Skin Findings Related to COVID-19, the Review of the Current Literature

Year 2021, , 69 - 79, 05.05.2021

Sezin Ünlü Açıkel Akın Aktaş

https://doi.org/10.47482/acmr.2021.18

Abstract

COVID-19 is an acute respiratory infection that is caused by SARS-CoV2 and it was declared a pandemic by the World Health Organization in March 2020. Many different skin manifestations such as urticarial lesions, maculovesicular lesions, papulovesicular lesions, MIS-C lesions, purpuric / petechial lesions, livedoid lesions, and thrombotic-ischemic lesions have been described in this infection. Thus, timely and accurate identification of skin findings might be beneficial in terms of early diagnosis. In addition, the type of lesion gives information about prognosis in some cases. The exact mechanism for the formation of skin lesions is not known, but the immune system activation, the direct cytopathic effect of the virus, the microvascular damage, hypercoagulopathy and complement activation are factors that are thought to play a role in the pathogenesis. Further studies are required in order to systematize the skin findings seen in COVID-19 and to reveal their mechanisms. Furthermore, the COVID-19 pandemic has also induced various skin complications such as pressure sores, dry skin, dermatitis, and contact urticaria due to the use of personal protective equipment (PPE). Besides, the use of PPE might cause exacerbation of skin diseases such as acne, rosacea, seborrheic dermatitis, atopic dermatitis.

Keywords

COVID-19, Skin Symptoms, SARS-CoV2, Pandemic.

