Cutaneous Manifestations in Patients With COVID-19: Clinical Characteristics and Possible Pathophysiologic Mechanisms

González, Felipe; Correa, Carolina Cortés; Contreras, E. Peñaranda

doi:10.1016/j.adengl.2021.01.024

Cited by 17 publications

(30 citation statements)

References 58 publications

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“… 16 , 17 , 18 However, there are several factors that could contribute to the genesis of these skin lesions like the immune response or the systemic consequences of the infection, rather than to direct damage of the virus to the skin. 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

No antibody response in cutaneous manifestations associated with COVID‐19: An observational study of 64 cases with microbiological and clinical characterization

García‐Gil

Serrano

Lapeña-Casado

et al. 2021

Dermatologic Therapy

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Background: The microbiological diagnosis of skin lesions related to COVID‐19 is not well known. Objective: Perform a microbiological diagnosis in COVID19‐related cutaneous manifestations. Methods: A cross‐sectional study was performed with 64 patients with cutaneous manifestations associated with COVID‐19 who underwent serological and nasopharyngeal reverse transcription polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2. Results: Out of the 64 patients, 6 patients had positive RT‐PCR, with all of them developing SARS‐CoV‐2 IgG and 4 of them had positive IgM + IgA. Of the 58 patients with negative RT‐PCR, 8 cases had positive IgM + IgA and only one of them had IgG seroconversion. Therefore, the infection was demonstrated in 7 cases (10.9%) and was doubtful in 7 other cases (10.9%) who presented negative RT‐PCR and presence of IgA + IgM without subsequent seroconversion of IgG. Fifty patients (78.1%) had negative serological tests. The most frequent cutaneous pattern was pseudo‐chilblain (48.4%) followed by maculo‐papular pattern (26.6%), urticarial lesions (10.9%), vesicular eruptions (6.3%) and livedoid pattern (4.7%). The maculo‐papular pattern showed the highest positivity in RT‐PCR (3 cases; 17.6%) and serologies (4 cases; 23.5%). Skin lesions developed after the systemic symptoms in most patients (19 cases; 61.3%). Conclusions: Microbiological confirmation tests may not be an effective diagnostic technique for COVID‐related cutaneous manifestations or that attributed lesions are not related to COVID‐19. Confounding factors such as adverse drug reaction, serological cross‐reactions with other viruses, the low production of antibodies in asymptomatic or mild forms of COVID‐19 or its rapid disappearance, increase diagnostic uncertainty.

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Section: Discussionmentioning

confidence: 99%

No antibody response in cutaneous manifestations associated with COVID‐19: An observational study of 64 cases with microbiological and clinical characterization

García‐Gil

Serrano

Lapeña-Casado

et al. 2021

Dermatologic Therapy

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“…Patients with diabetes mellitus and cardiovascular disease are more susceptible to severe COVID-19 infection. In the skin, acral cutaneous necrosis and livedo racemosa are signs of more significant coagulopathy in SARS-CoV-2 infected patients [ 21 ].…”

Section: Mechanistic Information Of Sars-cov-2mentioning

confidence: 99%

“…Chilblain-like lesions are one of the most common rashes seen in children with COVID-19 [ 8 ▪ , 21 , 23 ]. Chilblain-like lesions typically appear as round macules and papules with ill-defined borders.…”

Section: Chilblain-like Lesionsmentioning

confidence: 99%

Cutaneous coronavirus disease 2019 in children: a clinical primer for diagnosis and treatment

