Skin manifestations in COVID‐19 patients, state of the art. A systematic review

Perna, Andrea; Passiatore, Marco; Massaro, Antonio; Terrinoni, Alessandro; Bianchi, Luca; Cilli, V; D’Orio, Marco; Proietti, Luca; Taccardo, Giuseppe; Vitis, Rocco De

doi:10.1111/ijd.15414

Cited by 29 publications

(37 citation statements)

References 59 publications

(128 reference statements)

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“…The onset of vesicular lesions is usually later than that of SARS-CoV-2 disease symptoms, with a latency time of 14 days occurring more frequently in middle-aged patients [20]. However, according to other studies [30,33], these lesions appeared earlier than other clinical manifestations of COVID-19 in 72.5% of cases and were associated with a medium severity of SARS-CoV-2 infection. In this way, Jindal et al [31] reported that vesicular lesions occur in the early stages of COVID-19, even before the onset of fever and cough, and last about 10 days.…”

Section: Vesicular Eruptionsmentioning

confidence: 85%

“…In COVID-19, the prevalence of vesicular lesions is 15%, identifying a diffuse pattern in 75% and a localized pattern in 25% of patients [29]. Perna et al [30] described a prevalence of 12.5%, while according to a series of cases analyzed by Singh et al [22]-this percentage varies between 3.7% and 15%. These lesions occur more frequently in adults, most of them male (72.7%).…”

Section: Vesicular Eruptionsmentioning

confidence: 99%

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Identification, Mechanism, and Treatment of Skin Lesions in COVID-19: A Review

Fernández-Lázaro

Garrosa

2021

Viruses

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Coronavirus disease 2019 (COVID-19) is a multisystem disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), that primarily causes respiratory symptoms. However, an increasing number of cutaneous manifestations associated with this disease have been reported. The aim of this study is to analyze the scientific literature on cutaneous manifestations associated with SARS-CoV-2 by means of a narrative literature review until June 2021. The search was conducted in the following electronic databases: Medline (PubMed), SciELO, and Cochrane Library Plus. The most common cutaneous manifestations in patients with COVID-19 are vesicular eruptions, petechial/purpuric rashes, acral lesions, liveoid lesions, urticarial rash, and maculopapular-erythematous rash. These manifestations may be the first presenting symptoms of SARS-CoV-2 infection, as is the case with acral lesions, vesicular eruptions, and urticaria. In relation to severity, the presence of liveoid lesions may be associated with a more severe course of the disease. Treatment used for dermatological lesions includes therapy with anticoagulants, corticosteroids, and antihistamines. Knowledge of the dermatologic manifestations associated with SARS-CoV-2 contributes to the diagnosis of COVID-19 in patients with skin lesions associated with respiratory symptoms or in asymptomatic patients. In addition, understanding the dermatologic lesions associated with COVID-19 could be useful to establish a personalized care plan.

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Section: Vesicular Eruptionsmentioning

confidence: 85%

Section: Vesicular Eruptionsmentioning

confidence: 99%

Identification, Mechanism, and Treatment of Skin Lesions in COVID-19: A Review

Fernández-Lázaro

Garrosa

2021

Viruses

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“…There are two published cases of urticarial vasculitis [66]. However, a couple of systematic reviews have pointed out that most cutaneous manifestations could be traced to various drugs the patients were on [67,68]. The cause of purpura could be traced to thrombosis in several cases, and these would usually appear early in the disease onset.…”