References

• 1. Erganiş S, Bozdayı G. Virology, immunity and vaccine development of SARS-CoV-2. Arch Curr Med Res. 2021;2(1):05–13.
• 2. Drago F, Ciccarese G, Gasparini G, Cogorno L, Javor S, Toniolo A, et al. Contemporary infectious exanthems: an update. Future Microbiol. 2017;12:171–93.
• 3. Bouaziz JD, Duong TA, Jachiet M, Velter C, Lestang P, Cassius C, et al. Vascular skin symptoms in COVID-19: a French observational study. J Eur Acad Dermatol Venereol. 2020;34(9):e451–2.
• 4. Almutairi N, Schwartz RA. COVID‐19 with dermatologic manifestations and implications: An unfolding conundrum. Dermatol Ther. 2020;33(5):e13544.
• 5. Tang K, Wang Y, Zhang H, Zheng Q, Fang R, Sun Q. Cutaneous manifestations of the coronavirus disease 2019 (COVID-19): A brief review. Dermatol Ther. 2020;33(4):e13528.
• 6. Ghazal S, Litvinov I V, Aljahani N, Jfri A, Netchiporouk E. Cutaneous manifestations of coronavirus disease 2019 (COVID-19) infection-what do we know so far? J Cutan Med Surg. 24(4):416–7.
• 7. Suchonwanit P, Leerunyakul K, Kositkuljorn C. Diagnostic and prognostic values of cutaneous manifestations in COVID‐19. Dermatol Ther. 2020;33(4).
• 8. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020;80(6):656–65.
• 9. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020;34(5):e212–3.
• 10. Hedou M, Carsuzaa F, Chary E, Hainaut E, Cazenave-Roblot F, Masson Regnault M. Comment on “Cutaneous manifestations in COVID-19: a first perspective” by Recalcati S. J Eur Acad Dermatol Venereol. 2020;34(7):e299–300.
• 11. Radonjic-Hoesli S, Hofmeier KS, Micaletto S, Schmid- Grendelmeier P, Bircher A, Simon D. Urticaria and angioedema: an update on classification and pathogenesis. Clin Rev Allergy Immunol. 2018;54(1):88–101.
• 12. Galván Casas C, Català A, Carretero Hernández G, Rodríguez‐ Jiménez P, Fernández‐Nieto D, Rodríguez‐Villa Lario A, 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):71–7.
• 13. Henry D, Ackerman M, Sancelme E, Finon A, Esteve E. Urticarial eruption in COVID-19 infection. J Eur Acad Dermatol Venereol. 2020;34(6):e244–5.
• 14. van 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(7):e300–1.
• 15. Criado PR, Abdalla BMZ, de Assis IC, van Blarcum de Graaff Mello C, Caputo GC, Vieira IC. Are the cutaneous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms. Inflamm Res. 2020;69(8):745–56.
• 16. Kang JH. Febrile illness with skin rashes. Infect Chemother. 2015;47(3):155–66.
• 17. De Giorgi V, Recalcati S, Jia Z, Chong W, Ding R, Deng Y, 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):674–5.
• 18. Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, Veraldi S, et al. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020 May;98(2):75–81.
• 19. Paolino G, Canti V, Mercuri SR, Rovere Querini P, Candiani M, Pasi F. Diffuse cutaneous manifestation in a new mother with COVID-19 (SARS-Cov-2). Int J Dermatol. 2020;59(7):874–5.
• 20. Ahouach B, Harent S, Ullmer A, Martres P, Bégon E, Blum L, et al. Cutaneous lesions in a patient with COVID-19: are they related? Br J Dermatol. 2020;183(2):e31.
• 21. Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V. Cutaneous manifestations in the current pandemic of coronavirus infection disease (COVID 2019). An Pediatr. 2020;92(6):374–5.
• 22. 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 Dermatology Venereol. 2020;34(7).
• 23. Putra BE, Adiarto S, Dewayanti SR, Juzar DA. Viral exanthem with “Spins and needles sensation” on extremities of a COVID-19 patient: A self-reported case from an Indonesian medical frontliner. Int J Infect Dis. 2020;96:355–8.
• 24. Herrero-Moyano M, Capusan TM, Andreu-Barasoain M, Alcántara-González J, Ruano-Del Salado M, Sánchez-Largo Uceda ME, 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):e460–4.
• 25. Rubio-Muniz CA, Puerta-Peña M, Falkenhain-López D, Arroyo- Andrés J, Agud-Dios M, Rodriguez-Peralto JL, 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):e574–6.
• 26. De Masson A, Bouaziz J-D, Sulimovic L, Cassius C, Jachiet M, Ionescu M-A, 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(2):667–70.
• 27. Bursal Duramaz B, Yozgat CY, Yozgat Y, Turel O. Appearance of skin rash in pediatric patients with COVID-19: Three case presentations. Dermatol Ther. 2020;33(4):e13594.
• 28. Marzano A V., Cassano N, Genovese G, Moltrasio C, Vena GA. Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue. Br J Dermatol. 2020;183(3):431–42.
• 29. 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.
• 30. Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J, Burgos- Blasco P, de Perosanz-Lobo D, Suarez-Valle A, 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):872–5.
• 31. Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, 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):280–5.
• 32. Galeotti C, Bayry J. Autoimmune and inflammatory diseases following COVID-19. Nat Rev Rheumatol. 2020;16(8):413–4.
• 33. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771–8.
• 34. Ebina-Shibuya R, Namkoong H, Shibuya Y, Horita N. Multisystem inflammatory syndrome in children (MIS-C) with COVID-19: Insights from simultaneous familial Kawasaki Disease cases. Int J Infect Dis. 2020;97:371–3.
• 35. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324(3):259–69.
• 36. Miller J, Cantor A, Zachariah P, Ahn D, Martinez M, Margolis KG. Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children that is related to coronavirus disease 2019: A single center experience of 44 cases. Gastroenterology. 2020;159(4):1571-1574.e2.
