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Zaborska M, Chruszcz M, Sadowski J, Klaudel T, Pelczarski M, Sztangreciak-Lehun A, Bułdak RJ. The most common skin symptoms in young adults and adults related to SARS-CoV-2 virus infection. Arch Dermatol Res 2024; 316:292. [PMID: 38819524 PMCID: PMC11142985 DOI: 10.1007/s00403-024-02991-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024]
Abstract
Scientists from various areas of the world indicate in their studies that skin lesions occur in the course of infection with the SARS-CoV-2 virus. This article is a review of the most frequently described cutaneous manifestations of SARS-CoV-2 virus infection and the potential pathophysiology of their development, as well as information on abnormalities in histopathological tests. The article describes the impact of some factors related to the COVID-19 pandemic on the exacerbation of chronic dermatological diseases. This work was constructed on the basis of 142 research studies, reviews, and meta-analyses, focusing on the methods and materials used in individual works as well as the results and conclusions resulting from them. Some skin lesions may be a potential prognostic marker of the course of the disease and may also be a prodromal symptom or the only symptom of SARS-CoV-2 virus infection. Stress related to the COVID-19 pandemic may exacerbate some chronic dermatological diseases. A correlation was observed between the type of skin lesions and the patient's age. The occurrence of skin diseases may also be influenced by drugs used to treat infections caused by SARS-CoV-2. A relationship was observed between the patient's ethnic origin and skin lesions occurring in the course of COVID-19. There is a need to further diagnose the cutaneous manifestations of SARS-CoV-2 infection and to learn the detailed pathomechanism of their occurrence in order to better understand the essence of the disease and find an appropriate treatment method.
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Affiliation(s)
- Monika Zaborska
- Student Scientific Society of Clinical Biochemistry and Regenerative Medicine, Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland.
| | - Maksymilan Chruszcz
- Student Scientific Society of Clinical Biochemistry and Regenerative Medicine, Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland
| | - Jakub Sadowski
- Student Scientific Society of Clinical Biochemistry and Regenerative Medicine, Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland
| | - Tomasz Klaudel
- Student Scientific Society of Clinical Biochemistry and Regenerative Medicine, Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland
| | - Michał Pelczarski
- Student Scientific Society of Clinical Biochemistry and Regenerative Medicine, Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland
| | - Anna Sztangreciak-Lehun
- Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland
| | - Rafał Jakub Bułdak
- Department of Clinical Biochemistry and Laboratory Diagnostics, Institute of Medical Sciences, University of Opole, Oleska 48, 45-052, Opole, Poland
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Ramalho ADO, Fonseca RAG, Mazócoli E, Marin A, Nogueira PC. Incidence and risk factors of pressure injuries in critically ill patients with COVID-19. Rev Bras Enferm 2023; 76Suppl 1:e20220553. [PMID: 38055426 DOI: 10.1590/0034-7167-2022-0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/27/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs. METHOD a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI. RESULTS PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001). CONCLUSION PI incidence in critically ill patients with COVID-19 was high.
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Sandhu J, Miller C, Kapp S. Characteristics of COVID-19 patients who developed pressure injuries: a scoping review. J Wound Care 2023; 32:S9-S16. [PMID: 36930283 DOI: 10.12968/jowc.2023.32.sup3.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients. METHOD A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included. RESULTS In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3-77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment. CONCLUSION PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.
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Affiliation(s)
- Julie Sandhu
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
| | - Charne Miller
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
- School of Nursing & Midwifery, La Trobe University, Melbourne, Australia
| | - Suzanne Kapp
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
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Pendlebury GA, Oro P, Haynes W, Merideth D, Bartling S, Bongiorno MA. The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review. Dermatopathology (Basel) 2022; 9:212-243. [PMID: 35892480 PMCID: PMC9326733 DOI: 10.3390/dermatopathology9030027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.
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Affiliation(s)
- Gehan A. Pendlebury
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Peter Oro
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - William Haynes
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Drew Merideth
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Samantha Bartling
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| | - Michelle A. Bongiorno
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
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Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, Ohura N, Waters N, Worsley P, Black J, Barakat-Johnson M, Beeckman D, Fletcher J, Kirkland-Kyhn H, Lahmann NA, Moore Z, Payan Y, Schlüer AB. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care 2022; 31:S1-S72. [PMID: 35616340 DOI: 10.12968/jowc.2022.31.sup3a.s1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Amit Gefen
- Professor of Biomedical Engineering, The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Paulo Alves
- Assistant Professor and Coordinator, Wounds Research Laboratory, Catholic University of Portugal, Institute of Health Sciences, Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Guido Ciprandi
- Chief Wound Care, Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Fiona Coyer
- Professor of Nursing (joint appointment), Intensive Care Services, Royal Brisbane and Women's Hospital, School of Nursing, Queensland University of Technology, Brisbane, Australia. Visiting Professor, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, Bristol Hospital Wound and Hyperbaric Medicine, Bristol, Connecticut, US
| | - Karen Ousey
- Professor of Skin Integrity, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, Huddersfield University, UK; Clinical Professor, Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Norihiko Ohura
- Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada; Adjunct Professor, School of Nursing, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Peter Worsley
- Associate Professor in Rehabilitative Bioengineering, Clinical Academic Facility in the School of Health Sciences, University of Southampton, UK
| | - Joyce Black
- Professor, College of Nursing, University of Nebraska Medical Center. Nebraska, US
| | - Michelle Barakat-Johnson
- Clinical Lead and Skin Integrity Lead, HAC Pressure Injury Coordinator, Sydney Local Health District; Adj Associate Professor, Faculty of Medicine and Health, University of Sydney, Australia
| | - Dimitri Beeckman
- Professor, Skin Integrity Research Group (SKINT), Ghent University, Belgium; Professor and Vice-Head, School for Research and Internationalisation, Örebro University, Sweden
| | | | | | - Nils A Lahmann
- Deputy Director, Geriatrics Research Group, Charité University Berlin, Germany
| | - Zena Moore
- Professor and Head, School of Nursing and Midwifery. Director, Skin Wounds and Trauma Research Centre, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Yohan Payan
- Research Director, Laboratoire TIMC-IMAG, Grenoble Alpes University, France
| | - Anna-Barbara Schlüer
- Advanced Nurse Practitioner, Paediatric Skin and Wound Management, Head of the Paediatric Skin Centre, Skin and Wound Management and Department of Nursing Science, University Children's Hospital, Zurich, Switzerland
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Abstract
Coronavirus disease 2019 (COVID-19), an emergent disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the globe since its discovery in December 2019. Although first appreciated to cause pneumonia, numerous organ systems are now known to be involved. The objective of this article is to review the broad spectrum of cutaneous manifestations reported in association with SARS-CoV-2 infection. The most commonly reported cutaneous manifestations associated with COVID-19 infection include pernio (chilblain)-like acral lesions, morbilliform (exanthematous) rash, urticaria, vesicular (varicella-like) eruptions, and vaso-occlusive lesions (livedo racemosa, retiform purpura). It is important to consider SARS-CoV-2 infection in the differential diagnosis of a patient presenting with these lesions in the appropriate clinical context, as cutaneous manifestations may be present in otherwise asymptomatic individuals, or present before developing other symptoms of infection. With increased access to diagnostic testing, we are beginning to understand the utility and limitations of currently available assays.
