Immunological aspects of COVID ‐19‐related skin manifestations: Revisiting pathogenic mechanism in the light of new evidence

Abstract

The newly emerged coronavirus disease 2019 , induced by a novel strain of the coronavirus family, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading global threat. This virus affects a fair number of tissues in the human body by availing itself of potential target receptors like Angiotensin-Converting Enzyme 2 (ACE2). Presenting with diverse clinical manifestations, COVID-19 has raised the urge for extensive research in different medical fields, including dermatology. Developing a comprehensive knowledge of cutaneous manifestations is highly important as it can help us in early diagnosis and better management of the ongoing pandemic. The dermatological presentations of COVID-19 are classified into main categories of vascular and non-vascular (exanthematous) patterns.Though not yet fully confirmed, the pathogenesis of these cutaneous presentations has been suggested to be more related to the overactivation of the immune system. In this review, we discuss in detail the clinical features of the diverse skin lesions in COVID-19 patients and the imperative role of the immune system in their pathogenesis and development. Furthermore, we will discuss the reasons behind the accentuation of skin lesions in COVID-19 compared to the same virus family predecessors.

Epidemiology, clinical profiles, and prognostic value of COVID‐19‐related cutaneous manifestations in African populations: a rapid narrative review

“…They can, however, occur as a result of a drug-induced and virus-induced immune stimulation interaction. 40,41 The emergence of morbilliform eruptions in viral infections other than COVID-19 is attributed to the activity of CD4 + and CD8 + T cells and cytokines against virally infected keratinocytes, endothelial cells, and fibroblasts. The main mechanism in drug-induced maculopapular rashes is the type IV hypersensitivity reaction, which involves T cells.…”

“…The main mechanism in drug-induced maculopapular rashes is the type IV hypersensitivity reaction, which involves T cells. 41 Varicella-like lesions develop because of a direct viral effect on keratinocytes. The SARS-CoV-2 spike protein receptor, ACE2, has been found to be expressed in basal keratinocytes.…”

“…Maculopapular exanthems are also commonly caused by drug hypersensitivity and T‐cell‐mediated delayed hypersensitivity. They can, however, occur as a result of a drug‐induced and virus‐induced immune stimulation interaction 40,41 . The emergence of morbilliform eruptions in viral infections other than COVID‐19 is attributed to the activity of CD4 + and CD8 + T cells and cytokines against virally infected keratinocytes, endothelial cells, and fibroblasts.…”

“…The emergence of morbilliform eruptions in viral infections other than COVID‐19 is attributed to the activity of CD4 + and CD8 + T cells and cytokines against virally infected keratinocytes, endothelial cells, and fibroblasts. The main mechanism in drug‐induced maculopapular rashes is the type IV hypersensitivity reaction, which involves T cells 41 . Varicella‐like lesions develop because of a direct viral effect on keratinocytes.…”

COVID-19 in the Asia Pacific: impact on climate change, allergic diseases and One Health

“…SARS-CoV-2 is an unusual virus with infectious and parainfectious manifestations including immune-mediated lung and internal organ injury [ 10 ], dermatoses [ 11 ], myopericarditis [ 12 ], and prothrombotic events [ 13 ]. Multisystem inflammatory syndrome in childhood (MIS-C) [ 14 ], MIS in neonates born to mothers with SARS-CoV-2 infection [ 15 ], and MIS in adults [ 16 ] have been defined and described in various systematic reviews: comprising Kawasaki disease-like manifestations including fever, rash, cardiovascular, and gastrointestinal involvement.…”