Time of Onset of Selected Skin Lesions Associated with COVID-19: A Systematic Review

Abstract

Introduction Distinct skin lesions associated with coronavirus disease 2019 (COVID-19) have been described, but data regarding their time of onset during the COVID-19 course are scant. Our objective was to systematically review the studies reporting the time of onset of selected skin lesions with respect to the reported onset of the COVID-19 core symptoms. Methods A comprehensive search of studies published before 21 January 2021 was performed on MEDLINE via PubMed database using a predefined strategy to identify relevant articles. Results Out of 354 references, 87 were selected, reporting a total of 895 patients with skin lesions associated with COVID-19. The most frequent pattern was exanthema ( n = 430, 48%), followed by vascular ( n = 299, 33%), urticarial ( n = 105, 12%) and others ( n = 66, 7%). Skin lesions occurred more frequently in the first 4 weeks from the COVID-19 onset ( n = 831, 92%), whereas prodromal or late lesions were rarer ( n = 69, 8%). The urticarial and exanthema patterns were more frequent in the first 2 weeks. About the vascular pattern some differences were noted among its subtypes. Livedoid lesions occurred mainly in the first 2 weeks, while chilblain-like lesions between weeks 2 and 4. Purpuric/petechial lesions were equally distributed during the first 4 weeks. Several skin manifestations did not fall into the pattern classification, including erythema multiforme, generalized pruritus, Kawasaki disease and others. Conclusion The diversity in the time of onset of skin lesions as well as their polymorphic nature likely reflects the diversity of the pathogenetic underlying mechanisms . PROSPERO database registration number CRD42021236331. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00526-8.

Delayed skin reaction after mRNA-1273 vaccine against SARS-CoV-2: a rare clinical reaction

“…It is known that COVID-19 is associated with a wide clinical spectrum of skin lesions including urticarial, vesicular, vasculitic and chilblain‐like lesions. However, the risk factors and the time frame to develop a specific type of skin lesions during the COVID-19 infection are still unclear [ 7 , 15 , 22 ].…”

“…7 Local erythema and edema 3 days after the second dose of the mRNA-1273 vaccine Fig. 8 Erythema and edema at the injection site, 2 days after the second dose of the mRNA-1273 vaccine Hoff et al Eur J Med Res (2021) 26:98 [6]; [7] approved vaccinations [6,7,[9][10][11][12][13][14][15][16][17][18][19][20]. While the exact mechanism of these skin reactions is still unclear, a delayed hypersensitivity reaction has been hypothesized [11].…”

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“… 8 Studies also highlight the differences in the time of symptoms onset and their polymorphic nature. 9 Among COVID-19 patients with skin lesions, the majority of them experience the symptoms shortly after or concurrently with the onset of systemic symptoms. Only in 7% of them, topical skin rashes appear before systemic symptoms.…”

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