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Affiliation(s)
- Ritesh Agnihothri
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, 3rd Floor, San Francisco, CA 94115, USA
| | - Lindy P Fox
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, 3rd Floor, San Francisco, CA 94115, USA.
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McBride JD, Narang J, Simonds R, Agrawal S, Rodriguez ER, Tan CD, Baldwin WM, Dvorina N, Krywanczyk AR, Fernandez AP. Development of sacral/buttock retiform purpura as an ominous presenting sign of COVID-19 and clinical and histopathologic evolution during severe disease course. J Cutan Pathol 2021; 48:1166-1172. [PMID: 33931901 PMCID: PMC8239708 DOI: 10.1111/cup.14038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/19/2022]
Abstract
Retiform purpura has been described as a relatively frequent cutaneous finding in patients with coronavirus disease 2019 (COVID-19). The etiology is hypothesized to be related to thrombotic vasculopathy based on lesional biopsy specimen findings, but the pathogenesis of the vasculopathy is not completely understood. Here, we present a case of a retiform purpuric patch on the sacrum/buttocks in a hospitalized patient prior to subsequent diagnosis of COVID-19 and an eventual fatal disease course. Two lesional biopsy specimens at different time points in the disease course revealed thrombotic vasculopathy, despite therapeutic anticoagulation. Detailed histopathologic evaluation using immunohistochemical markers suggest the etiology of the vasculopathy involves both persistent complement activation and platelet aggregation, which possibly promote ongoing thrombus formation. This case highlights that sacral/buttock retiform purpuric patches may be a presenting sign of infection with SARS-CoV-2 virus and may represent an ominous sign supporting a future severe disease course. In addition, biopsy specimen findings at separate time points demonstrate that cutaneous vasculopathy may persist despite adequate systemic anticoagulation, possibly due to the combination of persistent complement and platelet activation. Finally, occlusive thrombi in sacral/buttock retiform purpuric patches may contribute to future ulceration and significant cutaneous morbidity in patients who survive COVID-19.
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Affiliation(s)
- Jeffrey D McBride
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jatin Narang
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Robert Simonds
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shruti Agrawal
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Carmela D Tan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - William M Baldwin
- Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | - Nina Dvorina
- Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
| | | | - Anthony P Fernandez
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
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Panda M, Dash S, Behera B, Sil A. Dermatological Manifestations Associated with COVID-19 Infection. Indian J Dermatol 2021; 66:237-245. [PMID: 34446946 PMCID: PMC8375538 DOI: 10.4103/ijd.ijd_464_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) causing the 2019 coronavirus disease (COVID-19) has infected millions in recent years and is a major public health concern. Various cutaneous manifestations of the COVID-19 disease have been identified. Skin is a mirror to internal disease and can be the presenting sign of COVID-19 disease. Several cutaneous manifestations can indicate severe COVID-19 disease. In the present scenario, physicians should know the various cutaneous manifestations of COVID-19 disease for early diagnosis and proper management of the disease.
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Affiliation(s)
- Maitreyee Panda
- Department of Skin and VD, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Siddhartha Dash
- Department of Skin and VD, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
| | - Biswanath Behera
- Department of Skin and VD, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, Odisha, India
| | - Abheek Sil
- Department of Dermatology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Rrapi R, Chand S, Lo JA, Gabel CK, Song S, Holcomb Z, Iriarte C, Moore K, Shi CR, Song H, Di Xia F, Yanes D, Gandhi R, Triant VA, Kroshinsky D. The significance of pressure injuries and purpura in COVID-19 patients hospitalized at a large urban academic medical center: A retrospective cohort study. J Am Acad Dermatol 2021; 85:462-464. [PMID: 33753253 PMCID: PMC7979268 DOI: 10.1016/j.jaad.2021.03.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Renajd Rrapi
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sidharth Chand
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer A Lo
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Colleen K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah Song
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zachary Holcomb
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Christopher Iriarte
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Kevin Moore
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Connie R Shi
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Hannah Song
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Fan Di Xia
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Daniel Yanes
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Combined Dermatology Residency, Harvard Medical School, Boston, Massachusetts
| | - Rajesh Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Virginia A Triant
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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