COVID-19-related oral mucosa lesions among confirmed SARS-CoV-2 patients: a systematic review

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19), which manifests as a flu-like respiratory infection affecting multiple organ systems, including the gastrointestinal system, central nervous system, cardiovascular system, skin, and mucosa. In this review, we investigated the literature on specific manifestations of COVID-19 in the oral mucosa. An online literature search in PubMed, Scopus, Google Scholar, and Medline was conducted to retrieve relevant studies on confirmed COVID-19 patients with oral mucosa findings published between December 31, 2019, and April 07, 2021. After an independent review by two authors, 39 articles considering 59 laboratory-confirmed cases of SARS-CoV-2 infection were included in the final analysis. The most common finding, reported in 29 patients (43.9%), was Kawasaki-like syndrome. In addition, oral ulcers including aphthous, hemorrhagic, and necrotic ulcers were reported in 24 patients (36.3%). Other lesions reported included pustules, macules, bullae, maculopapular enanthema, and erythema multiforme-like lesions. Concomitant skin lesions were present in 60.6% of patients. Fever was reported in 86.2% of patients. Forty-eight patients (76.1%) were hospitalized. Loss of taste and smell was present in 30.8% of the patients. A comprehensive understanding of the dermatologic manifestations of COVID-19 can improve and facilitate patient management and referrals.

FIGURE 1

SARS‐CoV‐2 confirmed cases with oral mucosa findings. (a) A 47‐year‐old woman with a maculopapular rash on admission developed erosions under the tongue and ulcers in the oral mucosa 3 days after diagnosing COVID‐19. (b) A 78‐year‐old man developed herpetiform ulcers unresponsive to valacyclovir on the tongue 10 days after diagnosis. Herpes simplex type I IgM was negative, and IgG was positive with a low titer, and herpes simplex type II IgM and IgG were negative (c). A 53‐year‐old woman developed a red, edematous painful tongue 4 days after PCR and chest CT confirmation of COVID‐19. (d) A 25‐year‐old woman with fever and a maculopapular rash developed cracked lips and erosions on the buccal mucosa. Herpes simplex type I and II antibodies were negative, and repeated SARS‐CoV‐2 PCR was positive on the 7th day of admission

FIGURE 2

Article selection flow chart according to PRISMA guidelines