COVID-19-specific skin changes related to SARS-CoV-2: Visualizing a monumental public health challenge

The Pandemic and Your Skin—Direct and Indirect Impact of COVID-19

Apart from well-known respiratory symptoms, less frequent symptoms also appear as a direct result of COVID-19 infection, or as indirect effects of the recommended quarantine and related lifestyle changes. The impact of the COVID-19 pandemic on human skin is predominantly focused on in this article. Cutaneous manifestations, including redness, chilblain-like symptoms (COVID toes), hives or urticaria rash, water blisters, and fishing net-like red-blue patterns on the skin, may appear as accompanying or as systemic COVID-19 symptoms with potential lesions at different skin sites. These symptoms were related to skin phototypes and vitamin D deficiency. Moreover, Black, Asian, and minority ethnic origin patients are found to be more sensitive to COVID-19 infection than Caucasians because of vitamin D deficiency. The region of population with lighter skin phototypes have a significantly higher chance to develop cutaneous manifestations than population with dark skin. In addition, adverse effects, such as skin barrier damage and irritation, may also occur due to extensive personal protective equipment usage (e.g., masks, protective suits, and a few others) and predominately alcohol-based sanitizers. This manuscript covers various aspects of COVID-19 and its clinical skin manifestations.

Cutaneous Manifestations Associated with COVID-19 Infection in a COVID-Designated Hospital in North Chennai - A Descriptive Cross-Sectional Study

Background

Coronavirus disease 2019 (COVID-19) affects different organ systems, including the skin. There are reports on cutaneous manifestations of COVID-19 available in the literature. In this study, we have tried to describe the dermatological signs of COVID-19 in different categories of patients.

Materials and Methods

A descriptive cross sectional study was conducted to describe various cutaneous manifestations of COVID-19 in different categories of reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 patients in a COVID-designated tertiary care hospital. Approval was obtained from the Institutional Ethical Committee, and 5460 RT-PCR-confirmed COVID-19-positive patients were included under five categories. Investigators following a strict COVID protocol examined and documented the findings. Investigations and treatment were carried out as per the protocol, and the study was conducted for a period of 6 months.

Results

Out of the 5460 patients studied, 1.9% patients had cutaneous manifestations. Vasculitis (24%) and maculo papular rash (19%) were the common findings. The incidence of vasculitis was 44.4%, 61%, and 6.6% in categories A, B, and C, respectively. Maculopapular rash and urticaria were the common findings in categories D and E, respectively. COVID digit was seen in only one case. Other manifestations such as acne, adverse drug reaction, erythroderma, and bullous disorders were also noted.

Conclusion

Cutaneous manifestations because of vascular pathology were the most common association in severe COVID-19, which indicates that the presence of vasculitic skin signs correlated with disease severity and elevated d-dimer values. Urticaria and maculo-papular rash were transient and did not give any clue to the diagnosis or severity of the disease.

[Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]

Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).