Dermatology and COVID-19

Abstract

Even early in the coronavirus disease 2019 (COVID-19) pandemic, it was clear that dermatologists had an important role in the management of patients. Although initial case series rarely documented skin changes, possibly due to the inability to perform a complete skin examination, subsequent research has suggested significantly higher rates of skin involvement. 1 The true prevalence of skin findings, the uncertainty of whether these represented direct infection or were associated with systemic illness (eg, reactive or due to medications), and how best to manage them were among the many questions challenging the evolving understanding of these cutaneous manifestations. This has been an important opportunity for dermatologists to learn and contribute. 2 What are the current priorities in dermatology research and clinical care as the COVID-19 pandemic progresses? Skin FindingsA broad spectrum of skin manifestations has been reported in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, spanning almost every inflammatory pattern. The variability of skin findings seen is substantial compared with other viral infections that typically present with characteristic skin patterns. The seemingly high (estimated as high as 20% in one study) prevalence in adults, who rarely present with viral exanthems, is also notable. Understanding the true prevalence of skin findings is complicated by the lack of testing, as well as likely reporting bias in publication. SARS-CoV-2 infection disproportionately affects people

Post–COVID-19 Syndrome: Theoretical Basis, Identification, and Management

“…17 In addition, a wide variety of skin manifestations, substantially more than seen with other viral infections, have been reported. 18 These symptoms are similar to those seen in patients affected by previous outbreaks of viral disease. A systematic review of data collected from patients hospitalized with SARS and Middle Eastern respiratory syndrome revealed long-term complications including depressed mood (10.5% of patients), insomnia (12.1%), anxiety (12.3%), irritability (12.8%), memory impairment (18.9%), and fatigue (19.3%).…”

“…For instance, livedoid changes are associated with occlusion of cutaneous vessels that may portend systemic thrombosis. 18 Neuropsychiatric manifestations of COVID-19 are abundant, with evidence of impact on both the central nervous system (CNS) and the peripheral nervous system. 4 The virus is known to be neurotropic, meaning that it replicates in neurons.…”

Pasos adelante y hacia atrás en la pandemia COVID-19

“…Se conoce ahora su morfología, genoma y su asidero selectivo al receptor de la enzima convertidora de angiotensina 2 (ACE2), abundante en el endotelio de arterias y venas, pero también en el epitelio del tracto respiratorio (1) . Al ingresar al cuerpo humano y multiplicarse, ocasiona un síndrome de insuficiencia respiratoria aguda, seguido por shock cardiogénico, eventos tromboembólicos, afectación de bronquios, pulmones, sistema nervioso (2) , riñones (3) , sistema gastrointestinal (4) , la mente (5) , piel (6) , entre otros. El niño parece infectarse poco, frecuentemente de manera asintomática, pero su carga viral puede contagiar a los adultos (7) .…”

Cutaneous Manifestations of COVID-19: Characteristics, Pathogenesis, and the Role of Dermatology in the Pandemic

“…Of note, a multisystem inflammatory disease seen in US children subsequent to infection with COVID-19 has been associated with rash in as many as 74% of cases. 11 Although COVID-19 disproportionately impacts people with skin of color, there are few reports of cutaneous manifestations in that population, 12 highlighting the challenges of the dermatologic examination in individuals with darker skin and suggesting the prevalence of dermatologic disease in COVID-19 may be greater than reported.…”