Skin manifestations of COVID-19 – part I

A round-up of the key findings from the latest medical studies focusing on the dermatological manifestations of COVID-19, covering type of symptoms, onset and duration.

Like Comment

Content


You may also be interested in

Image library

The dermatological signs of COVID-19

>> Access the image library


Long COVID in the skin: a registry analysis of COVID-19 dermatological duration

Dataset: 331 laboratory-confirmed or suspected COVID-19 cases with dermatological manifestations from 41 countries that were reported in the international registry for COVID-19 dermatological manifestations, which was set up in April 2020.

Key findings

  • Urticarial and morbilliform eruptions were relatively ephemeral.
  • Papulosquamous eruptions, and particularly pernio, were longer-lasting.

Median duration of dermatological manifestations among patients with laboratory-confirmed COVID-19:

  • Morbilliform rashes: 7 days — maximum duration 28 days
  • Urticarial eruptions: 4 days — maximum duration 28 days
  • Papulosquamous eruptions: 20 days — one case lasted 70 days.
  • Pernio: 12 days — in patients with suspected COVID-19: 15 days. In 7 (6.8%) of the 103 cases with pernio, the condition lasted > 60 days.

Pernio – 2 case descriptions:

  • Patient presenting with 20 days of cough and fatigue and 13 days of pernio lesions
    • Initially tested negative for COVID-19 by SARS-CoV-2 nasopharyngeal PCR, serum IgM, and IgG
    • Seroconverted to anti-SARS-CoV-2 IgM positivity within 6 weeks after pernio onset
    • Continued to experience severe pernio and fatigue for > 133 days.
  • Patient who developed pernio and livedo reticularis 1 month after exposure to a SARS-CoV-2 nasopharyngeal PCR-positive family member
    • Tested positive for SARS-CoV-2 serum IgG 1 month after pernio lesion onset
    • Continued to experience pernio and livedo reticularis lesions for > 150 days.

Read the research in The Lancet
Back to top

An itchy erythematous papular skin rash as a possible early sign of COVID-19: a case report

Key findings

Skin manifestations, when taken into account with other situational factors (such as profession and patient history), should be taken into proper consideration by frontline physicians as possibly being caused by SARS-CoV-2.

Case description

  • Italian 32-year-old female nurse who had several close contacts with multiple patients with COVID-19 as part of her professional workload.
  • She developed an itchy, erythematous papular rash – sparing only her face, scalp, and abdomen – which lasted for 10 days.
  • The rash was accompanied by a feeling of general fatigue that gradually worsened over the following days and has continued for 5 months.
  • During the first week of remote assessment carried out by her GP, the patient gradually developed a dry cough, intermittent fever, and diarrhoea and then had a positive test result for SARS-CoV-2.
  • Her skin manifestations disappeared completely 48 days after the onset of the disease, followed by the disappearance of the dry cough.

Read the research in The Journal of Medical Case Reports
Back to top

Enanthem in patients with COVID-19 and skin rash

Key findings

  • Pustular morphology and dusky lesions are suggestive of drug aetiology, while petechial or vesicular pattern, involvement of buttocks or acral sites, and enanthem suggest an infectious aetiology, especially viral.
  • Enanthems may present with petechiae, macules, papules, or vesicles in the mouth.
  • Erythemato-vesicular and petechial patterns were most commonly associated with viral infections, the latter being more frequent in adults.
  • The presence of enanthem is a strong clue that suggests a viral aetiology rather than a drug reaction, especially when a petechial pattern is observed.

Read the research in JAMA Dermatology
Back to top

Clinical and histological characterisation of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital

Key findings

Out of 24 patients, diagnosed with COVID‐19 and vesicular lesions, and who were included in this prospective observational study:

  • 19 (79.2%) developed the skin rash after the onset of COVID-19 symptoms.
  • 18 patients (75%) had a disseminated pattern
  • 6 (25%) had a localized pattern
  • Median duration of the skin rash was 10 days.

Read the research in Clinical and Experimental Dermatology
Back to top

Cutaneous manifestations in SARS-CoV-2 infection (COVID-19): a French experience and a systematic review of the literature

Key findings

  • 8 patients (1%, 6 males, 2 females, mean age 55.6) presented with skin lesions,
  • Lesions were mainly disseminated maculo‐papular exanthema, but also digitate papulo‐squamous rash (reported in 1), herpes recurrence, papulo‐vesicular rash and Grover’s disease.
  • Mean delay between respiratory/systemic and dermatological signs was 13 days.

Read the research in JEADV
Back to top

Cutaneous manifestations of SARS-CoV-2 infection: a clinical update

Key findings

The patterns of dermatological manifestations associated with SARS‐CoV‐2 infection could be classified into four categories:

  • Exanthema (varicella‐like, papulo‐vesicular and morbilliform rash),
  • Vascular (chilblain‐like, purpuric/petechial and livedoid lesions),
  • Urticarial
  • Acro‐papular eruption

Read the research in JEADV
Back to top

How to deal with post-viral cutaneous eruptions in the era of coronavirus infection

Key findings

  • Virally induced immune-mediated skin eruptions occur in patients that have negligible symptoms of a systemic viral disease.
  • These observations hint at the possible role of specific genetic factors that, while a predisposition to the development of skin eruptions, may protect from severely symptomatic presentations of coronavirus infection.
  • There may be a relationship between SARS-CoV-2 and virus-induced skin conditions that may help identify asymptomatic carriers of the virus.

Read the research in Frontiers in Medicine
Back to top

Focus on "COVID Toes"

Key findings

  • Worldwide case collections of cutaneous manifestations of COVID-19 are showing acral lesions (similar to classic chilblains) as one of the reported patterns.
  • Also known as pernio-like, pseudo-chilblain, acute acro-ischemia, and “COVID toes,” the pattern of acral lesions is described as erythematous to purple purpuric macules, papules, and/or vesicles.
  • It is still unclear whether a viral cytopathic process vs a viral reaction pattern or other mechanism is responsible.

Read the research in JAMA Dermatology
Back to top

Unraveling the mystery of COVID-19 cytokine storm: from skin to organ systems

Key findings

  • Clinically, many of the skin lesions on COVID-19 are likely secondary to occlusion of small to medium blood vessels due to microthrombi formation or due to viral laden antigen‐antibody immune complexes.
  • Therefore, a similar mechanism may underlie the possible hypoxemic injury simultaneously occurring in other vital organs like lungs, heart, brain and kidneys.

Read the research in Dermatologic Therapy
Back to top


You may also be interested in

Image library

The dermatological signs of COVID-19

>> Access the image library

OnMedica

Editorial team, Wilmington Healthcare

OnMedica provides high-quality, easy to digest content and CPD for UK-based GPs and clinicians. Our team of expert editors and clinicians develops content across a wide range of topics in a variety of formats—expert articles, bitesize news and quizzes, courses, videos, and more. You can explore OnMedica via the homepage, drop down menu or by typing your topic of choice in the search bar. Why not find out how OnMedica can help you to keep up to date quickly and easily?
3794 Contributions
221 Followers
1 Following