Mucocutaneous lesions associated with SARS‑CoV‑2 infection (Review)

Abstract

The ongoing COVID-19 pandemic, declared by the World Health Organisation in March 2020, with the emergence of new, possibly more contagious and more virulent strains, remains a research subject, with the complex systemic involvement better described and understood, but also with a variety of skin and mucosal lesions described in the literature. Mucocutaneous lesions associated with SARS-CoV-2 infection are still under investigation, due to their polymorphic clinical aspect and incompletely understood pathogenic mechanism. The cutaneous inflammatory, exanthematous and purpuric rashes, erythemato-purpuric enanthems, oral ulcers, lichenoid oral lesions, conjunctivitis, conjunctival pseudomembranes, or corneal lesions have been described in patients with COVID-19. Several classifications have been proposed based on the clinical pattern, histological findings, and possible pathogenic mechanisms. The pathogenic mechanism, the diagnostic criteria, the prognostic importance of these lesions are still being debated. The diverse clinical aspects of dermatological manifestations render the diagnosis difficult. However, several clinical patterns strongly associated with COVID-19, such as chilblains, papulovesicular exanthems, and febrile rash require increased awareness and changes to the investigation protocols for these conditions, to include testing for SARS-CoV-2. In the present review, the mucocutaneous findings associated with the novel coronavirus infection, reported thus far in the literature, was provided. Contents 1. Introduction 2. Research methods 3. Prevalence 4. Pathogenesis 5. Classification and description of cutaneous, oral, and ocular mucosal lesions 6. Discussion and conclusions

How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19

“…Cutaneous manifestations of COVID-19 occur in 1% to 5.7% of cases [ 48 , 49 , 50 ] and the five most common patterns of skin lesions identified in patients with COVID-19 were: pseudo-chilblains (40.9%), maculopapular rash (27.9%), urticarial (12.5%), vesicular (10.7%), and vaso-occlusive lesions (4.4%) [ 48 , 51 ].…”

“…The urticarial rash associated with COVID-19 was reported in numerous publications ranging from 1.9% to 19% [ 43 , 49 , 50 , 52 , 53 ]. Urticaria usually appears simultaneously with systemic symptoms, lasts ~1 week, and predominantly involves the trunk and the limbs and spares acral sites affecting mostly adolescents/young adults [ 51 , 54 ].…”

The relationship of skin disorders, COVID-19, and the therapeutic potential of ginseng: a review

“…The pathogenesis of SARS-CoV-2-associated livedo racemosa remains unclear, but a few pathogenic hypotheses have been posited. One is the inhibition of type I interferon response, in which the binding of single-stranded RNA of the SARS-CoV-2 virus to toll-like receptors 7 and 8 promotes the production of type I interferons [ 42 , 43 ]. Interferons are then secreted and bound to the homodimer receptors of type I interferons.…”

“…STAT1, which plays a pivotal role in signal transduction and transcriptional activation, is then phosphorylated and activated. STAT2, which initiates the generation of a host of protective proteins, such as interferon-induced transmembrane protein (IFITM) 3, is also phosphorylated, promoting its ability to reduce COVID-19 outcomes [ 43 ]. In patients with COVID-19, it has been confirmed that the type I interferon response is minimal [ 42 ].…”

“…The second, a localized pattern, occurs less frequently and is topically distributed on the trunk, focused on the mid-chest and back. Although papulovesicular exanthems are typically seen in patients around the age of 60 years, they sometimes occur in children [ 46 ]. A pathogenic hypothesis of COVID-19-related papulovesicular rash is associated with direct viral damage to basal keratinocytes, leading to epidermal necrosis causing acantholysis and the expansion of keratinocytes and ballooning degeneration of keratinocytes and vascular endothelium in the dermal vessels [ 47 ].…”