Cutaneous manifestations of COVID-19: report of three cases

Chaabane, I.; Loukil, M.; Amri, R.; Badri, I.; Baha, Hajer; Lajmi, M.; Bouzaïdi, Khaled; Ghrairi, H.

doi:10.1007/s00403-020-02112-y

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…On October 7, 2020 searching on PubMed "COVID-19 OR COVID-2019 OR severe acute respiratory syndrome coronavirus 2 OR severe acute respiratory syndrome coronavirus 2 OR 2019-nCoV OR SARS-CoV-2 OR 2019nCoV OR (Wuhan AND coronavirus) AND (skin OR cutaneous manifestation) we found 771 reports. Skin manifestations due to SARS-CoV-2 infection are of different types and currently reported in numerous case reports, case series, and literature reviews (259)(260)(261)(262)(263)(264). The first case study on skin manifestations was published by Recalcati et al and included 88 patients that showed widespread urticaria, erythematous rush and chickenpox-like vesicles (265).…”

Section: Skinmentioning

confidence: 99%

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

et al. 2020

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The explosion of the new coronavirus (SARS-CoV-2) pandemic has brought the role of the angiotensin converting enzyme 2 (ACE2) back into the scientific limelight. Since SARS-CoV-2 must bind the ACE2 for entering the host cells in humans, its expression and body localization are critical to track the potential target organ of this infection and to outline disease progression and clinical outcomes. Here, we mapped the physiological body distribution, expression, and activities of ACE2 and discussed its potential correlations and mutal interactions with the disparate symptoms present in SARS-CoV-2 patients at the level of different organs. We highlighted that despite during SARS-CoV-2 infection ACE2-expressing organs may become direct targets, leading to severe pathological manifestations, and subsequent multiple organ failures, the exact mechanism and the potential interactions through which ACE2 acts in these organs is still heavily debated. Further scientific efforts, also considering a personalized approach aimed to consider specific patient differences in the mutual interactions ACE2-SARS-CoV-2 and the long-term health effects associated with COVID-19 are currently mandatory.

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Section: Skinmentioning

confidence: 99%

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

et al. 2020

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“…Twenty-two cases of erythema multiforme-like pattern have been described, of which three were generalized pustular figurate erythema and one Stevens-Johnson syndrome [8,20,24,37,46,63,75,84,86,[107][108][109][110][111][112]. Sixteen of the patients described had a previous history of drug intake: Hydroxychloroquine, lopinavir/ritonavir, teicoplanin, azithromycin, acetaminophen, cefcapene, and loxoprofen, preceding the rash onset with 3 to 28 days [8,37,46,63,84,86].…”

Section: Erythema Multiforme/generalized Pustular Figurate Erythema/s...mentioning

confidence: 99%

Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review

Conforti

Dianzani

Agozzino

et al. 2020

Biology

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There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.

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“…1,2,[15][16][17][18][19][20][21][22][23][24][25] It has also been described as other vascular sub-patterns like non-necrotic purpura, livedo reticularis, petechial rashes, porcelain-like macules and dry gangrene. 17,[26][27][28][29][30][31] Compared to maculo-papular eruptions, chilblain-like rashes appeared later in the course of COVID-19 and lasted longer (mean 12.7 days in duration vs 8.6 days in maculo-papular eruptions). 1 Chilblain also affected younger people compared to the group of livedo racemosa/retiform purpura/acral ischemia.…”

Section: Lesions Of Vascular Originmentioning

confidence: 99%

“…56,57 Besides AGEP, multiple erythema multiforme-like patterns and one case of Stevens-Johnson syndrome have been reported. 17,28 In the study by Rubio-Muniz et al, 5 of 34 patients were individuated as having targetoid lesions with histopathologic features of erythema multiforme. These lesions were all observed after initiation of drug therapies.…”

Section: Acute Generalized Exanthematous Pustulosis (Agep) Erythema Multiforme (Em) and Other Polymorphic/atypical Reactionsmentioning

confidence: 99%

Synthesis of the Data on COVID-19 Skin Manifestations: Underlying Mechanisms and Potential Outcomes

Farinazzo¹,

Dianzani²,

Zalaudek³

et al. 2021

CCID

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The incidence of coronavirus disease 2019 (COVID-19)-related skin manifestations has progressively grown, in parallel with the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. The available evidence indicates that cutaneous signs are heterogeneous and can be divided as follows: a) erythematous rashes, b) lesions of vascular origin, c) vesicular rashes, d) urticarial rashes, and e) acute generalized exanthematous pustulosis (AGEP), erythema multiforme (EM) and other polymorphic/atypical reactions. Most cutaneous manifestations appear simultaneously or after respiratory and/or systemic symptoms such as fever, even if rarely urticaria has been reported as the first sign of the disease. It has been proposed that erythematous and vesicular rashes, as well as urticaria, are the result of immunological activation against Sars-CoV-2, similarly to other viral exanthems; alternatively, reactivation or co-infection of herpesviruses and drug hypersensitivity represent possible etiologic diagnosis that has to be considered. Regarding lesions of vascular origin, ischemic ones are the result of systemic hypercoagulability established in severe infections, whereas chilblains seem to be linked to the type I-interferon massively produced to halt virus replication. AGEP is triggered by drugs, whereas EM could represent a delayed immune response to the virus or a hypersensitivity reaction to drugs elicited by the inflammatory process built to fight the infection. A further pathogenic hypothesis is that the virus, or its particles detected in the skin (particularly in endothelium and eccrine glands), could be responsible for certain skin reactions, including chilblains and EM. From the available data, it appears that chilblains are correlated with younger age and less severe disease, while ischemic manifestations occur in the elderly with severe infection. In conclusion, larger studies are needed to confirm the suggested pathogenetic mechanisms of COVID-19-related skin reactions and to determine the potential prognostic significance of each one.

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Cutaneous manifestations of COVID-19: report of three cases

Cited by 9 publications

References 19 publications

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review

Synthesis of the Data on COVID-19 Skin Manifestations: Underlying Mechanisms and Potential Outcomes

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