SARS‐CoV‐2, skin lesions and the need of a multidisciplinary approach

Kaur

et al. 2021

Advances in Wound Care

131

189

Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a pandemic. Although pulmonary health has been the primary focus of studies during the early days of COVID-19, development of a comprehensive understanding of this emergent disease requires knowledge of all possible disease manifestations in affected patients. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant review focuses on cutaneous manifestations reported in COVID-19 patients. Approach: Literature review was conducted using the PubMed database to examine various cutaneous manifestations related to the SARS-CoV-2 infection. Published articles (n = 56) related to search criteria from the onset of the COVID-19 pandemic to June 30, 2020, were included. The primary literature articles included in this study were mainly from France, Spain, Italy, and the United Kingdom. Results: Unique to many other symptoms of COVID-19, its cutaneous manifestations have been found in people of all age groups, including children. The cutaneous manifestations of COVID-19 are varied and include maculopapular, chilblain-like, urticarial, vesicular, livedoid, and petechial lesions. In addition, rashes are common in multisystem inflammatory syndrome in children, a new and serious health condition that shares symptoms with Kawasaki disease and is likely related to COVID-19. In addition, personal protective equipmentrelated skin wounds are of serious concern since broken cutaneous barriers can create an opening for potential COVID-19 infections. Innovation and Conclusion: As this virus continues to spread silently, mainly through asymptomatic carriers, an accurate and rapid identification of these cutaneous manifestations may be vital to early diagnosis and lead to possible better prognosis in COVID-19 patients. This systematic review and photo atlas provide a detailed analysis of the skin pathologies related to COVID-19. Study of these cutaneous manifestations and their pathogenesis, as well their significance in human health will help define COVID-19 in its entirety, which is a prerequisite to its effective management.

Section: Urticarial Lesionsmentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: A Systematic Review

Kaur

et al. 2021

Advances in Wound Care

131

189

“…It is important to note erythematous rashes are not extensively described in these reports and may represent a heterogeneous group phenomenon. In particular, three studies – from India, 36 Spain, 37 and Italy 38 – briefly describe erythematous rashes in one to three PCR confirmed patients, respectively, without much additional information aside from two biopsies which demonstrated: (i) intraepidermal vesicles with fibrin debris, some necrotic cells, and discrete ballooning keratinocytes in the margins; and (ii) a mixed interface pattern with dilated vessels filled with neutrophils, frequent blood extravasation, and scattered necrotic keratinocytes.…”

Section: Resultsmentioning

confidence: 99%

“…Within smaller cohorts, 14,15,19–21,36,37 there were between one and seven reported cases of urticaria. Larger studies of over 300 patients found several patients with urticaria as well.…”

Section: Resultsmentioning

confidence: 99%

“…The average age for pediatric patients with a dermatologic manifestation was 12.9 years of age (SD 3.6, or median 14 years with IQR [14, 14]) 11,12,16–18,32,33,52,53,65,66,72,86 and for adults was 34.2 years (SD 21.8, or median 56.8 years with IQR [26, 78]) 5,6,8–15,19,21–26,28–31,34–41,43,45–51,54–61,63,64,67–71,73–77,79–85,88,89 . There was a slight preponderance of females in the pediatric population (57.1%) 12,16–18,32,33,52,53,65,66,72,86 and adult population (52.3%) 5,6,8–15,19,21–26,28–31,34–41,43,45–51,54–61,63,64,67–71,73–77,79–82,84,85,88,89 . Average latency from COVID‐19 symptoms to cutaneous findings for pediatric patients was 1.5 days (SD 2.9, ranging from −3 to 7 days) and for adult patients was 7.9 days (SD 10.7, or median 7 days with IQR [3, 20]), with a range of −2 days (i.e.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Dermatologic manifestations of COVID‐19: a comprehensive systematic review

et al. 2020

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.

Indian Journal of Dermatology

“…It has been found that lesions with apparent vascular involvement (associated with alterations in coagulation) do not differ from other types of skin lesions, with respect to the analytical parameters. [ 23 ] Another group of authors feels skin manifestations are more likely due to endogenous viral reactivation. SARS-CoV-2 infection is often associated with a strong systemic inflammatory response and altered immunological reaction.…”

Section: Cutaneous Manifestations and Their Etiopathogenesismentioning

confidence: 99%

Virology and Etiopathogenesis of COVID-19 with Special Reference to Cutaneous Implications

Sarkar

Bhargava

Mendiratta

2021

Severe Acute Respiratory Virus Corona Virus 2 (SARS-CoV-2) has got its name Corona from Latin meaning “crown.” It has crown-like spikes present on the surface, which encloses the RNA, genetic material of this deadly virus. The virus attacks pneumocytes after binding with the angiotensin-converting enzyme 2 (ACE2) of the cell surface, which ultimately leads to chemotaxis followed by leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung leading to various symptoms. Skin provides a window to the internal changes of the body and also to mechanisms that are not readily visible. Commonly observed skin manifestations include vesicular lesions, maculopapular exanthema, urticarial eruptions, livedo or necrosis, and other forms of vasculitis, chilblain-like lesions. The skin lesions are attributed to either the virus directly affecting the skin or interferon dysregulation due to viral RNA or vascular involvement associated with alteration in coagulation or drug-induced skin manifestations. Observation of skin involvement and the vasculature due to SARS-CoV-2 illustrates the need for a precise stratification and differential diagnostic valuation so that the mechanisms of this novel virus are clearer for better management of the condition in the future. Vascular skin lesions are not seen in all the patients of COVID, but certain lesions should definitely alarm us to evaluate for coagulation abnormalities, complement levels, and skin biopsy, especially in critically ill patients. This review attempts to outline the pathogen briefly and the pathomechanism behind the development of various cutaneous manifestations.