Cutaneous Manifestations of COVID-19

Abstract

Patients with coronavirus disease 2019 (COVID-19) present with multisystem signs and symptoms, including dermatologic manifestations. The recent literature has revealed that dermatologic manifestations of COVID-19 often are early onset and provide helpful cues to a timely diagnosis. We compiled the relevant emerging literature regarding the dermatologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) so that physicians can be aware of the various clinical cutaneous presentations in this time of high incidence of COVID-19. Cutis. 2021;107:90-94. T he pathogenesis of coronavirus disease 2019 (COVID-19), the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is not yet completely understood. Thus far, it is known to affect multiple organ systems, including gastrointestinal, neurological, and cardiovascular, with typical clinical symptoms of COVID-19 including fever, cough, myalgia, headache, anosmia, and diarrhea. 1 This multiorgan attack may be secondary to an exaggerated inflammatory reaction with vasculopathy and possibly a hypercoagulable state. Skin manifestations also are prevalent in COVID-19, and they often result in polymorphous presentations. 2 This article aims to summarize cutaneous clinical signs of COVID-19 so that dermatologists can promptly identify and manage COVID-19 and prevent its spread. Methods A PubMed search of articles indexed for MEDLINE was conducted on June 30, 2020. The literature included observational studies, case reports, and literature reviews from January 1, 2020, to June 30, 2020. Search terms included COVID-19, SARS-CoV-2, and coronavirus used in combination with cutaneous, skin, and dermatology. All of the resulting articles were then reviewed for relevance to the cutaneous manifestations of COVID-19. Only confirmed cases of COVID-19 infection were included in this review; suspected unconfirmed cases were excluded. Further exclusion criteria included articles that discussed dermatology in the time of COVID-19 that did not explicitly address its cutaneous manifestations. The remaining literature was evaluated to provide dermatologists and patients with a concise resource for the cutaneous signs and symptoms of COVID-19. Data extracted from the literature included geographic region, number of patients with skin findings, status of COVID-19 infection and timeline, and cutaneous signs. If a cutaneous sign was not given a clear diagnosis in the literature, the senior authors Cutaneous Manifestations of COVID-19

Epidemiology, clinical profiles, and prognostic value of COVID‐19‐related cutaneous manifestations in African populations: a rapid narrative review

“…29,45 In contrast, acral erythema and chilblain-like lesions in older patients are thought to be caused by acral ischemia caused by insufficient type 1 IFNs. 45 The MIS-C associated with SARS-CoV-2 infection is caused by an overactive innate immune response, which causes similar pathologic abnormalities in affected internal organs and skin. 16 The association of MIS-C or MIS-A with COVID-19 cutaneous manifestations is well documented.…”

“…45 Hypercoagulation may cause small blood clots to lodge in blood vessels, causing acral cyanosis and gangrene. 29,45 In contrast, acral erythema and chilblain-like lesions in older patients are thought to be caused by acral ischemia caused by insufficient type 1 IFNs. 45 The MIS-C associated with SARS-CoV-2 infection is caused by an overactive innate immune response, which causes similar pathologic abnormalities in affected internal organs and skin.…”

“…SARS‐CoV‐2‐related chilblain/pernio‐like lesions (CBLL) can be explained by tissue damage caused by immune complex depositions in blood vessels, peripheral thrombotic microangiopathy caused by increased interferon type 1 (IFN‐1) signaling, and/or secondary ischemia due to vascular damage 16,43,44 . Acral ischemia could be a manifestation of COVID‐19 link to hypercoagulation 45 . Hypercoagulation may cause small blood clots to lodge in blood vessels, causing acral cyanosis and gangrene 29,45 .…”

Pathophysiologie von COVID-19 und deren mögliche Bedeutung für Long-COVID

“…Anreicherung von opportunistischen Organismen und Abnahme nützlicher Kommensalen [97] ⇒ Aktivierung von Immunzellen & Freisetzung von pro-inflammatorischen Zytokinen ⇒ Schaffung eines pro-inflammatorischen Umfelds ⇒ Aggravation der systemischen Entzündung [98] • Durchfall, Übelkeit, Erbrechen, Bauchschmerzen, gastro-ösophagealer Reflux, Mangelernährung/Anorexie, gastrointestinalen Blutungen, Appetitlosigkeit und Obstipation [99] Endokrinologie Endo- & exokrine Pankreas-Insuffizienz [100] Direkte Infektion von β-Inselzellen des Pankreas ⇒ Insulinspiegel ↓ & Insulinsekretion im Pankreas ↓ & Apoptose der β-Zellen (ähnlich wie bei Typ-1-Diabetes) [101] • Gestörte Glukose-Homöostase mit abnormer glykometabolischer Kontrolle und Insulinresistenz bis hin zu neu aufgetretenem Diabetes mellitus [102] destruktive Thyreoiditis (Wieder-)Auftreten von Autoimmunerkrankungen der Schilddrüse [103] • Subakute Schilddrüsenentzündung mit Hypothyreose bis zu Thyreotoxikose Muskuloskelettal • Myalgie • Demineralisierung der Knochen • Erkrankungen des rheumatologischen Formenkreises (z.B. Dermatomyositis) [104] • Generalisierte Muskelatrophie • Defizit Muskelkraft und -ausdauer Dermatologie • Alopezie [105] • Dermatomyositis/prolongierte post-virale Myositis [106] Hämatologie Freisetzung von prokoagulierenden und proinflammatorischen Zytokinen [107] ⇒ Aktivierung der Gerinnungskaskade ⇒ thrombotische Komplikationen (wie z.B. disseminierte intravaskuläre Gerinnung) thromboembolische Zustände ↑ (v.a.…”

Cutaneous Drug Eruption after COVID-19 Vaccination

“…Compared to the Pfizer vaccine, the Moderna vaccine demonstrated a higher incidence of cutaneous eruptions, many of which look similar to the cutaneous signs of COVID-19 infection [6]. Both the vaccines and viral infection can cause a wide array of dermatologic manifestations such as morbilliform exanthem, urticaria, exaggerated herpes zoster, pernios, and pityriasis-rosea like exanthems [6,7]. This overlap in dermatologic signs of vaccination reaction and COVID-19 infection presents a new challenge for dermatologists to distinguish the cause.…”