Abstract

Research Article

The dermatologic manifestations of COVID-19: a mini-review

Sabah Alharazy*

Published: 27 August, 2021 | Volume 5 - Issue 1 | Pages: 042-048

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan, China, and caused coronavirus disease-19 (COVID-19), which is still a global pandemic. Dermatologic manifestations have increasingly been identified as significant extrapulmonary manifestations of COVID-19. The dermatologic manifestations associated with COVID-19 infection reported to date include maculopapular rash, vesicular lesions, urticaria-like lesions, and chilblain-like lesions. Knowledge of dermatologic manifestations of COVID-19 may be essential for early diagnosis and a better prognosis in COVID-19 patients. This review summarizes the current understanding of common COVID-19-associated dermatologic manifestations.

Read Full Article HTML DOI: 10.29328/journal.apb.1001015 Cite this Article Read Full Article PDF

Keywords:

Dermatologic; COVID-19; SARS-CoV-2; Maculopapular rash; Vesicular lesions; Urticaria-like lesions; Chilblain-like lesions

References

  1. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. WHO Director General’s speeches 2020. PubMed: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 .
  2. Wong CKH, Wong JYH, Tang EHM, et al. Clinical presentations, laboratory and radiological findings, and treatments for 11,028 COVID-19 patients: a systematic review and meta-analysis. Sci Rep. 2020; 10: 19765.
  3. da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, de Oliveira TF, Alcântara RC, et al. Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr. 2021: 133: 377-382. PubMed: https://pubmed.ncbi.nlm.nih.gov/33242148/
  4. Johnson KD, Harris C, Cain JK, Hummer C, Goyal H, et al. Pulmonary and Extra-Pulmonary Clinical Manifestations of COVID-19. Front Med. 2020; 7: 526. PubMed: https://pubmed.ncbi.nlm.nih.gov/32903492/
  5. Singh H, Kaur H, Singh K, Sen CK. Cutaneous Manifestations of COVID-19: A Systematic Review. Adv Wound Care. 2021; 10: 51-80. PubMed: https://pubmed.ncbi.nlm.nih.gov/33035150/
  6. Jamshidi P, Hajikhani B, Mirsaeidi M, Vahidnezhad H, Dadashi M, et al. Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review. Front Med. 2021; 8: 634208. PubMed: https://pubmed.ncbi.nlm.nih.gov/33665200/
  7. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382: 1708-1720.
  8. Recalcati S. Cutaneous manifestations in COVID‐19: a first perspective. J Eur Acad Dermatol Venereol. 2020; 34: e212-e213. PubMed: https://pubmed.ncbi.nlm.nih.gov/32215952/
  9. Klejtman T. Skin and COVID-19. JMV-Journal Médecine Vasc. 2020; 45: 175-176.
  10. Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, et al. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020; 98: 75-81. PubMed: https://pubmed.ncbi.nlm.nih.gov/32381430/  
  11. Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020; 183: 71-77. PubMed: https://pubmed.ncbi.nlm.nih.gov/32348545/
  12. Najarian DJ. Morbilliform exanthem associated with COVID-19. JAAD Case Rep. 2020; 6: 493-494. PubMed: https://pubmed.ncbi.nlm.nih.gov/32313826/
  13. de Masson A, Bouaziz JD, Sulimovic L, Cassius C, Jachiet M, et al. Chilblains is a common cutaneous finding during the COVID-19 pandemic: A retrospective nationwide study from France. J Am Acad Dermatol. 2020; 83: 667-670. PubMed: https://pubmed.ncbi.nlm.nih.gov/32380219/
  14. Askin O, Altunkalem RN, Altinisik DD, Uzuncakmak TK, Tursen U, et al. Cutaneous manifestations in hospitalized patients diagnosed as COVID-19. Dermatol Ther 2020; 33: e13896. PubMed: https://pubmed.ncbi.nlm.nih.gov/32579756/
