Severe and life‐threatening COVID‐19‐related mucocutaneous eruptions: A systematic review

Abstract

Objectives Earlier diagnosis and the best management of virus‐related, drug‐related or mixed severe potentially life‐threatening mucocutaneous reactions of COVID‐19 patients are of great concern. These patients, especially hospitalised cases, are usually in a complicated situation (because of multi‐organ failures), which makes their management more challenging. In such consultant cases, achieving by the definite beneficial management strategies that therapeutically address all concurrent comorbidities are really hard to reach or even frequently impossible. Methods According to the lack of any relevant systematic review, we thoroughly searched the databases until 5 October 2020 and finally found 57 articles including 93 patients. It is needed to know clinical presentations of these severe skin eruptions, signs and symptoms of COVID in these patients, time of skin rash appearance, classifying drug‐related or virus‐related skin lesions, classifying the type of skin rash, patients’ outcome and concurrent both COVID‐19 therapy and skin rash treatment. Result Severe and potential life‐threatening mucocutaneous dermatologic manifestations of COVID‐19 usually may be divided into three major categories: virus‐associated, drug‐associated, and those with uncertainty about the exact origin. Angioedema, vascular lesions, toxic shock syndrome, erythroderma, DRESS, haemorrhagic bulla, AGEP, EM, SJS and TEN, generalised pustular figurate erythema were the main entities found as severe dermatologic reactions in all categories. Conclusion We can conclude vascular injuries may be the most common cause of severe dermatologic manifestations of COVID‐19, which is concordant with many proposed hypercoagulation tendencies and systemic inflammatory response syndrome as one of the most important pathomechanisms of COVID‐19 so the skin may show these features in various presentations and degrees.

First reported case of delayed‐type hypersensitivity reaction to non‐hyaluronic acid Polycaprolactone dermal filler following COVID‐19 vaccination: A case report and a review of the literature

“… 13 It is worth mentioning that the authors of this manuscript have broadly worked on COVID‐19 and skin as well as cosmetic fields. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 To the best of our knowledge, this is the first reported case of nodule formation due to the PCL reaction following Sinopharm COVID‐19 vaccination and further investigations with longer follow‐ups are recommended. Our case highlights the importance of reporting similar cases in order to better understand this phenomenon and its management.…”

Pansclerotic Morphea Following COVID-19: A Case Report and Review of Literature on Rheumatologic and Non-rheumatologic Dermatologic Immune-Mediated Disorders Induced by SARS-CoV-2

“…During the pandemic, the authors especially focused on various skin manifestations of COVID-19 in their research on the subject ( 16 – 29 ).…”

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus, therapy, and the vaccination

“…It most commonly affected the extremities and put patients aged 60 years and older at higher mortality risk than the rest. 12 Ischemic complications lead to the tissue necrosis which highlights the importance of the emergent vascular surgery consultation to consider intravenous thrombolytic therapy. 13 Hypercoagulation state in severe COVID‐19 resulting in hemostatic disturbances and disseminated intravascular coagulation (DIC) is another cause for mortality.…”

“… 12 Acute generalized exanthematous pustulosis (AGEP), Stevens‐Johnson‐like syndrome (SJS)/toxic epidermal necrolysis (TEN), erythema multiform major (EM) were also reported rarely in this category. 12 …”

“…11 In addition, ischemic and necrotic mucocutaneous involvement in COVID-19 patients increases the likelihood of disease severity as a reflection of organ damages. 12 Types of virus-related skin lesions:…”