Sarsa cov 2 skin review jun 25

Cutaneous Manifestations of SARS-CoV-2 Infection

Journal of the European Academy of Dermatology and Venereology: JEADV

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• Review of the literature on cutaneous manifestations of SARS-CoV-2 infection demonstrates four main reaction patterns: exanthema, vascular, urticarial, and acropapular. Exanthema, including varicella-like and morbilliform types, typically have an early onset, beginning either with or shortly after other symptoms. This type of reaction is associated with more severe disease in older patients. Urticarial reactions also tend to occur with an early onset. Vascular-type reactions including chilblain-like lesions, purpura, and livedoid lesions typically have a late onset, as do the acropapular eruptions.

• Early recognition of cutaneous manifestations suggestive of SARS-CoV-2 infection may assist in diagnosis of infection. However, further understanding of the relationship between skin involvement and viral load or impact on prognosis is needed.

– Margaret Hammond, MD

Written by

 

 

Erin E. Boh MD, PhD, FAAD

Throughout the COVID-19 pandemic, various clinical patterns of disease have been reported. This article nicely summarizes the cutaneous clinical patterns which have been reported at different times in the disease course, and which are associated with the duration, severity, and possibly prognosis of COVID-19 infections. Briefly, there are four main patterns: exanthematous, vascular, urticarial, and acral papular.

Exanthematous patterns include varicella-like eruptions and morbilliform eruptions. Approximately 9% have a varicella-like pattern and it is seen more commonly in middle-aged patients with moderate to severe disease. The pruritic morbilliform pattern is seen in older, severely affected patients. In one report, there was a 47% prevalence of morbilliform eruptions. Both patterns appear approximately 3 days after symptoms appear and last up to 8 days.

Vascular patterns include chilblain-like lesions, especially in children ("COVID toes"), livedoid lesions, or purpuric acral lesions. All tend to occur in younger patients. True thrombotic events can occur as well as microvascular dysfunction in various organ systems. These lesions can be asymmetric, edematous, or bullous and are often pruritic or frankly painful. Livedoid lesions occur in mild cases in the young but can occur in older patients, and are associated with severe disease.

Kawasaki disease-like presentation in young patients often is associated with severe disease and worse prognosis. This multisystem inflammatory syndrome has recently been reported in adults and portends worse prognosis.

Acral papular eruptions can be seen with many viral infections, including COVID-19.

Urticarial patterns are seen in adults with more severe disease. It appears around the same time as symptoms develop. This pattern is fairly common (~19%) and is pruritic.

While severe disease diagnosis and management is outside our purview, familiarity with these skin manifestations may be relevant for those patients who are asymptomatic or mildly symptomatic and may persuade one to get tested for infection.

Abstract 

On 11 March 2020, the World Health Organization (WHO) has declared the novel coronavirus disease (COVID-19) a global pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). A consistent number of case reports and clinical series have been already published describing a complex spectrum of skin manifestations associated with the SARS-CoV-2 infection. We carried out a review of the English-language literature up to 20 May 2020, reporting original cases or case series of the cutaneous manifestations of SARS-CoV-2 virus infection. The following databases were consulted: PubMed, Embase, Google Scholar and ResearchGate. The search of papers was conducted by using the key term 'COVID-19' or 'SARS-CoV-2' or 'coronavirus' combined with each of the following: 'skin', 'cutaneous', 'dermatologic' or 'dermatology', 'manifestation', 'lesions', or 'rash'. 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 and acro-papular eruption. Lastly, other skin manifestations to be considered are the cutaneous adverse reactions to the drugs prescribed for the treatment of COVID-19. Whether SARS-CoV-2 infection can directly cause a worsening of chronic inflammatory diseases such as psoriasis or atopic dermatitis remains to be determined. Dermatology's outlook in the COVID-19 pandemic is multidimensional.

Journal of the European Academy of Dermatology and Venereology: JEADV

Cutaneous Manifestations of SARS-CoV-2 Infection: A Clinical Update

J Eur Acad Dermatol Venereol 2020 Jun 25;[EPub Ahead of Print], P Gisondi, S PIaserico, C Bordin, M Alaibac, G Girolomoni, L Naldi 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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