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Karch JL, Okorie CL, Maymone MBC, Laughter M, Vashi NA. Vascular cutaneous manifestations of COVID-19 and RNA viral pathogens: a systematic review. Clin Exp Dermatol 2024; 49:313-324. [PMID: 37936304 DOI: 10.1093/ced/llad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND COVID-19, the widely recognized and highly contagious respiratory tract infection, has had a substantial impact on the field of dermatology since its emergence in 2019. SARS-CoV-2, the causative virus of COVID-19, is classified as an RNA virus. Various skin-related symptoms have been reported in patients with COVID-19, most notably the distinctive purple-red acral rash resembling chilblain lesions, commonly referred to as 'COVID toe'; similarly, skin-related symptoms have been observed in connection with other RNA viruses. OBJECTIVES To explore the relationship between RNA viruses and their associated vascular cutaneous manifestations vs. those observed in patients infected with SARS-CoV-2. METHODS A systematic literature review was conducted using PubMed and medical subject heading terms related to RNA viruses and related skin manifestations. RESULTS In total, 3994 patients diagnosed with COVID-19 presenting with skin rashes were included. Chilblain-like lesions were most frequently observed (30.2%), followed by erythematous maculopapular/morbilliform rashes (9.1%) and urticarial rashes (4.7%). Of 8362 patients diagnosed with RNA viruses, more than half of the skin findings reported were erythematous/maculopapular/morbilliform rashes (52.3%), followed by unspecified (11.3%) and purpuric rashes (10.6%). CONCLUSIONS When comparing RNA viral infections with COVID-19 infection, we observed similarities in the reported skin manifestations and their presumed pathways, with many implicated in the proinflammatory response. Owing to the wide range of cutaneous symptoms associated with RNA viruses and our currently limited understanding of the underlying mechanisms, additional research is warranted to investigate the pathology behind viral-induced skin lesions.
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Affiliation(s)
- Jamie L Karch
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Chiamaka L Okorie
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Mayra B C Maymone
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Melissa Laughter
- Department of Dermatology, New York University, New York, NY, USA
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
- Department of Dermatology, US Department of Veteran Affairs, Boston Health Care System, Boston, MA, USA
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Arai Y, Okamura K, Saito T, Ito Y, Suzuki T. A case of acute localized exanthematous pustulosis following COVID-19 infection. J Dermatol 2024; 51:e37-e38. [PMID: 37753547 DOI: 10.1111/1346-8138.16983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Yosuke Arai
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Ken Okamura
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Toru Saito
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | | | - Tamio Suzuki
- Department of Dermatology, Faculty of Medicine, Yamagata University, Yamagata, Japan
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Bianchi S, Fappani C, Gori M, Canuti M, Colzani D, Monti MC, Torriani C, Raviglione MC, Zuccotti G, Tanzi E, Amendola A. Serological investigation of SARS-CoV-2 infection in patients with suspect measles, 2017-2022. Virol J 2023; 20:160. [PMID: 37474969 PMCID: PMC10357797 DOI: 10.1186/s12985-023-02117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Several studies suggested that SARS-CoV-2 was already spreading worldwide during the last months of 2019 before the first outbreak was detected in Wuhan, China. Lombardy (Northern Italy) was the first European region with sustained SARS-CoV-2 transmission and recent investigations detected SARS-CoV-2-RNA-positive patients in Lombardy since late 2019. METHODS We tested for anti-SARS-CoV-2 IgG all serum samples available in our laboratory (N = 235, collected between March 2017 and March 2022) that we received within the framework of measles/rubella surveillance from measles and rubella virus-negative patients. RESULTS Thirteen of 235 samples (5.5%) were IgG-positive. The positivity rate increased starting in 2019 and was significantly different from the expected false positive rate from 2019 onwards. Additionally, in 2019 the percentage of IgG-positive patients was significantly lower among SARS-CoV-2 RNA-negative patients (3/92) compared to SARS-CoV-2 RNA-positive patients (2/7, p = 0.04). The highest percentage of IgG positivity in the pre-pandemic period was recorded during the second half of 2019. This coincided with an increase in negativity for measles and a widening of the peak of the number of measles discarded cases per 100,000 inhabitants, indicating a higher-than-normal number of measles-negative patients experiencing fever and rash. This also coincided with the first patient positive for SARS-CoV-2 RNA (September 12th, 2019); this patient was also positive for anti-SARS-CoV-2 IgG and IgM. CONCLUSIONS Although the number of samples was low and one cannot conclusively establish that the virus started circulating in Lombardy around September 2019, our findings should stimulate similar research investigating the possibility of undetected SARS-CoV-2 pre-pandemic circulation.
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Affiliation(s)
- Silvia Bianchi
- Department of Health Sciences, Universita' degli Studi di Milano, Milan, Italy
- Coordinated Research Center "EpiSoMI", Universita' degli Studi di Milano, Milan, Italy
| | - Clara Fappani
- Department of Health Sciences, Universita' degli Studi di Milano, Milan, Italy
- Coordinated Research Center "EpiSoMI", Universita' degli Studi di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, Milan, Italy
| | - Maria Gori
- Department of Health Sciences, Universita' degli Studi di Milano, Milan, Italy
- Coordinated Research Center "EpiSoMI", Universita' degli Studi di Milano, Milan, Italy
| | - Marta Canuti
- Coordinated Research Center "EpiSoMI", Universita' degli Studi di Milano, Milan, Italy.
