Cutaneous manifestations associated with COVID-19: summary of current knowledge
DOI:
https://doi.org/10.12775/JEHS.2024.56.005Keywords
Covid-19, skin manifestations of COVID-19, cutaneous manifestations of COVID-19, COVID-19 skin lesionsAbstract
Introduction and purpose: Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had been spreading rapidly throughout the world, mainly affecting respiratory system. Except pulmonary symptoms, skin lesions might also occur. The precise percentage of patients with confirmed COVID-19 who presented cutaneous manifestations is still unknown (0.2% - 20.4%). Part of the skin lesions might be drug-induced.
Brief description of the state of knowledge: Cutaneous manifestations in the course of the coronavirus disease could be divided into six main groups: maculopapular rash, urticarial lesions, chilblain‐like lesions, vesicular eruptions, petechial/purpuric lesions and livedoid lesions. The most common skin lesions are maculopapular eruptions (47%). Trunk is the most affected location, whereas pruritus is the most frequent additional symptom among patients with skin lesions associated with coronavirus disease. These lesions appear mainly in elderly patients except pseudo chilblains which are present among children and young adults with SARS-Cov-2 infection. The majority of cutaneous manifestations occur after COVID-19 systemic symptoms, but the appearance of vesicular lesions before the respiratory signs was also reported. Cutaneous manifestations resolved spontaneously at different times, ranging from a few days to 2-4 weeks. Moreover, patients with severe course of COVID-19 with maculopapular rash have better prognosis (2% mortality rate) in comparison to patients who developed livedoid lesions in course of the coronavirus disease (10% mortality rate).
Summary: Pseudo-chilblains and vesicular lesions are the most specific cutaneous manifestations of coronavirus disease. Healthcare professionals should pay attention to patients who present skin symptoms in the course of COVID-19. Cutaneous manifestations can facilitate the doctor the diagnosis and even estimate the severity of coronavirus disease.
References
Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017 https://doi.org/10.1056/NEJMoa2001017
World Health Organization, Coronavirus disease (COVID-19) pandemic [Internet]; c2024 [cited 2023 Dec 29]. Available from: https://www.who.int/europe/emergencies/situations/covid-19
World Health Organization, COVID-19 Dashboard [Internet]; c2024 [cited 2023 Dec 29]. Available from: https://data.who.int/dashboards/covid19/cases?n=c
Lai CC, Ko WC, Lee PI, Jean SS, Hsueh PR. Extra-respiratory manifestations of COVID-19. Int J Antimicrob Agents. 2020;56(2):106024. doi:10.1016/j.ijantimicag.2020.106024
https://doi.org/10.1016/j.ijantimicag.2020.106024
Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol. 2020;251(3):228-248. doi:10.1002/path.5471
https://doi.org/10.1002/path.5471
Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032
https://doi.org/10.1056/NEJMoa2002032
Sachdeva M, Gianotti R, Shah M, et al. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020;98(2):75-81. doi:10.1016/j.jdermsci.2020.04.011
https://doi.org/10.1016/j.jdermsci.2020.04.011
Türsen Ü, Türsen B, Lotti T. Cutaneous sıde-effects of the potential COVID-19 drugs. Dermatol Ther. 2020;33(4):e13476. doi:10.1111/dth.13476
Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020;82(5):e177. doi:10.1016/j.jaad.2020.03.036
https://doi.org/10.1016/j.jaad.2020.03.036
Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-1741. doi:10.1111/all.14238
https://doi.org/10.1111/all.14238
Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:m2094. Published 2020 Jun 3. doi:10.1136/bmj.m2094
https://doi.org/10.1136/bmj.m2094
Galván Casas C, Català A, Carretero Hernández G, 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(1):71-77. doi:10.1111/bjd.19163
https://doi.org/10.1111/bjd.19163
Herrero-Moyano M, Capusan TM, Andreu-Barasoain 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(9):e460-e464. doi:10.1111/jdv.16631
Reymundo A, Fernáldez-Bernáldez A, Reolid A, et al. Clinical and histological characterization of late appearance maculopapular eruptions in association with the coronavirus disease 2019. A case series of seven patients. J Eur Acad Dermatol Venereol. 2020;34(12):e755-e757. doi:10.1111/jdv.16707
Dalal A, Jakhar D, Agarwal V, Beniwal R. Dermatological findings in SARS-CoV-2 positive patients: An observational study from North India. Dermatol Ther. 2020;33(6):e13849. doi:10.1111/dth.13849
Freeman EE, McMahon DE, Lipoff JB, et al. The spectrum of COVID-19-associated dermatologic manifestations: An international registry of 716 patients from 31 countries. J Am Acad Dermatol. 2020;83(4):1118-1129. doi:10.1016/j.jaad.2020.06.1016
https://doi.org/10.1016/j.jaad.2020.06.1016
