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Mashayekhi F, Seirafianpour F, Pour Mohammad A, Goodarzi A. Severe and life-threatening COVID-19-related mucocutaneous eruptions: A systematic review. Int J Clin Pract 2021; 75:e14720. [PMID: 34411409 PMCID: PMC8420487 DOI: 10.1111/ijcp.14720] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Earlier diagnosis and the best management of virus-related, drug-related or mixed severe potentially life-threatening mucocutaneous reactions of COVID-19 patients are of great concern. These patients, especially hospitalised cases, are usually in a complicated situation (because of multi-organ failures), which makes their management more challenging. In such consultant cases, achieving by the definite beneficial management strategies that therapeutically address all concurrent comorbidities are really hard to reach or even frequently impossible. METHODS According to the lack of any relevant systematic review, we thoroughly searched the databases until 5 October 2020 and finally found 57 articles including 93 patients. It is needed to know clinical presentations of these severe skin eruptions, signs and symptoms of COVID in these patients, time of skin rash appearance, classifying drug-related or virus-related skin lesions, classifying the type of skin rash, patients' outcome and concurrent both COVID-19 therapy and skin rash treatment. RESULT Severe and potential life-threatening mucocutaneous dermatologic manifestations of COVID-19 usually may be divided into three major categories: virus-associated, drug-associated, and those with uncertainty about the exact origin. Angioedema, vascular lesions, toxic shock syndrome, erythroderma, DRESS, haemorrhagic bulla, AGEP, EM, SJS and TEN, generalised pustular figurate erythema were the main entities found as severe dermatologic reactions in all categories. CONCLUSION We can conclude vascular injuries may be the most common cause of severe dermatologic manifestations of COVID-19, which is concordant with many proposed hypercoagulation tendencies and systemic inflammatory response syndrome as one of the most important pathomechanisms of COVID-19 so the skin may show these features in various presentations and degrees.
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Affiliation(s)
- Farzaneh Mashayekhi
- Department of General MedicineRasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
| | - Farnoosh Seirafianpour
- Student Research CommitteeSchool of MedicineIran University of Medical SciencesTehranIran
| | - Arash Pour Mohammad
- Student Research CommitteeSchool of MedicineIran University of Medical SciencesTehranIran
| | - Azadeh Goodarzi
- Department of DermatologyRasool Akram Medical ComplexIran University of Medical Sciences (IUMS)TehranIran
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Mohseni Afshar Z, Babazadeh A, Hasanpour A, Barary M, Sayad B, Janbakhsh A, Aryanian Z, Ebrahimpour S. Dermatological manifestations associated with COVID-19: A comprehensive review of the current knowledge. J Med Virol 2021; 93:5756-5767. [PMID: 34241899 PMCID: PMC8427109 DOI: 10.1002/jmv.27187] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a significant health problem globally. The virus has spread widely and become a global pandemic. The pathophysiology for SARS-CoV-2 has not been explained clearly. It has been associated with several multiorgan symptoms, among which its dermatological manifestations are of great interest. Primarily, there has been no report of skin features among COVID-19 patients. Nevertheless, recently there have been several reports regarding COVID-19 patients who presented with cutaneous manifestations. In the current review, we focus on the various cutaneous manifestations of COVID-19 infection.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
| | | | - Mohammad Barary
- Student Research CommitteeBabol University of Medical SciencesBabolIran
| | - Babak Sayad
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
- Department of Dermatology, School of MedicineBabol University of Medical SciencesBabolIran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
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Schwartzberg L, Advani S, Clancy D, Lin A, Jorizzo J. A systematic review of dermatologic manifestations among adult patients with COVID-19 diagnosis. SKIN HEALTH AND DISEASE 2021; 1:e20. [PMID: 34235511 PMCID: PMC8250095 DOI: 10.1002/ski2.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Infection with COVID-19 is characterized by respiratory, gastrointestinal and neurologic symptoms. However, limited evidence exists of the involvement of the integumentary system among COVID-19 patients and evidence suggests that these symptoms may even be the first presenting sign. OBJECTIVE To systematically evaluate the literature published on dermatologic signs of COVID-19 in order to educate doctors about the dermatologic signs of COVID-19 infection. METHODS Lit COVID, World Health Organization COVID-19 database and PubMed were searched using terminology to identify adult patients with confirmed COVID-19 infection and dermatologic manifestations of disease. The last search was completed on 13 July 2020. RESULTS There were 802 reports found. After exclusion, 20 articles were found with 347 patients with confirmed COVID-19 infection. Within these articles, 27 different skin signs were reported. LIMITATIONS Limitations of this review include the recency of COVID-19 infection; so, there are limited published reports and that many reports are not by dermatologists, and so, the cutaneous signs may be misdiagnosed or misdescribed. CONCLUSION Dermatologic manifestations of COVID-19 may be the first presenting sign of infection; so, dermatologists and doctors examining the skin should be aware of the virus's influence on the integumentary system in order to promptly diagnose and treat the infected patients.
