Oral ulceration and blistering in patients with COVID-19

Sinadinos, Angela; Shelswell, Jonathan

doi:10.1038/s41432-020-0100-z

Cited by 57 publications

(64 citation statements)

References 3 publications

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“…Pseudo-chilblain and urticarial lesions were the next most common presentations, each making up 19%, while vesicular lesions (9%) and livedo or necrosis (6%) making up the rest [ 61 ]. Cases of oral ulcers and blistering [ 62 ] and herpetiform lesions [ 63 ] were also reported. Dermatological manifestations were also reported in children.…”

Section: Narrative Reviewmentioning

confidence: 99%

“…For the projection of long-term outcomes based on SARS and MERS, no reports of dermatological outcomes in both diseases were found. As dermatological examinations are often not routinely conducted in patients with coronaviruses, the prevalence of adverse dermatological outcomes in COVID-19 patients may be under-reported [ 61 , 62 ]. Larger epidemiological studies are needed to assess the impact of COVID-19 on rare but severe dermatological outcomes.…”

Section: Narrative Reviewmentioning

confidence: 99%

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Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

Leung

Chan

et al. 2020

Emerging Microbes & Infections

183

132

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The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.

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Section: Narrative Reviewmentioning

confidence: 99%

Section: Narrative Reviewmentioning

confidence: 99%

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

Leung

Chan

et al. 2020

Emerging Microbes & Infections

183

132

View full text Add to dashboard Cite

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“…A flurry of studies have reported of oral ulcerations, and vesicular‐ and aphthous‐like lesions to be associated with COVID‐19 infection 5 . Most of these reports were individual case studies and case series; it is still unclear whether the reported cases were related to the COVID‐19 infection, unrelated occasional phenomenon, or indirectly related occurrence associated with stress, anxiety, and comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Increased odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis

Katz

Yue

2020

J Oral Pathology Medicine

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The ACE2 receptor, the binding sites for the COVID‐19, is expressed abundantly in the oral cavity, raising the question of whether the mouth is a target for the virus in addition to organs such as kidneys and lungs. Recently, a flurry of individual case reports on oral manifestation of COVID‐19 including ulceration, blistering lesions, and stomatitis were published. However, it is not clear whether the oral presentations that are not unique to the virus are indeed related to the virus and appear at a higher prevalence than in the general population. We used the i2b2 platform of hospital patient's registry to determine the odds ratio for COVID‐19 in patients that were diagnosed with recurrent aphthous stomatitis, an entity restricted to the oral cavity. The overall odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis before adjustments was 14 and after adjustment for gender, race, and age was 13.9, 6.5, and 2.93, respectively. The odds ratio remained increased after adjustments of the comorbidities such as respiratory disease, endocrine disease, obesity, diabetes, circulatory disease, and smoking and was 3.66, 7.46, 4.6, 10.54, 7.37, and 7.52, respectively. When adjusted for recurrent aphthous stomatitis, the respiratory disease had an odd ratio of 8.56 to be associated with COVID‐19. African American race and age‐group 18‐34 were additional significant risk factors. The present study has demonstrated a significant association between COVID‐19 and RAS; however, additional longitudinal and laboratory studies are necessary to establish a cause and effect relationship between these 2 conditions.

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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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Oral ulceration and blistering in patients with COVID-19

Abstract: Design Case series.

Cited by 57 publications

References 3 publications

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review

Increased odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis

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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