COVID‐19 and cutaneous manifestations: A review of the published literature

Abstract

Background COVID‐19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID‐19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020. Aim Skin manifestations related to SARS‐CoV‐2 infection can be divided mainly into five groups: chilblainlike lesions (CBLLs), maculopapular eruptions, urticarial eruptions, vesicular eruptions, and livedo or necrosis. Other skin findings reported are erythema multiforme (EM)‐like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS‐C) and rarely with multisystem inflammatory syndrome in adults (MIS‐A). Other manifestations such as pityriasis rosea or shingles are also reported. Methods A total of 60 articles including reviews, studies and case reports were selected for the evaluation in this review. Results The skin manifestations associated with COVID‐19 infection are numerous and can vary widely. The major dermatological patterns of COVID‐19 can be classified as inflammatory reactions (maculopapular/morbilliform, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo acemose‐like pattern) Conclusion We believe that the dermatologist could play an important role in the response to the SARS‐CoV‐2 pandemic through early recognition of skin lesions suggestive of COVID‐19, particularly in paucisymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis.

How to differentiate skin rash in covid, mononucleosis, chickenpox, sixth disease and measles

“…Considering only instances for which a correlation with medications was ruled out, a recent study on 38 patients showed that maculopapular rash occurred most commonly after the onset of COVID-19 symptoms (76%) [7 && ], consistently with data from other analyses not excluding possibly drug-related cases [1][2][3][4]. Symptoms were present in most of instances (77%), with a prevalence of pruritus and pain/burning of 61 and 16%, respectively [7…”

“…showing the same stage of development), apart from diffuse subtypes in which papules, and pustules may be observed apart from vesicles [2,4]. Pruritus is frequently reported (generally more than 50% of cases), while pain and burning sensation have been described less commonly [1–5,6 ▪ ,7 ▪▪ ,8 ▪ ,9,10].…”

“…Histology varies according to the lesion ‘age’: ‘early lesions’ feature basal layer vacuolar degeneration, multinucleated and hyperchromatic keratinocytes with dyskeratotic apoptotic cells, and minimal to absent inflammatory infiltrate, while ‘late lesions’ show intraepidermal unilocular vesicles containing multinucleated and ballooned keratinocytes with acantholytic and dyskeratotic cells along with epidermal reticular degeneration [11]. Although diffuse vesicular eruptions, with lesions developing simultaneously on the trunk and spreading distally with possible involvement of the palms and soles have been reported, localized forms with scattered lesions are the most frequent presentations [1,4,12]. Trunk is the most common affected area in these subtypes, yet extremities involvement is not uncommon [3].…”

“…The term maculopapular (morbilliform) rash describes the onset of erythematous macules and papules with the tendency to coalesce and leave circumscribed areas of spared skin [1][2][3][4]. It is among the most frequent cutaneous manifestations seen during SARS-CoV-2 infection, being observed in up to 70% of cases with skin involvement, especially middle-aged individuals with no sex prevalence [1,5].…”

“…Although precise pathomechanisms of skin manifestations occurring during COVID-19 are still not completely clear, it has been speculated that they might be related to the binding of SARS-CoV-2 to angiotensin-converting enzyme-2 (ACE2) receptors of the skin (cutaneous blood vessels, eccrine gland epithelial cells and hair follicles), a cytokine storm released by the immune system as a response to the virus, or reactivation of latent HSV, VZV or HHV-6 [1][2][3]. Of note, COVID-19-induced skin changes usually arise simultaneously or subsequently to respiratory illness, yet they may also occur previously or be the main presentation of paucisymptomatic or asymptomatic patients [1][2][3]. This underlines the importance of recognizing dermatological manifestations due to SARS-CoV-2 to timely diagnose the infection and take proper action.…”