Section: Rheumatic Manifestations In Covid-19mentioning

confidence: 99%

COVID-19 and the clinical course of rheumatic manifestations

2021

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The manifestations of COVID-19 have been evolving over time. Various post-COVID-19 syndromes are being recognised. Various viruses have been implicated in the pathogenesis of autoimmune diseases, and we expect a similar outcome with the severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2). The SARS-CoV-2 virus penetrates various tissues and organs and has a predisposition to lead to endotheliitis that may cause vascular manifestations including thrombosis. SARS-CoV-2 has been shown to activate Toll-like receptors and the complement system. It perpetuates NETosis and leads to autoantibody formation. These predispose to systemic autoimmunity. Both reactive arthritis and connective tissue disorders such as lupus and inflammatory myositis have been reported after COVID-19. Other reported autoimmune disorders include haemolytic anaemia, immune thrombocytopenia, cutaneous vasculitis, and Guillain Barré-like acute demyelinating disorders. The multisystem inflammatory syndrome in children and its adult counterpart are another post-COVID-19 entity that presents as an admixture of Kawasaki disease and staphylococcal toxic shock syndrome. Patients with preexisting rheumatic diseases may flare during the SARS-CoV-2 infection. They may develop novel autoimmune features also. The immune-suppressants used during the acute COVID-19 illness may confound the outcomes whereas comorbidities present in patients with rheumatic diseases may mask them. There is an urgent need to follow-up patients recovering from COVID and monitor autoantibody production in the context of rheumatic manifestations. Key Points • COVID-19 is associated with both innate and acquired immune reactions and production of various autoantibodies. • Various immune-mediated manifestations such as arthritis, myositis, haemolytic anaemia, thrombocytopenia, and acute demyelination may develop after COVID-19. • Longitudinal cohort data are warranted to describe, predict, and test prevent various rheumatic manifestations in post-COVID-19 subjects.

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“…The limbs seem to be more frequently involved than trunk and face. [8] Male-to-female ratio of 1 : 9 has been found in several studies. Chilblains are typical feature of COVID-19, very common amongst the skin lesions and are seen in almost half of all cases with skin lesions.…”

Section: Role Of Dermatologists In Covid-19 Pandemicmentioning

confidence: 85%

“…Recently cases of Kawasaki disease in children are increasingly being reported. [8] Recently it has been suggested that cryofibrinogenemia might be an important pathogenic factor for the development of chilblains related to COVID-19. [9] Chilblains, purpuric lesions, livedo reticularis, cyanosis, Raynaud's phenomenon, acral blisters, and ulceration are common clinical manifestations of cryofibrinogenemia as such.…”

Section: Role Of Dermatologists In Covid-19 Pandemicmentioning

confidence: 99%

Significance of cutaneous manifestations of COVID-19

Malathi

Thappa

2021

CSDM

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The COVID-19 pandemic has brought the whole world to a grinding halt. With the pandemic still ongoing, it is worthwhile to recapitulate the cutaneous manifestations for dermatologists, their significance, and spectrum of COVID-19 disease. COVID-19 is a highly contagious respiratory tract disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first reported on December 1, 2019, from Wuhan, China and was declared a pandemic by the World Health Organization on March 11, 2020. COVID-19 indirectly involves the skin just like any other viral infection and is independent of the disease stage or severity. Cutaneous manifestations of COVID-19 may present a few days before or after the first general symptoms of the disease. The appearance of cutaneous manifestations before early respiratory symptoms can promote early recognition of COVID-19 in such cases. The pathophysiology of cutaneous lesions in COVID-19 is still unclear. It is attributed to immune dysregulation, vasculitis, vessel thrombosis, neogenesis, hypercoagulable states, or simple hypersensitivity in COVID-19. Endothelial swelling with the presence of SARS-CoV-2 viral particles in the endothelial cells has also been seen on electron microscopy. Thus, the clinical features indicative of viral exanthems/enanthems which can be found in other diseases therefore fail to provide specific clues for diagnosis and prognosis of COVID-19. On the other hand, vasculopathy-related skin manifestations may provide prognostic values by indicating severe complications due to COVID-19 and may help in monitoring disease severity. Early detection of cutaneous signs associated with severe disease is crucial to improve patient outcomes.

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Skin manifestations in COVID‐19 patients, state of the art. A systematic review

Cited by 29 publications

References 59 publications

Identification, Mechanism, and Treatment of Skin Lesions in COVID-19: A Review

Identification, Mechanism, and Treatment of Skin Lesions in COVID-19: A Review

COVID-19 and the clinical course of rheumatic manifestations

Significance of cutaneous manifestations of COVID-19

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