The COVID-19 pandemic and its skin effects

Abstract

ObjectiveTo review the current literature on cutaneous diseases associated with the global coronavirus disease 2019 (COVID-19) pandemic, and to provide a general overview for family physicians of dermatologic presentations associated with COVID-19.Quality of evidence Google Scholar and PubMed searches were conducted using the terms COVID-19, pandemic, dermatology, livedoid, chilblain, urticaria, maculopapular, Kawasaki's, and related synonyms. Additional terms were personal protective equipment (PPE), hand hygiene, and psychosocial factors affecting skin diseases. Only English-language literature was reviewed. Evidence ranged from levels I to III. Main messageCoronavirus disease 2019 is associated with a range of cutaneous presentations through direct infection with severe acute respiratory syndrome coronavirus 2, such as maculopapular, vesicular, pseudo-chilblain, livedoid, necrotic, urticarial, and Kawasaki-like rashes. Indirect presentations secondary to behavioural modifications are associated with use of personal protective equipment and sanitization procedures. Furthermore, psychosocial factors and stress associated with the pandemic also exacerbate pre-existing skin conditions. ConclusionThe COVID-19 pandemic has increased rates of dermatologic conditions through direct infection, behavioural changes, and association with psychosocial factors. As the incidence of COVID-19 increases, family physicians should be well equipped to diagnose and manage dermatologic presentations as they change within the context of the pandemic. Révision cliniqueThis article has been peer reviewed. Cet article a fait l'objet d'une révision par des pairs.

The impact of masks on the condition of facial skin in the time of the COVID-19 pandemic

“…In order to protect against the infection, masks were introduced for daily use, a social distance of up to 2 meters was recommended, as well as increased hygiene of hands and face. As a result of the massive use of masks, the number of reported adverse reactions and skin irritation has increased, which from a dermatological point of view constitute the basis of the following study [8].…”

The cutaneous manifestations of COVID-19, personal protective equipment and treatment

“…COVID-19 may affect the skin at various stages of the disease and although in few cases the rash preceded the fever and respiratory symptoms [1,2], the more common scenario is an eruption that followed the flu like illness. Distinction between a rash attributed to C0VID-19 alone or complicated by therapy may be difficult and specific histological findings have not been found.…”

“…Distinction between a rash attributed to C0VID-19 alone or complicated by therapy may be difficult and specific histological findings have not been found. The pathophysiology of skin involvement is thought to mirror other organs involvement via direct injury of the cells through immune response to viral nucleotides or vessels damage leading to vasculitic injury and thrombotic vasculopathy with a key role of angiotensin converting enzyme 2 (ACE2) [1][2][3]. A large number of cases detailing skin involvement in COVID19 patients has been reported since the start of the pandemic.…”

Diagnosis of stress-associated dermatologic conditions in New York City safety-net hospitals during the COVID-19 pandemic

“…Reportedly, presentations of shingles, psoriasis, and eczema, conditions that are also precipitated or impacted by stress, have increased similarly during the pandemic. 2 , 3 , 4 Nonetheless, real-world data demonstrating the frequency of diagnosis of such disorders are notably lacking. Low-income minority populations have been disproportionately affected by stress related to SARS-CoV-2 because of a higher prevalence of infection, morbidity, mortality, and economic instability.…”

“…The arrival of COVID-19 engendered a unique environment presumed to trigger the expression of disorders with known links to stress. 1 , 2 , 3 , 4 Unexpectedly, diagnoses long held to be provoked or exacerbated by stress (eg, herpes zoster, psoriasis, urticaria, etc) were unaffected, even in a population heavily impacted by the pandemic. 5 Only the prevalence of telogen effluvium and acne (likely due to mask-wearing) had increased.…”