  15. De Giorgi V, Recalcati S, Jia Z, Chong W, Ding R, et al. Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): A prospective study from China and Italy. J Am Acad Dermatol. 2020; 83: 674-675. PubMed: https://pubmed.ncbi.nlm.nih.gov/32442696/
  16. Herrero-Moyano M, Capusan TM, Andreu-Barasoain M, Alcántara-González J, Ruano-Del Salado M, et al. A clinicopathological study of eight patients with COVID-19 pneumonia and a late-onset exanthema. J Eur Acad Dermatol Venereol. 2020; 34: e460-e464. PubMed: https://pubmed.ncbi.nlm.nih.gov/32426864/
  17. Rubio‐Muniz CA, Puerta‐Peña M, Falkenhain‐López D, Arroyo-Andrés J, Agud-Dios M, et al. The broad spectrum of dermatological manifestations in COVID‐19: clinical and histopathological features learned from a series of 34 cases. J Eur Acad Dermatol Venereol. 2020; 34: e574-e576. PubMed: https://pubmed.ncbi.nlm.nih.gov/32526040/
  18. Damme C, Berlingin E, Saussez S, Accaputo O. Acute urticaria with pyrexia as the first manifestations of a COVID‐19 infection. J Eur Acad Dermatol Venereol. 2020; 34: e300-e301. PubMed: https://pubmed.ncbi.nlm.nih.gov/32329915/
  19. Estébanez A, Pérez‐Santiago L, Silva E, Guillen‐Climent S, García-Vázquez A, et al. Cutaneous manifestations in COVID‐19: a new contribution. J Eur Acad Dermatol Venereol. 2020; 34: e250-e251. PubMed: https://pubmed.ncbi.nlm.nih.gov/32294264/
  20. Amatore F, Macagno N, Mailhe M, Demarez B, Gaudy-Marqueste C, et al. SARS‐CoV‐2 infection presenting as a febrile rash. J Eur Acad Dermatol Venereol 2020; 34: e304-e306. PubMed: https://pubmed.ncbi.nlm.nih.gov/32330336/
  21. Henry D, Ackerman M, Sancelme E, Finon A, Esteve E. Urticarial eruption in COVID‐19 infection. J Eur Acad Dermatol Venereol 2020; 34: e244-e245. PubMed: https://pubmed.ncbi.nlm.nih.gov/32294273/
  22. Novak N, Peng W, Naegeli MC, et al. SARS‐CoV‐2, COVID‐19, skin and immunology – What do we know so far? Allergy. 2021; 76: 698-713.
  23. Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J, Burgos-Blasco P, de Perosanz-Lobo D, et al. Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital. Clin Exp Dermatol. 2020; 45: 872-875. PubMed: https://pubmed.ncbi.nlm.nih.gov/32384180/
  24. Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol. 2020; 83: 280-285. PubMed: https://pubmed.ncbi.nlm.nih.gov/32305439/
  25. Llamas-Velasco M, Rodríguez-Jiménez P, Chicharro P, De Argila D, Muñoz-Hernández P, et al. Reply to “Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients”: To consider varicella-like exanthem associated with COVID-19, virus varicella zoster and virus herpes simplex must be ruled ou. J Am Acad Dermatol. 2020; 83: e253-e254. PubMed: https://pubmed.ncbi.nlm.nih.gov/32442700/
  26. Marzano AV, Genovese G. Response to: "Reply to “Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients”: To consider varicella-like exanthem associated with COVID-19, virus varicella zoster and virus herpes simplex mu. J Am Acad Dermatol. 2020; 83: e255-e256.
  27. Colmenero I, Santonja C, Alonso-Riaño M, Noguera-Morel L, Hernández-Martín A, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. Br J Dermatol. 2020; 183: 729-737. PubMed: https://pubmed.ncbi.nlm.nih.gov/32562567/
  28. Trellu LT, Kaya G, Alberto C, Calame A, McKee T, et al. Clinicopathologic Aspects of a Papulovesicular Eruption in a Patient With COVID-19. JAMA Dermatol. 2020; 156: 922-924. PubMed: https://pubmed.ncbi.nlm.nih.gov/32579185/
  29. Jones VG, Mills M, Suarez D, Hogan CA, Yeh D, et al. COVID-19 and Kawasaki Disease: Novel Virus and Novel Case. Hosp Pediatr 2020; 10: 537-540. PubMed: https://pubmed.ncbi.nlm.nih.gov/32265235/
