A comprehensive narrative review of the cutaneous manifestations associated with COVID-19

Abstract

The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID-19) include fever, coughing, sneezing, sore throat, rhinitis, dyspnea, chest pain, malaise, fatigue, anorexia and headache. Moreover, cutaneous manifestations have been reported in 0.2% to 20.4% of cases. Early diagnosis of COVID-19 leads to a better prognosis; knowledge of its cutaneous manifestations is one way that may help fulfil this goal. In this review, PubMed and Medline were searched with the terms "dermatology", "skin" and "cutaneous", each in combination with "SARS-CoV-2" or "COVID-19". All articles, including original articles, case reports, case series and review articles published from the emergence of the disease to the time of submission, were included. In this comprehensive narrative review, we tried to provide an analysis of the cutaneous manifestations associated with COVID-19, including maculopapular rash, urticaria, Chilblain-like, vesicular lesions, livedo reticularis and petechiae in asymptomatic/symptomatic COVID-19 patients that might be the first complication of infection after respiratory symptoms. Immune dysregulation, cytokine storms, side effects of antiviral drugs, environmental conditions and high-dose intravenous immunoglobulin (IVIG) therapy might be involved in the pathogenesis of the cutaneous manifestations in COVID-19 patients. Therefore, knowledge of cutaneous COVID-19 manifestations might be vital in achieving a quick diagnosis in some COVID-19 patients, which would help control the pandemic. Further research is very much warranted to clarify this issue.

Keywords: COVID-19; SARS-CoV-2; chilblain-like; cutaneous manifestations; livedo reticularis; maculopapular rash; petechiae; urticaria; vesicular lesions.

FIGURE 1

Histopathology of the main cutaneous patterns in COVID‐19 patients. (A) Maculopapular rash, Skin biopsy showed epidermal spongiosis(blue arrow), lymphocytic exocytosis, dermal infiltrate of eosinophils, lymphocytes and histocytosis (black arrow). (B) and (C) Urticaria, Skin biopsy showed superficial dermal edema, dilatation of small blood vessels with few eosinophils infiltration (blue arrow). (D) and (E) Vasculitis, Skin biopsy showed inflammatory infiltrate in wall of dermal vessels (blue arrow), red blood cell extravasation (red arrow), viriable fibrinoid necrosis of vessel walls.