Experience with Cutaneous Manifestations in COVID-19 Patients during the Pandemic

Abstract

After the beginning of the SARS-CoV-2 pandemic, our dermatology department created a multidisciplinary unit to manage patients with cutaneous manifestations associated with COVID-19. With the objective of identifying skin lesions in patients with suspected COVID-19 and evaluating possible associations with systemic involvement, other infectious agents and coagulation disorders, we carried out a prospective observational study that included all patients that attended our COVID-19 dermatology clinic with a multidisciplinary protocol. A total of 63 patients (mean 34.6 years) were enrolled between May 2020 and February 2021. Overall, 27 patients (42.9%) had a positive COVID-19 test, and 74.6% had COVID-19 clinical signs. The most common skin lesion was maculopapular rash (36.5%), predominantly seen in male (54.2%) and older patients (42 vs. 30 years), followed by chilblain-like lesions (20.6%) in younger patients (13.9 vs. 20.9 years) who were predominantly barefoot at home (69.2%); these patients exhibited a tendency towards a negative COVID-19 test. A total of 12 patients (19.1%) had positive serology for herpesvirus 6 (IgM or IgG). We conclude that the COVID-19-associated skin lesions we observed were similar to those previously described. Questions as to the underlying mechanisms remain. Interferon, possibly aided by cold exposure, may cause perniosis-like lesions. Other cutaneous manifestations were similar to those caused by other viruses, suggesting that SARS-CoV-2 may reactivate or facilitate other viral infections.

Clinical features and outcomes of COVID-19 patients with concomitant herpesvirus co-infection or reactivation: A systematic review

“…Though all of the studies in this review were observational study by nature with heterogenous data, 11 of them are retrospective study and the rest 8 of them are prospective studies [ [11] , [12] , [13] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ] . Heterogeneity was observed in terms of population, study design (both prospective and retrospective), exposure reporting, and outcome reporting.…”

“…A total of 539 participants were included in this study. Studies were conducted in all six WHO regions and the highest 10 studies were from WHO EUR region [ 11 , 25 , [27] , [28] , [29] , [30] , [31] , [32] , 34 , 36 , 38 ]. Though various ethnicities were included, in this review no association was found between ethnicities and Herpesviridae co-infection or reactivation.…”

“…Another one showed (CMV) co-infection after post renal transplantation [ 24 ]. Four studies showed both reactivation and co-infection of Human Herpes virus-6 respectively [ [25] , [26] , [27] , [28] ]. Five studies that investigated the reactivation of more than one Herpesviridae at a time (HSV, EBV, CMV, HHV-6) showed association with mortality [ 11 , 25 , 29 , 30 ].…”

“…[ 34 ] reported that significant use of steroids, such as methylprednisolone, can affect outcomes but was not statistically linked to patient mortality. In cases of HHV-6 reactivation or co-infection, both oral and topical steroids were administered, with no reported association between clinical outcomes and steroid use [ [26] , [27] , [28] ]. Four studies associated with single reactivation of EBV showed significant relation with blood lymphocyte count level of LDH, sodium, D-dimer level in blood along with length of stay in the ICU in case of critically ill patients [ 12 , 31 , 33 , 35 ].…”

“…organ transplantation) related to more susceptibility of COVID-19 infection there were included as high risk of selection bias for study participants (3 studies) [ 24 , 25 , 36 ]. As for performance bias, in studies if there was any ICU protocol for patients to go for tests of any viruses of Herpesviridae family but the test was not done for patient with COVID-19 in ICU were considered as high risk (8 studies) [ 12 , 23 , 28 , 31 , 33 , 35 , 37 ] and studies where COVID-19 patients, who were not in ICU but were tested positive for any of the Herpesviridae family were included as low risk of performance bias (11studies) [ 11 , 13 , [24] , [25] , [26] , 29 , 30 , 32 , 34 , 36 , 38 ].

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