Avellana Moreno R, Estela Villa LM, Avellana Moreno V, Estela Villa C, Moreno Aparicio MA, Avellana Fontanella JA. Cutaneous manifestation of COVID-19 in images: a case report. J Eur Acad Dermatol Venereol. 2020;34(7):e307-e309. doi:10.1111/jdv.16531
Rubio-Muniz CA, Puerta-Peña M, Falkenhain-López D, 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(10):e574-e576. doi:10.1111/jdv.16734
Gianotti R, Veraldi S, Recalcati S, et al. Cutaneous Clinico-Pathological Findings in three COVID-19-Positive Patients Observed in the Metropolitan Area of Milan, Italy. Acta Derm Venereol. 2020;100(8):adv00124. Published 2020 Apr 23. doi:10.2340/00015555-3490
https://doi.org/10.2340/00015555-3490
Zengarini C, Orioni G, Cascavilla A, et al. Histological pattern in COVID-19-induced viral rash. J Eur Acad Dermatol Venereol. 2020;34(9):e453-e454. doi:10.1111/jdv.16569
Diotallevi F, Campanati A, Bianchelli T, et al. Skin involvement in SARS-CoV-2 infection: Case series. J Med Virol. 2020;92(11):2332-2334. doi:10.1002/jmv.26012
Askin O, Altunkalem RN, Altinisik DD, Uzuncakmak TK, Tursen U, Kutlubay Z. Cutaneous manifestations in hospitalized patients diagnosed as COVID-19. Dermatol Ther. 2020;33(6):e13896. doi:10.1111/dth.13896
Fernandez-Nieto D, Ortega-Quijano D, Segurado-Miravalles G, Pindado-Ortega C, Prieto-Barrios M, Jimenez-Cauhe J. Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies. J Eur Acad Dermatol Venereol. 2020;34(6):e252-e254. doi:10.1111/jdv.16470
Freeman EE, McMahon DE, Lipoff JB, 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(2):486-492. doi:10.1016/j.jaad.2020.05.109
https://doi.org/10.1016/j.jaad.2020.05.109
Docampo-Simón A, Sánchez-Pujol MJ, Juan-Carpena G, et al. Are chilblain-like acral skin lesions really indicative of COVID-19? A prospective study and literature review. J Eur Acad Dermatol Venereol. 2020;34(9):e445-e447. doi:10.1111/jdv.16665
Andina D, Noguera-Morel L, Bascuas-Arribas M, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020;37(3):406-411. doi:10.1111/pde.14215
Colonna C, Genovese G, Monzani NA, et al. Outbreak of chilblain-like acral lesions in children in the metropolitan area of Milan, Italy, during the COVID-19 pandemic. J Am Acad Dermatol. 2020;83(3):965-969. doi:10.1016/j.jaad.2020.06.019
López-Robles J, de la Hera I, Pardo-Sánchez J, Ruiz-Martínez J, Cutillas-Marco E. Chilblain-like lesions: a case series of 41 patients during the COVID-19 pandemic. Clin Exp Dermatol. 2020;45(7):891-892. doi:10.1111/ced.14275
https://doi.org/10.1111/ced.14275
Marzano AV, Genovese G, Fabbrocini 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(1):280-285. doi:10.1016/j.jaad.2020.04.044
https://doi.org/10.1016/j.jaad.2020.04.044
De Giorgi V, Recalcati S, Jia Z, et al. Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): A prospective study from China and Italy. J Am Acad Dermatol. 2020;83(2):674-675. doi:10.1016/j.jaad.2020.05.073
https://doi.org/10.1016/j.jaad.2020.05.073
Tammaro A, Adebanjo GAR, Parisella FR, Pezzuto A, Rello J. Cutaneous manifestations in COVID-19: the experiences of Barcelona and Rome. J Eur Acad Dermatol Venereol. 2020;34(7):e306-e307. doi:10.1111/jdv.16530
Martín Carreras-Presas C, Amaro Sánchez J, López-Sánchez AF, Jané-Salas E, Somacarrera Pérez ML. Oral vesiculobullous lesions associated with SARS-CoV-2 infection. Oral Dis. 2021;27 Suppl 3(Suppl 3):710-712. doi:10.1111/odi.13382
Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J, et al. Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital. Clin Exp Dermatol. 2020;45(7):872-875. doi:10.1111/ced.14277
https://doi.org/10.1111/ced.14277
Magro C, Mulvey JJ, Berlin D, 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. doi:10.1016/j.trsl.2020.04.007
https://doi.org/10.1016/j.trsl.2020.04.007
Cordoro KM, Reynolds SD, Wattier R, McCalmont TH. Clustered cases of acral perniosis: Clinical features, histopathology, and relationship to COVID-19. Pediatr Dermatol. 2020;37(3):419-423. doi:10.1111/pde.14227
Khalil S, Hinds BR, Manalo IF, Vargas IM, Mallela S, Jacobs R. Livedo reticularis as a presenting sign of severe acute respiratory syndrome coronavirus 2 infection. JAAD Case Rep. 2020;6(9):871-874. doi:10.1016/j.jdcr.2020.07.014
https://doi.org/10.1016/j.jdcr.2020.07.014
Janah H, Zinebi A, Elbenaye J. Atypical erythema multiforme palmar plaques lesions due to Sars-Cov-2. J Eur Acad Dermatol Venereol. 2020;34(8):e373-e375. doi:10.1111/jdv.16623
Jimenez-Cauhe J, Ortega-Quijano D, Carretero-Barrio I, et al. Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. Clin Exp Dermatol. 2020;45(7):892-895. doi:10.1111/ced.14281
https://doi.org/10.1111/ced.14281
Kalner S, Vergilis IJ. Periorbital erythema as a presenting sign of COVID-19. JAAD Case Rep. 2020;6(10):996-998. doi:10.1016/j.jdcr.2020.05.001
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Magdalena Jung, Kinga Woźniak, Maximilian Jung, Oliwia Sysło, Patryk Hedesz, Monika Gardian-Baj, Alicja Szczerbiak, Krystian Jędral, Aleksandra Żuk-Łapan, Aleksandra Doryń
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 331
Number of citations: 0
