COVID-19 Skin Manifestations in Skin of Colour

Abstract

Coronavirus disease (COVID-19) skin manifestations have been increasingly reported in medical literature. Recent discussions have identified a lack of images of skin of color (SOC) patients with COVID-19 related skin findings despite people with skin of color being disproportionately affected with the disease. There have been calls to prioritize the identification of COVID-19 skin manifestations in patients with SOC and disseminate these findings. The objective of this article is to review the existing literature on COVID-19 skin manifestations and, where possible, discuss how they may present differently in patients with SOC. Further research is needed to allow primary care physicians and dermatologists to be aware of and easily identify patients with cutaneous findings that may be secondary to COVID-19. Patients presenting with idiopathic dermatologic manifestations should be considered for COVID-19 testing and follow public health guidelines for self-isolation.

Update in cutaneous manifestations of COVID-19: Special populations

“…39 Notably, these disparities increased when rates of hospitalization and death were considered. 39 Despite this, there has been a Kawasaki-like clinical presentation in pediatric patients 22 Majority developed fever prior or concurrently with mucocutaneous fi ndings 22 Cutaneous fi ndings not correlated with more severe clinical course 22 Patients tend to be older and have more gastrointestinal symptoms than in Kawasaki disease 22 Non-White patients [17][18][19][20][21]23,24 Small reports of decreased rates of specifi c COVID-19 skin fi ndings 23,24 Scalp involvement and telogen effl uvium may be more common [17][18][19][20] Hyperpigmentation may provide insight into previous infl ammatory process 21 No defi nitive data comparing outcomes based on cutaneous fi ndings…”

“…Palpation can be identify cutaneous eruptions when erythema is subtle 21 Messenger RNA COVID-19 vaccines 9,12,[25][26][27][28] Acute and delayed local reactions most commonly seen, followed by urticarial and morbilliform eruptions 9 Median time to onset after fi rst dose was 7 days, occurring in 2 clusters between day 1-3 and day 7-8 9 Shorter median time from second dose, occurring at day 19…”

“…[1][2][3][4][5][6][7][8] The development and dissemination of COVID-19 vaccines has also generated notable cutaneous fi ndings, [9][10][11][12][13][14][15][16] and studies have noted skin phenotype as a factor in cutaneous COVID-19 manifestations. [17][18][19][20][21] Recognition of these reactions and their implications is benefi cial to clinicians in shaping patient counseling and anticipatory guidance (Table 1). 9,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] ■ PEDIATRIC OVERVIEW…”

“…[17][18][19][20][21] Recognition of these reactions and their implications is benefi cial to clinicians in shaping patient counseling and anticipatory guidance (Table 1). 9,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] ■ PEDIATRIC OVERVIEW…”

Viruses, Variants, and Vaccines: How COVID-19 Has Changed the Way We Look at Skin

“…Much of the literature and imaging available today surrounding COVID-19 and cutaneous manifestation is on lighter skin, with little representation of skin of color [ 70 , 71 ]. This is despite the fact that individuals with skin of color are disproportionately affected by COVID-19 [ 72 , 73 ]. Early in the pandemic, Lester et al reported that of publications on COVID-19 and dermatology, 91% of images involved white patients and 9% were Hispanic, with no representation of cutaneous manifestations in dark skin [ 74 ].…”