COVID-19-associated dermatologic manifestations

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2] Ogechukwu Hannah Nnabude, MD

Overview

Skin rashes have been uncommonly described in patients with COVID-19. Descriptions include:

An erythematous exanthem (including a lacy pattern and a petechial, dengue-like rash); a)Livedo reticularis b)Cutaneous vasculitis c)Acute urticaria d)Chickenpox-like blisters

CUTEANEOUS MANIFESTATIONS

The most common cutaneous manifestation of COVID-19 was found to be maculopapular exanthem (morbilliform), presenting in 36.1% (26/72) patients. The other cutaneous manifestations included: a papulovesicular rash (34.7%, 25/72), urticaria (9.7%, 7/72), painful acral red purple papules (15.3%, 11/72) of patients, livedo reticularis lesions (2.8%, 2/72) and petechiae (1.4%, 1/72). Majority of lesions were localized on the trunk (66.7%, 50/72), however, 19.4% (14/72) of patients experienced cutaneous manifestations in the hands and feet. Skin lesion development occurred before the onset of respiratory symptoms or COVID-19 diagnosis in 12.5% (9/72) of the patients, and lesions spontaneously healed in all patients within 10 days. Majority of the studies reported no correlation between COVID-19 severity and skin lesions.

Lesions may be classified as acral areas of erythema with vesicles or pustules (Pseudo‐chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptionThe most common cutaneous manifestation of COVID-19 was found to be maculopapular exanthem (morbilliform), presenting in 36.1% (26/72) patients. The other cutaneous manifestations included: a papulovesicular rash (34.7%, 25/72), urticaria (9.7%, 7/72), painful acral red purple papules (15.3%, 11/72) of patients, livedo reticularis lesions (2.8%, 2/72) and petechiae (1.4%, 1/72). Majority of lesions were localized on the trunk (66.7%, 50/72), however, 19.4% (14/72) of patients experienced cutaneous manifestations in the hands and feet. Skin lesion development occurred before the onset of respiratory symptoms or COVID-19 diagnosis in 12.5% (9/72) of the patients, and lesions spontaneously healed in all patients within 10 days. Majority of the studies reported no correlation between COVID-19 severity and skin lesions. Lesions s (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo‐chilblain pattern frequently appears late in the evolution of the COVID‐19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID‐19. Severity of COVID‐19 shows a gradient from less severe disease in acral lesions to most severe in the latter groups. Results are similar for confirmed and suspected cases, both in terms of clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo‐chilblain and vesicular).

COVID-19 Toes

“COVID TOES” and Other Skin Changes of COVID-19 There have been many reports that the COVID-19 virus can have effects on the skin. The first official reports came out of Italy and were published in March 2020 that about 20% of patients with COVID-19 were experiencing skin issues. The skin changes related to COVID-19 can look many different ways, and we are learning more about this almost on a daily basis. There have been reports of the following skin changes with COVID-19: “Covid toes” (or covid hands) – similar to the type of cold related changes we have seen in the feet of people for many years, but often occurring in places where the conditions are not cold and damp. These seem to happen more commonly in younger patients. Rash with our without small blisters Widespread hives (urticaria) Small bruises and broken blood vessels (petechiae) Although these skin findings are not currently listed as symptoms to look out for that should make you consider getting tested for COVID-19, you may want to add them to your list of things to look out for. As time goes on, we will likely have more information about why these skin changes happen with COVID-19 and when in the timing of exposure to the virus do they seem to occur.