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Review

Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review

1
Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy
2
Dermatology Section, Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy
3
Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy
4
Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy
5
Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania
*
Author to whom correspondence should be addressed.
Biology 2020, 9(12), 449; https://doi.org/10.3390/biology9120449
Received: 3 November 2020 / Revised: 2 December 2020 / Accepted: 3 December 2020 / Published: 5 December 2020
(This article belongs to the Special Issue Coronavirus Disease 2019 (COVID-19))
Patients diagnosed with COVID-19 and concomitant skin rashes have been frequently reported. We summarized the cases described to date, including only patients with positive RT-PCR testing from nasopharyngeal swabs. Six hundred and fifty-five patients were found who presented different types of skin rashes, from maculopapular, vascular, vesicular, urticarial, to atypical forms and ocular involvement. Chilblains which are lesions resembling frostbite have been more frequent in the younger population and seemed to predict a milder disease course. Vascular-purpuric lesions appeared in older patients and were linked to a more severe evolution. In the case of vesicular rashes, the possibility of herpesvirus co-infections was raised. Moreover, cutaneous hydroxychloroquine drug reactions have been described. For patients with conjunctivitis, eye discharge might be contagious. These skin manifestations may help identify asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.
There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others. View Full-Text
Keywords: COVID-19; novel coronavirus; skin rash; cutaneous manifestations; histopathology; ocular COVID-19; novel coronavirus; skin rash; cutaneous manifestations; histopathology; ocular
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MDPI and ACS Style

Conforti, C.; Dianzani, C.; Agozzino, M.; Giuffrida, R.; Marangi, G.F.; di Meo, N.; Morariu, S.-H.; Persichetti, P.; Segreto, F.; Zalaudek, I.; Neagu, N. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. Biology 2020, 9, 449. https://doi.org/10.3390/biology9120449

AMA Style

Conforti C, Dianzani C, Agozzino M, Giuffrida R, Marangi GF, di Meo N, Morariu S-H, Persichetti P, Segreto F, Zalaudek I, Neagu N. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. Biology. 2020; 9(12):449. https://doi.org/10.3390/biology9120449

Chicago/Turabian Style

Conforti, Claudio, Caterina Dianzani, Marina Agozzino, Roberta Giuffrida, Giovanni Francesco Marangi, Nicola di Meo, Silviu-Horia Morariu, Paolo Persichetti, Francesco Segreto, Iris Zalaudek, and Nicoleta Neagu. 2020. "Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review" Biology 9, no. 12: 449. https://doi.org/10.3390/biology9120449

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