The clinics of HHV ‐6 infection in COVID ‐19 pandemic: Pityriasis rosea and Kawasaki disease

Abstract

A new type of coronavirus family (SARS‐CoV‐2), which can be found in humans and animals, with many varieties and clinical symptoms, was first seen in Wuhan, China in late 2019, under the name novel Coronavirus Disease 2019 (COVID‐19). In the literature, cutaneous symptoms related to the disease are generally emphasized. However, it is not yet known whether this new SARS‐CoV‐2 virus, which has entered our lives, plays a role in the etiopathogenesis of dermatological diseases. The patients who were admitted to the dermatology outpatient clinic between 1 April and 15 May 2019, and on 1 April and 15 May 2020 were retrospectively analyzed by searching the hospital automation system and patient files. The reason for the same months to be included in the study was to exclude seasonal effects on the diseases. After pandemic, the number of patients with Pityriasis rosea and Kawasaki disease increased significantly in patients who applied to the dermatology outpatient clinic. Our study is the first study showing Pityriasis rosea increase during the pandemic period. We think that this increase is related to HHV‐6 reactivation. Herein, we wanted to draw attention to two diseases in which Human Herpes 6 (HHV‐6) was accused in etiopathogenesis: Kawasaki disease and Pityriasis rosea.

Kawasaki-like disease in children with COVID-19

“…We have reported four patients, along with the review of 320 pediatric patients from the systematic literature search (Table 1) [6,[12][13][14][15][16][17]. In addition to these articles presented in the table, six articles reported Kawasaki-like disease in children with COVID-19 [36,[48][49][50][51][52]. These articles were not included since there were no details about the reported patients.…”

Manifestações Cutâneas Associadas à COVID-19: Uma Revisão Narrativa

“…10 Pouco depois começaram a ser descritos múltiplos casos clínicos e séries de casos evidenciando lesões semelhantes [11][12][13] e outras francamente distintas, como lesões petequiais, tipo-perniose, vasculíticas, livedóides e tipo-eritema polimorfo. [14][15][16][17][18] Adicionalmente, a emergência de quadros de pitiríase rosea e doença de Kawasaki em doentes infetados sugeriu que o SARS-CoV-2 poderá ter também um papel na reativação de outros vírus, 19,20 ou na estimulação de mecanismos pro-inflamatórios que conduzem a estas patologias em doentes suscetíveis, como no caso da doença de Kawasaki em que há evidência de produção anómala de interferão do tipo I. 21 Suchonwanit et al dividiram as manifestações cutâneas da COVID-19 em dois grupos de acordo com prováveis mecanismos fisiopatológicos: exantemas virais, que representam uma resposta imune a moléculas virais; e lesões cutâneas, nomeadamente vasculite e vasculopatia trombótica, secundárias a consequências sistémicas causadas pelo vírus (Tabela 1).…”

The Dermatological Manifestations in the Coronavirus Infection COVID-19

“…Сыпь имеет тенденцию к слиянию и характеризуется отсутствием «материнской бляшки». Как правило, высыпания разрешаются без рубцов, образуя очаги гипопигментации с телеангиэктазиями или, в отдельных случаях, поверхностную рубцовую атрофию [20]. Авторы не исключают вклад реактивации вируса герпеса человека 6-типа [Human Herpes Virus 6 (HHV-6)], и акцентируют внимание к двум заболеваниям, в этиопатогенез которых вовлечён HHV-6: болезнь Кавасаки и розовый лишай.…”