  30. Center for Disease Control and Prevention. Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C). CDC. 2021. PubMed: https://www.cdc.gov/mis-c/hcp/
  31. World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19: Scientific Brief 15 May 2020. WHO. 2020; 1-9 PubMed: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19
  32. Dufort EM, Koumans EH, Chow EJ, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020; 383: 347-358.
  33. Conforti C, Dianzani C, Agozzino M, Giuffrida R, Marangi GF, et al. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. Biology (Basel). 2020; 9: 449. PubMed: https://pubmed.ncbi.nlm.nih.gov/33291502/
  34. Cappel JA, Wetter DA. Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011. Mayo Clin Proc. 2014; 89: 207-215. PubMed: https://pubmed.ncbi.nlm.nih.gov/24485134/
  35. Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, et al. Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries. J Am Acad Dermatol. 2020; 83: 486-492. PubMed: https://pubmed.ncbi.nlm.nih.gov/32479979/
  36. Roca-Ginés J, Torres-Navarro I, Sánchez-Arráez J, Abril-Pérez C, Sabalza-Baztán O, et al. Assessment of Acute Acral Lesions in a Case Series of Children and Adolescents During the COVID-19 Pandemic. JAMA Dermatol. 2020; 156: 992-997. PubMed: https://pubmed.ncbi.nlm.nih.gov/32584397/
  37. Kolivras A, Dehavay F, Delplace D, Feoli F, Meiers I, et al. Coronavirus (COVID-19) infection–induced chilblains: A case report with histopathologic findings. JAAD Case Rep. 2020; 6: 489-492. PubMed: https://pubmed.ncbi.nlm.nih.gov/32363225/
  38. Locatelli AG, Robustelli Test E, Vezzoli P, Carugno A, Moggio E, et al. Histologic features of long-lasting chilblain-like lesions in a paediatric COVID-19 patient. J Eur Acad Dermatol Venereol. 2020; 34: e365-e368. PubMed: https://pubmed.ncbi.nlm.nih.gov/32386459/
  39. Santonja C, Heras F, Núñez L, Requena L. COVID‐19 chilblain‐like lesion: immunohistochemical demonstration of SARS‐CoV‐2 spike protein in blood vessel endothelium and sweat gland epithelium in a polymerase chain reaction‐negative patient. Br J Dermatol. 2020; 183: 778-780. PubMed: https://pubmed.ncbi.nlm.nih.gov/32585767/
  40. Herman A, Peeters C, Verroken A, Tromme I, Tromme I, Tennstedt D, et al. Evaluation of Chilblains as a Manifestation of the COVID-19 Pandemic. JAMA Dermatol. 2020; 156: 998-1003. PubMed: https://pubmed.ncbi.nlm.nih.gov/32584377/
  41. Marzano AV, Cassano N, Genovese G, Moltrasio C, Vena GA, et al. Cutaneous manifestations in patients with COVID‐19: a preliminary review of an emerging issue. Br J Dermatol. 2020; 183: 431-442. PubMed: https://pubmed.ncbi.nlm.nih.gov/32479680/
  42. Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020; 220: 1-13. PubMed: https://pubmed.ncbi.nlm.nih.gov/32299776/
  43. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18: 844-847. PubMed: https://pubmed.ncbi.nlm.nih.gov/32073213/
  44. Bertoli F, Veritti D, Danese C. Ocular Findings in COVID-19 Patients: A Review of Direct Manifestations and Indirect Effects on the Eye. J Ophthalmol. 2020; 2020: 1-9.
  45. Wu P, Duan F, Luo C, Liu Q, Qu X, et al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020; 138: 575-578. PubMed: https://pubmed.ncbi.nlm.nih.gov/32232433/
  46. Zhou Y, Duan C, Zeng Y, Tong Y, Nie Y, et al. Ocular Findings and Proportion with Conjunctival SARS-COV-2 in COVID-19 Patients. Ophthalmol. 2020; 127: 982-983. PubMed: https://pubmed.ncbi.nlm.nih.gov/32359840/
  47. Marinho PM, Marcos AAA, Romano AC, Nascimento H, Belfort R SJr. Retinal findings in patients with COVID-19. Lancet. 2020; 395: 1610. PubMed: https://pubmed.ncbi.nlm.nih.gov/32405105/

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?