Comment on ‘Two cases of COVID‐19 presenting with a clinical picture resembling chilblains: first report from the Middle East’: pernio unrelated to COVID‐19

Torres‐Navarro, Ignacio; Abril‐Pérez, Carlos; Roca-Ginés, Juncal; Sánchez-Arráez, Javier; Botella‐Estrada, Rafael; Évole‐Buselli, Montserrat

doi:10.1111/ced.14255

Cited by 11 publications

(27 citation statements)

References 6 publications

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“…According to Galvan Casas et al, acral lesions were significantly associated with younger aged patients and with a milder disease course. Patients with acral lesions typically required fewer [3,16,33,35,36] c Other rashes included: eruptive cherry angioma (n = 1), reactivation of herpes simplex virus-1 (n = 1), and unspecified cases of eczematous, angiomatous, or annular lesions (n = 41) treatments than those with vascular rashes, erythematous maculopapular rashes, urticarial rashes, and vesicular rashes [13]. Of note, these acral lesions were largely unrelated to cold exposure (secondary to social isolation and stay-athome orders) or a prior history of Raynaud's disease [9,20,[32][33][34]36].…”

Section: Discussionmentioning

confidence: 99%

“…A total of 996 patients with dermatologic symptoms were included in the analysis, of which 54.3% were female and the mean age was 37.3 years (range 1.0-98.0 years). [9,18,20,[33][34][35][36]. These non-laboratory confirmed patients all presented during the COVID-19 outbreak and, for those with a negative COVID-19 PCR result, antibody testing was not available to establish the possibility of prior infection.…”

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

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Cutaneous Manifestations of COVID-19: An Evidence-Based Review

2020

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Background The coronavirus disease 2019 (COVID-19) pandemic has affected 18 million people and killed over 690,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported. Objective The aim of this review was to collate and categorize the dermatologic findings reported in patients with COVID-19 and identify specific lesions that may facilitate diagnosis and prognostication. Methods An evidence-based review of the PubMed database was conducted on 14 May, 2020 using the search terms "Covid-19 skin," "Covid-19 rash," "Covid-19 exanthem," and "Covid-19 chilblains." Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis. Results The literature search identified 115 records, of which 34 publications describing 996 patients with dermatologic conditions were included. Case reports (n = 15), case series (n = 13), and observational prospective studies (n = 4) were the most common publication types. Acral lesions resembling pseudo-chilblains were the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes affected 21.3% of patients, most frequently impacting middle-aged adults (mean age, 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes affected 13.0% of patients, appearing in middle-aged adults (mean age, 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes affected 10.9% of patients, appearing in adults (mean age, 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo or purpura were uncommon (4% of cases), appearing in elderly patients (mean age, 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions, although infrequent (3.7% of cases), affected mostly children (mean age, 12.2 years). Conclusions Vesicular rashes may suggest an initial diagnosis of COVID-19, acral lesions may be most appropriate for epidemiological uses, and vascular rashes may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all healthcare professionals be well versed in these increasingly common cutaneous manifestations of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: An Evidence-Based Review

2020

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“…for COVID-19). 9,18,20,[33][34][35][36] These non-laboratory con rmed patients all presented during the COVID-19 outbreak and, for those with a negative COVID-19 PCR result, antibody testing was not available to establish the possibility of prior infection. Case fatality rates ranged from 0.0% to 13.6%.…”

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

“…4,12,23,3,10 ** Studies by De Masson, Fernandez-Nieto, Piccolo, Recalcati and Torres-Navarro excluded because of inability to extract exact data. 3,16,33,35,36 ** Other rashes included: eruptive cherry angioma (n = 1), reactivation of HSV-1 (n = 1), and unspecified cases of eczematous, angiomatous or annular lesions (n = 41). .…”

Section: Study Characteristics and Patient Demographicsmentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: A Systematic Review

Daneshgaran

Dubin

Gould

2020

Preprint

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Background: The COVID-19 pandemic has affected 4.5 million people and killed over 300,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported.Objective: The aim of this review was to collate and categorize the dermatologic findings reported in COVID-19 patients and identify specific lesions that may facilitate diagnosis and prognostication.Methods: A systematic review of the PubMed database was conducted on May 14th, 2020 using the search terms “Covid-19 skin,” “Covid-19 rash,” “Covid-19 exanthem,” and “Covid-19 chilblains.” Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.Results: The literature search identified 115 records, of which 34 publications describing 996 dermatologic patients were included. Case reports (n=15), case series (n=10) and observational studies (n=7) were the most common publication types. Pseudo-chilblains (PC) was the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, MA, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes (EMR) affected 21.3% of patients, most frequently impacting middle-aged adults (MA 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes (VR) affected 13.0% of patients, appearing in middle-aged adults (MA 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes (UR) affected 10.9% of patients, appearing in adults (MA 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo/purpura/necrosis (LPN) were uncommon (4% of cases), appearing in elderly patients (MA 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions (EME), although infrequent (3.7% of cases), affected mostly children (MA 12.2 years).Conclusions: VR may suggest an initial diagnosis of COVID-19, PC may be most appropriate for epidemiological uses, and LPN may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all health care professionals be well-versed in these increasingly common cutaneous manifestations of COVID-19.

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“…However, other symptoms have been reported, including gastrointestinal and neurological manifestations. Cutaneous lesions were not recognized at the early stages of the pandemic, but have received much recent attention in scientific journals [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%