Identification, Mechanism, and Treatment of Skin Lesions in COVID-19: A Review

Abstract

Coronavirus disease 2019 (COVID-19) is a multisystem disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), that primarily causes respiratory symptoms. However, an increasing number of cutaneous manifestations associated with this disease have been reported. The aim of this study is to analyze the scientific literature on cutaneous manifestations associated with SARS-CoV-2 by means of a narrative literature review until June 2021. The search was conducted in the following electronic databases: Medline (PubMed), SciELO, and Cochrane Library Plus. The most common cutaneous manifestations in patients with COVID-19 are vesicular eruptions, petechial/purpuric rashes, acral lesions, liveoid lesions, urticarial rash, and maculopapular-erythematous rash. These manifestations may be the first presenting symptoms of SARS-CoV-2 infection, as is the case with acral lesions, vesicular eruptions, and urticaria. In relation to severity, the presence of liveoid lesions may be associated with a more severe course of the disease. Treatment used for dermatological lesions includes therapy with anticoagulants, corticosteroids, and antihistamines. Knowledge of the dermatologic manifestations associated with SARS-CoV-2 contributes to the diagnosis of COVID-19 in patients with skin lesions associated with respiratory symptoms or in asymptomatic patients. In addition, understanding the dermatologic lesions associated with COVID-19 could be useful to establish a personalized care plan.

Keywords: COVID-19; SARS-CoV-2; coronaviruses; cutaneous manifestations; skin lesions.

Figure 1

COVID-19 and skin manifestations.

Figure 2

Vesicular lesions associated with COVID-19. (I) Vesicular eruptions associated with COVID-19; (II) skin biopsy with spongiotic vesicular eruption. HE × 10. Arias-Arguello A. (2020) [32].

Figure 3

Purpura associated with COVID-19. (I) Purpuric lesions on the lower extremities; (II) purpuric plaques on the leg. García-Molina C. (2020) [38].

Figure 4

COVID fingers. (I) COVID-19 toes; (II) mixed pattern composed of dactyliotis and macula papules purpura. Arias-Arguello A. (2020) [32].

Figure 5

Livedo reticularis associated with COVID-19. (I) Livedo reticularis in the plantar region; (II) skin biopsy showing pauci-inflammatory thrombogenic vasculopathy (HE × 400). Arias Arguello A. (2020) [32].

Figure 6

Vascular damage by COVID-19. (I) Livedoid lesions or necrosis pattern as a consequence of a vasculopathy; (II) skin biopsy with focal thrombosis (arrow) in the papillary dermis capillaries and extravasation of hematomas (HE × 100). Singh H. et al. (2021) [22].

Figure 7

Urticarial Rash. (I) Urticarial rash, similar to hives, appearing on patient’s neck and chest; (II) urticarial lesions dispersed along buttocks and proximal lower extremity (thigh); (III) urticarial pattern with mild edema, perivascular inflammation, and dilated vessels in the upper dermis. Inset: vessels filled with neutrophils and mixed perivascular inflammation. Singh H. et al. (2021) [22].

Figure 8

Maculopapular-erythematous rash. (I) Maculopapular lesions described as small plaques after fusion of the lesions; (II) maculopapular rash appearing on the posterior trunk; (III) skin biopsy showing clusters of apoptotic keratinocytes in the epidermis (arrow). Singh H. et al. (2021) (I,II) [22] and Arias Arguello A. (2020) (III) [32].

Figure 9

Papule-squamous eruption. * Papule-squamous eruption in abdomen. Sanchez J. et al. (2020) [53].