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Affiliation(s)
- L.N. Schwartzberg
- New York Institute of Technology College of Osteopathic MedicineNew YorkUSA
| | - S. Advani
- Terasaki Institute of Biomedical InnovationLos AngelesCaliforniaUSA
| | - D.C. Clancy
- New York Institute of Technology College of Osteopathic MedicineNew YorkUSA
| | - A. Lin
- Department of DermatologySt. John's Episcopal HospitalNew YorkUSA
| | - J.L. Jorizzo
- Department of DermatologyWake Forest Baptist HealthWinston‐SalemNorth CarolinaUSA
- Weill Cornell Medicine DermatologyNew YorkUSA
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Gisondi P, Di Leo S, Bellinato F, Cazzaniga S, Piaserico S, Naldi L. Time of Onset of Selected Skin Lesions Associated with COVID-19: A Systematic Review. Dermatol Ther (Heidelb) 2021; 11:695-705. [PMID: 33811315 PMCID: PMC8018690 DOI: 10.1007/s13555-021-00526-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Distinct skin lesions associated with coronavirus disease 2019 (COVID-19) have been described, but data regarding their time of onset during the COVID-19 course are scant. Our objective was to systematically review the studies reporting the time of onset of selected skin lesions with respect to the reported onset of the COVID-19 core symptoms. METHODS A comprehensive search of studies published before 21 January 2021 was performed on MEDLINE via PubMed database using a predefined strategy to identify relevant articles. RESULTS Out of 354 references, 87 were selected, reporting a total of 895 patients with skin lesions associated with COVID-19. The most frequent pattern was exanthema (n = 430, 48%), followed by vascular (n = 299, 33%), urticarial (n = 105, 12%) and others (n = 66, 7%). Skin lesions occurred more frequently in the first 4 weeks from the COVID-19 onset (n = 831, 92%), whereas prodromal or late lesions were rarer (n = 69, 8%). The urticarial and exanthema patterns were more frequent in the first 2 weeks. About the vascular pattern some differences were noted among its subtypes. Livedoid lesions occurred mainly in the first 2 weeks, while chilblain-like lesions between weeks 2 and 4. Purpuric/petechial lesions were equally distributed during the first 4 weeks. Several skin manifestations did not fall into the pattern classification, including erythema multiforme, generalized pruritus, Kawasaki disease and others. CONCLUSION The diversity in the time of onset of skin lesions as well as their polymorphic nature likely reflects the diversity of the pathogenetic underlying mechanisms. PROSPERO DATABASE REGISTRATION NUMBER CRD42021236331.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
| | - Sara Di Leo
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Stefano Piaserico
- Section of Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
- Centro Studi GISED, Bergamo, Italy
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Conforti C, Dianzani C, Agozzino M, Giuffrida R, Marangi GF, di Meo N, Morariu SH, Persichetti P, Segreto F, Zalaudek I, Neagu N. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. BIOLOGY 2020; 9:E449. [PMID: 33291502 PMCID: PMC7762103 DOI: 10.3390/biology9120449] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/07/2023]
Abstract
There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Caterina Dianzani
- Dermatology Section, Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy;
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy;
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Silviu-Horia Morariu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Nicoleta Neagu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
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Abdelmaksoud A, Goldust M, Vestita M. Comment on "Cutaneous manifestations of COVID-19: A case report and a new finding from Egypt". Dermatol Ther 2020; 33:e14120. [PMID: 32741063 PMCID: PMC7436207 DOI: 10.1111/dth.14120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Ayman Abdelmaksoud
- Department of Dermatology, Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
| | - Mohamad Goldust
- Department of Dermatology, University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Michelangelo Vestita
- Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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