Exanthema and eosinophilia in COVID‐19 patients: has viral infection a role in drug induced exanthemas?

Rosell‐Díaz, Ángel Manuel; Mateos‐Mayo, Ana; Nieto‐Benito, Lula María; Balaguer-Franch, Inmaculada; Torre-Ruiz, Elisa Hernández de la; Lainez‐Nuez, A.; Suárez‐Fernández, R.; Bergón‐Sendín, Marta

doi:10.1111/jdv.16709

Cited by 25 publications

(34 citation statements)

References 5 publications

(18 reference statements)

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“…Maculopapular exanthem seems to be the most common cutaneous manifestation associated with COVID-19, occurring in 22-47% of cases [3,4,13]. Reports associated with SARS-CoV-2 infection have varied clinical descriptions such as development at disease onset or as a later manifestation with negative repeat SARS-CoV-2 RT-PCR, suggesting a potential drug-induced etiology [2,3,5,[14][15][16][50][51][52][53][54][55]. These exanthems may be pruritic or non-pruritic.…”

Section: Maculopapular Exanthemsmentioning

confidence: 99%

“…Reymundo and colleagues reported on 7 adult patients without recent medication use who primarily developed truncal exanthems later on in the course of SARS-CoV-2 infection [16]. Histologic findings are varied ( Ahouach et al [14] Superficial perivascular inflammation with eosinophils compatible with drug reaction Rosell-Díaz et al [15] Lichenoid pattern with eosinophils compatible with drug reaction Rosell-Díaz et al [15] Mild superficial perivascular lymphocytic infiltrate; spongiosis Reymundo et al [16] Erythema multiforme Skroza et al [30] Retiform purpura Pauci-inflammatory thrombogenic vasculopathy involving capillaries, venules, and/or arterioles or small arteries; dermal arterial thrombosis; deposits of complement C5b-9 (also with features of acral livedo racemosa)…”

Section: Maculopapular Exanthemsmentioning

confidence: 99%

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Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Mawhirt

Frankel

Diaz³

2020

Curr Allergy Asthma Rep

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Purpose of Review COVID-19 (coronavirus viral disease 2019), due to the novel SARS-CoV-2, may present with different types of cutaneous manifestations of varying pathophysiology. During the ongoing pandemic, publications reporting dermatologic findings in COVID-19 continue to emerge. Recent Findings Cutaneous vasculopathy and microthrombus-related changes including acral and sacral lesions, retiform purpura, livedo reticularis, and cutaneous vasculitis are notable findings in adult patients. Other exanthems include urticaria or angioedema, morbilliform/maculopapular exanthems, erythema multiforme, and vesicular eruptions. Increased recognition of these findings, especially those consistent with cutaneous microthrombi or vasculitis, is of particular importance. Additionally, occupational dermatologic disease related to extended personal protective equipment (PPE) use, such as skin damage and irritant or allergic contact dermatitis (ACD), represents another emerging problem amidst the pandemic. Summary In this review, we highlight the various cutaneous manifestations associated with COVID-19 in adult patients and occupational dermatitis in health care workers (HCWs) caring for this patient population. Keywords COVID-19. SARS-CoV-2. Cutaneous manifestations. Dermatologic. Rash. Contact dermatitis Abbreviations AAD American Academy of Dermatology ACD Allergic contact dermatitis ACE2 Angiotensin-converting enzyme 2 AD Atopic dermatitis AGEP Acute generalized exanthematous pustulosis ARDS Acute respiratory distress syndrome COVID-19 Coronarvirus viral disease 2019 CSSV Cutaneous small vessel vasculitis DIC Disseminated intravascular coagulation DiHS/DRESS Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms HCW Health care worker ICD Irritant contact dermatitis ITP Immune thrombocytopenic purpura PPE Personal protective equipment PT Patch test RT-PCR Reverse transcriptase polymerase chain reaction SARS-CoV-2 Severe acute respiratory distress syndrome coronavirus 2 SDRIFE Symmetrical drug-related intertriginous and flexural exanthema This article is part of the Topical Collection on Allergic Skin Diseases

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Section: Maculopapular Exanthemsmentioning

confidence: 99%

Section: Maculopapular Exanthemsmentioning

confidence: 99%

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Mawhirt

Frankel

Diaz³

2020

Curr Allergy Asthma Rep

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“…The characteristics of skin lesions in patients with COVID-19, as described recently in case reports or case series, are summarized in the Table 1 [ 2 , 3 , 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 ,…”

Section: Introductionmentioning

confidence: 99%

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

2020

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In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions—and in severe cases, microvascular injury and thrombosis—associated with COVID-19, and provide important clues to their pathological mechanisms.

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“…Six patients were treated with corticosteroids and rest with topical steroids. All improved with treatment 44 …”

Section: Resultsmentioning

confidence: 95%

Dermatologic manifestations of COVID‐19: a comprehensive systematic review

et al. 2020

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Recent reports have suggested that there may be dermatologic manifestations of COVID‐19. We searched 12 databases for peer‐reviewed or pre‐print published studies until July 15, 2020, for this PRISMA‐compliant review (CRD42020182050). We used the Oxford Center for Evidence‐Based Medicine Levels of Evidence to facilitate data synthesis. From 86 retrieved studies, we collated data on 2,560 patients with dermatologic manifestations of COVID‐19. The most common findings were chilblains/pernio‐like lesion (51.5%), erythematous maculopapular rashes (13.3%), and viral exanthem (7.7%). Average pediatric age was 12.9 years (SD 3.6) and adult was 34.2 years (SD 21.8). Average latency from time of upper respiratory illness symptoms to cutaneous findings was 1.5 days (SD 2.9) in children and 7.9 days (SD 10.7) in adults, ranging from −3 to 38 days. Roughly one‐tenth in both populations were otherwise asymptomatic or presented with only skin findings for the entirety of the disease course; 13.3% (pediatrics) and 5.3% (adults) presented with skin issues first. Dermatologic findings may play an important role in identifying cases early and serve as an important proxy to manage spread. Further prospective data collection with international prospective registries is needed.

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Exanthema and eosinophilia in COVID‐19 patients: has viral infection a role in drug induced exanthemas?

Abstract: Letter to the Editor e561 Table 1 Characteristics of 12 patients with atypical exanthemas and eosinophilia Case

Cited by 25 publications

References 5 publications

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

Dermatologic manifestations of COVID‐19: a comprehensive systematic review

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