Review of adverse cutaneous reactions of pharmacologic interventions for COVID-19: A guide for the dermatologist

Abstract

The new coronavirus SARS-CoV-2 is associated with a wide variety of cutaneous manifestations. While new skin manifestations caused by COVID-19 are continuously being described, other cutaneous entities should also be considered in the differential diagnosis, including adverse cutaneous reactions to drugs used in the treatment of COVID-19 infections. The aim of this review is to provide dermatologists with an overview of the cutaneous side effects associated with the most frequently prescribed drugs in patients with COVID-19. The skin reactions of antimalarials (chloroquine and hydroxychloroquine), antivirals (lopinavir/ritonavir, ribavirin +/- interferon, oseltamivir, remdesivir, favipiravir and darunavir) and treatments for complications (imatinib, tocilizumab, anakinra, immunoglobulins, corticosteroids, colchicine and low molecular weight heparins) are analyzed. Information regarding possible skin reactions, their frequency, management and key points for differential diagnosis are presented.

Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns

“…, 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 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83. , 84 , 85 , …”

“…70 , 71 , 72 Bacterial infections have been suspected to co-associate with COVID-19, especially Mycoplasma pneumoniae, which may trigger erythema multiforme. 84 The main differential diagnosis involves adverse drug reactions 85 , 86 whose histopathology includes a wide range of microscopic patterns, 87 from spongiotic or perivascular mixed infiltrate to interface dermatitis or vasculitis. Temporal correlation with drug administration, as well as the spectrum of reactions associated with a specific drug, 86 together with main histologic features may help distinguish COVID-19 lesions from drug-related ones.…”

A data-driven pipeline to extract potential side effects through co-prescription analysis: application to a cohort study of 2,010 patients taking hydroxychloroquine with an 11-year follow-up

“…It is impossible to know for which indication valsartan was prescribed, but because the signal is weak (borderline significant) and was not reproduced with the SCCO method, it may be a false positive signal due to multiple testing. This pipeline did not detect any drugs that could reflect an adverse dermatological effect, even though it has been described in the literature (40).…”

Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries

“…However, the policies and guidelines for COVID-19 treatment differ between countries, and some researchers have decided against administering treatment for asymptomatic patients and for those with mild symptoms, based on the premise that symptoms can disappear spontaneously after several days [ 24 , 25 ]. Patients with moderate to severe symptoms may receive multiple treatments, including systemic antibiotics/antivirals or interferons which are indicated in the appearance of generalized skin eruptions, and care should be taken when using these drugs as they further increase the complexity of the disease [ 26 , 27 ].…”