• 37. Hameed S, Elbaaly H, Reid CEL, Santos RMF, Shivamurthy V, Wong J, et al. Spectrum of imaging findings at chest radiography, US, CT, and MRI in multisystem inflammatory syndrome in children associated with COVID-19. Radiology. 2021;298(1):E1–10.
• 38. McCrindle BW, Manlhiot C. SARS-CoV-2-Related inflammatory multisystem syndrome in children: Different or shared etiology and pathophysiology as kawasaki disease? JAMA. 2020;324(3):246–8.
• 39. Castelnovo L, Capelli F, Tamburello A, Faggioli PM, Mazzone A. Symmetric cutaneous vasculitis in COVID-19 pneumonia. J Eur Acad Dermatol Venereol. 2020;34(8):e362–3.
• 40. Dominguez-Santas M, Diaz-Guimaraens B, Garcia Abellas P, Moreno- Garcia Del Real C, Burgos-Blasco P, Suarez-Valle A. Cutaneous smallvessel vasculitis associated with novel 2019 coronavirus SARS-CoV-2 infection (COVID-19). J Eur Acad Dermatol Venereol. 2020;34(10):e536– 7.
• 41. Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, 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.
• 42. Mayor-Ibarguren A, Feito-Rodriguez M, Quintana Castanedo L, Ruiz- Bravo E, Montero Vega D, Herranz-Pinto P. Cutaneous small vessel vasculitis secondary to COVID-19 infection: a case report. J Eur Acad Dermatol Venereol. 2020;34(10):e541–2.
• 43. Sajjan VV, Lunge S, Swamy MB, Pandit AM. Livedo reticularis: A review of the literature. Indian Dermatol Online J. 6(5):315–21.
• 44. Llamas-Velasco M, Muñoz-Hernández P, Lázaro-González J, Reolid- Pérez A, Abad-Santamaría B, Fraga J, et al. Thrombotic occlusive vasculopathy in a skin biopsy from a livedoid lesion of a patient with COVID-19. Br J Dermatol. 2020;183(3):591–3.
• 45. 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(4):844–7.
• 46. Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic manifestation of COVID-19: Transient livedo reticularis. J Am Acad Dermatol. 2020;83(2):700. 47. Launay E, Gras-Le Guen C, Martinot A, Assathiany R, Blanchais T, Mourdi N, et al. Suboptimal care in the initial management of children who died from severe bacterial infection: a population-based confidential inquiry. Pediatr Crit Care Med. 2010;11(4):469–74.
• 48. Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006;367(9508):397–403.
• 49. 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(2):207–15.
• 50. Hughes M, Herrick AL. Raynaud’s phenomenon. Best Pract Res Clin Rheumatol. 2016;30(1):112–32.
• 51. Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Takeshita J, 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):486–92.
• 52. Docampo-Simón A, Sánchez-Pujol MJ, Juan-Carpena G, Palazón- Cabanes JC, Vergara-De Caso E, Berbegal L, 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):e445–7.
• 53. Duong TA, Velter C, Rybojad M, Comte C, Bagot M, Sulimovic L, et al. Did Whatsapp® reveal a new cutaneous COVID-19 manifestation? J Eur Acad Dermatol Venereol. 2020;34(8):e348–50.
• 54. Colonna C, Genovese G, Monzani NA, Picca M, Boggio F, Gianotti R, 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):965–9.
• 55. Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020;37(3):406–11.
• 56. Wollina U, Karadağ AS, Rowland-Payne C, Chiriac A, Lotti T. Cutaneous signs in COVID-19 patients: A review. Dermatol Ther. 2020;33(5):e13549.
• 57. Gaspari V, Neri I, Misciali C, Patrizi A. COVID-19: how it can look on the skin. Clinical and pathological features in 20 COVID-19 patients observed in Bologna, north-eastern Italy. J Eur Acad Dermatol Venereol. 2020;34(10):e552–3.
• 58. Garcia-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz- Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. 2020;33(5):e13516.
• 59. El Hachem M, Diociaiuti A, Concato C, Carsetti R, Carnevale C, Ciofi Degli Atti M, et al. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblainlike lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. 2020;34(11):2620–9.
• 60. Yan Y, Chen H, Chen L, Cheng B, Diao P, Dong L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatol Ther. 2020;33(4):e13310.
• 61. Jiang Q, Song S, Zhou J, Liu Y, Chen A, Bai Y, et al. The prevalence, characteristics and prevention status of skin injury caused by personal protective equipment among medical staff in fighting COVID-19: A multicenter, cross-sectional study. Adv wound care. 2020;9(7):357–64.
• 62. Lan J, Song Z, Miao X, Li H, Li Y, Dong L, et al. Skin damage among health care workers managing coronavirus disease-2019. J Am Acad Dermatol. 2020;82(5):1215–6.
• 63. Hu K, Fan J, Li X, Gou X, Li X, Zhou X. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine (Baltimore). 2020;99(24):e20603.
• 64. Elston DM. Occupational skin disease among health care workers during the coronavirus (COVID-19) epidemic. J Am Acad Dermatol. 2020;82(5):1085–6.
• 65. Oranges T, Janowska A, Dini V. Reply to: “Skin damage among health care workers managing coronavirus disease-2019”. J Am Acad Dermatol. 2020;82(6):e233–4.
• 66. Kantor J. Behavioral considerations and impact on personal protective equipment use: Early lessons from the coronavirus (COVID-19) pandemic. J Am Acad Dermatol. 2020;82(5):1087–8.
• 67. American Academy of Dermatology. Preventing and treating occupationally induced dermatologic conditions during COVID-19. Available at: https://www. aad.org/public/diseases/coronavirus/ occ-induced/ Accessed March 21,2021.
• 68. Türsen Ü, Türsen B, Lotti T. Cutaneous sıde-effects of the potential COVID-19 drugs. Dermatol Ther. 2020;33(4):e13476.