- Department of Pathophysiology and Transplantation, Universita' degli Studi di Milano, Milan, Italy.
- Centre for Multidisciplinary Research in Health Science (MACH), Universita' degli Studi di Milano, Milan, Italy.
| | - Daniela Colzani
- Department of Health Sciences, Universita' degli Studi di Milano, Milan, Italy
| | - Maria Cristina Monti
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Camilla Torriani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mario C Raviglione
- Department of Pathophysiology and Transplantation, Universita' degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Universita' degli Studi di Milano, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Paediatrics, Children Hospital V. Buzzi, Universita' degli Studi di Milano, Milan, Italy
- Romeo and Enrica Invernizzi Pediatric Research Center, Universita' degi Studi di Milano, Milan, Italy
| | - Elisabetta Tanzi
- Department of Health Sciences, Universita' degli Studi di Milano, Milan, Italy
- Coordinated Research Center "EpiSoMI", Universita' degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Universita' degli Studi di Milano, Milan, Italy
| | - Antonella Amendola
- Department of Health Sciences, Universita' degli Studi di Milano, Milan, Italy
- Coordinated Research Center "EpiSoMI", Universita' degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Universita' degli Studi di Milano, Milan, Italy
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Errichetti E, Stinco G. How to differentiate skin rash in covid, mononucleosis, chickenpox, sixth disease and measles. Curr Opin Infect Dis 2023; 36:109-113. [PMID: 36718910 DOI: 10.1097/qco.0000000000000904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Skin rashes seen during COVID-19 usually feature maculopapular or vesicular morphology, thus mimicking cutaneous eruptions occurring in other common infectious dermatoses, such as mononucleosis, chickenpox, sixth disease and measles, with possible diagnostic mistakes. In this review article, we sought to provide a practical overview about clinical appearance of skin rashes related to SARS-CoV-2 infection. RECENT FINDINGS The study summarizes literature evidence on clinical patterns of COVID-19-associated maculopapular or vesicular rash, with a particular emphasis on the principal points of differentiation with possible mimickers. SUMMARY Several differences do exist between rashes due to SARS-CoV-2 infection and other viral eruptions, mainly including lesions morphology, spreading pattern, symptoms and mucosal involvement. The increase of awareness of such features among clinicians may help promptly recognize COVID-19-related exanthemas in order to take proper action to manage the infection.
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Affiliation(s)
- Enzo Errichetti
- Institute of Dermatology, 'Santa Maria della Misericordia' University Hospital, Udine, Italy
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Russo D, Accarino R, Varricchio S, Franca RA, Potestio L, Patruno C, Napolitano M, Mascolo M. Granuloma annulare after SARS-CoV-2 vaccination: A case report and a literature review. Pathol Res Pract 2023; 242:154300. [PMID: 36638589 PMCID: PMC9804962 DOI: 10.1016/j.prp.2022.154300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION During the Cov-19 pandemic, many studies reported a broad spectrum of cutaneous reactions presenting as erythematous rashes or pernio-like, urticaria-like or vesicular/bullous patterns associated with Cov-19-infection and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS The authors documented the clinical and histopathological features of an unexpected case of granuloma annulare (GA) arising a few days after the SARS-CoV-2 vaccination and reviewed all GAs reported in the literature following the SARS-CoV-2 vaccination and Cov-19-infection. CASE REPORT A 69-year-old woman developed a single reddish lesion on the left deltoid region, where the SARS-CoV-2 vaccine seven days earlier was injected. The clinicians performed a punch skin biopsy, and histology revealed an interstitial GA. CONCLUSIONS Clinicians should be aware of the potential, though rare, GA occurrence as a possible adverse event after the SARS-CoV-2 vaccination. This additional case, like what happens after the administration of other vaccines, supports the idea that GA may result from the immune system activation following the vaccination. However, notwithstanding, they should encourage their patients to obtain immunization to assist the public health systems in overcoming the COVID-19 pandemic.
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Affiliation(s)
- Daniela Russo
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Rossella Accarino
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Silvia Varricchio
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Raduan Ahmed Franca
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Unit of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Massimo Mascolo
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
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Martora F, Villani A, Fabbrocini G, Battista T. COVID-19 and cutaneous manifestations: A review of the published literature. J Cosmet Dermatol 2023; 22:4-10. [PMID: 36342945 PMCID: PMC9877578 DOI: 10.1111/jocd.15477] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID-19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020. AIM Skin manifestations related to SARS-CoV-2 infection can be divided mainly into five groups: chilblainlike lesions (CBLLs), maculopapular eruptions, urticarial eruptions, vesicular eruptions, and livedo or necrosis. Other skin findings reported are erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C) and rarely with multisystem inflammatory syndrome in adults (MIS-A). Other manifestations such as pityriasis rosea or shingles are also reported. METHODS A total of 60 articles including reviews, studies and case reports were selected for the evaluation in this review. RESULTS The skin manifestations associated with COVID-19 infection are numerous and can vary widely. The major dermatological patterns of COVID-19 can be classified as inflammatory reactions (maculopapular/morbilliform, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo acemose-like pattern) CONCLUSION: We believe that the dermatologist could play an important role in the response to the SARS-CoV-2 pandemic through early recognition of skin lesions suggestive of COVID-19, particularly in paucisymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Alessia Villani
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Gabriella Fabbrocini
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
| | - Teresa Battista
- Section of Dermatology – