receptors described as interaction targets of SARS‐CoV‐2, as well to understand the current state of knowledge on skin expression of these receptors, in order to substantiate future research. The authors present a thorough literature review on SARS‐CoV‐2 and its possible interaction with cell receptors and human tissues including the skin. They discuss a molecular hypothesis to explain the lower prevalence of dermatological manifestations from direct SARS‐CoV‐2 infection. Distinct human cell receptors binding the virus appear to be less expressed in the skin compared to other organs. Additionally, the presence of resolvins and the disintegrin metalloprotease ADAM17 provide a putative protection to the skin, explaining the majority of COVID‐19 manifestations to be extracutaneous. This review represents an excellent opportunity for future studies using skin biopsies from COVID‐19 patients to investigate molecular expression in the pathophysiology of cutaneous manifestations of the disease.

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Dermatologic findings in 2 patients with COVID-19

Cited by 33 publications

References 6 publications

Three cases of COVID‐19 patients presenting with erythema

Three cases of COVID‐19 patients presenting with erythema

The trend of cutaneous lesions during COVID‐19 pandemic: lessons from a meta‐analysis and systematic review

Potential interactions of SARS‐CoV‐2 with human cell receptors in the skin: Understanding the enigma for a lower frequency of skin lesions compared to other tissues

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