Dinulos

2021

Current Opinion in Pediatrics

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Purpose of review This review examines the global literature regarding rashes encountered in children and adults infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and aims to provide practicing pediatricians with an understanding of the relationship between instances of rashes and coronavirus disease 2019 (COVID-19) in children in order to effectively evaluate and treat patients. Recent findings The true incidence of cutaneous reactions in children infected with SARS-CoV-2 is not known. Children's immune systems differ from those of adults and rashes as a manifestation of immune responses, in turn, differ in morphology and distribution. Rarely, children develop a severe multisystem inflammatory syndrome that has overlapping clinical features with Kawasaki disease. In addition, vaccinations produce rashes similar to natural infections. The rashes associated with COVID-19 vaccination are mild and transient, and should not preclude vaccination. Lastly, children who chronically wear masks are more likely to experience flaring of acne around the nose and mouth (’maskne’) and facial conditions such as seborrheic dermatitis. Summary There are ongoing worldwide registries, clinical and basic science studies to better understand the burden of skin disease and pathophysiology of rashes seen in patients infected with COVID-19. Robust vaccination programs should be encouraged as a way to contain viral spread among children and the greater population.

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“…4 These lesions typically follow a benign course. 4,5 The mortality rate associated with patients with cutaneous presentations is reported as lower than 5%. 6 The pathogenesis of cutaneous lesions is still unclear at this time; however, some theories have been postulated.…”

mentioning

confidence: 99%

“…5 Additionally, COVID-19 is known to enter cells via the angiotensin-converting enzyme 2 (ACE-2) receptor, which is found in endothelial cells. 5 It is postulated that the virus can gain entry via this route and lead to cutaneous presentations in patients. 5 There are a few limitations to our study.…”

mentioning

confidence: 99%

Cutaneous manifestations of hospitalized COVID‐19 patients in the VIRUS COVID‐19 registry

et al. 2022

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Cutaneous manifestations of hospitalized COVID-19 patients in the VIRUS COVID-19 registry Dear Editor, In the United States alone, over 65 million cases of COVID-19 have been diagnosed till mid-January 2022, likely underestimating the prevalence as many individuals are asymptomatic and thus untested. 1 Given the global burden and death toll of this pandemic, understanding the presenting signs, disease course, predictors of severity and outcomes, and long-term consequences of COVID-19 is important.Current literature has documented a vast array of cutaneous manifestations of COVID-19 from maculopapular to vesicular morphology to chilblain-like lesions. 2 We aimed to assess the prevalence of skin findings, characterization of these presentations, clinical outcomes, and treatment regimens using a multinational database of COVID-19-positive hospitalized patients.We designed a retrospective observational descriptive study of dermatological symptoms from a large international VIRUS: COVID-19 registry conducted by the Society of Critical Care Medicine (SCCM) Discovery Network. VIRUS is a multinational database that collects and stores patient's data for those who are hospitalized with COVID-19. 3 The VIRUS Registry has enrolled hospitalized patients with laboratory confirmed COVID-19 patients. A laboratory confirmed case is defined as a positive result using a reverse-transcriptase-polymerase chain reaction (RT-PCR) assay.We created data elements based on smaller studies that were published for patients with dermatologic manifestations of COVID-19. We also utilized the expertise of a dermatologist (A.A.) to determine what data points would be valuable to add.The data elements for inclusion were selected to capture the types of skin manifestations that develop, patient demographics, dermatologic comorbidities, existing skin allergies, treatments, and their outcomes. These data elements were used to create an Excel document for collection. To collect dermatological symptoms for each patient, we sent an Excel survey to the sites that recorded patients with "rash" in the database. All sites that mentioned "rash" as a symptom were invited to fill out this Excel form. If sites had noted "urticaria," "hives," "itch," or "mottle" in the Research Electronic Data Capture (REDCap) system, they were also asked to fill out this Excel. The charts were reviewed

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Cutaneous Manifestations in Patients With COVID-19: Clinical Characteristics and Possible Pathophysiologic Mechanisms

Cited by 17 publications

References 58 publications

No antibody response in cutaneous manifestations associated with COVID‐19: An observational study of 64 cases with microbiological and clinical characterization

No antibody response in cutaneous manifestations associated with COVID‐19: An observational study of 64 cases with microbiological and clinical characterization

Cutaneous coronavirus disease 2019 in children: a clinical primer for diagnosis and treatment

Cutaneous manifestations of hospitalized COVID‐19 patients in the VIRUS COVID‐19 registry

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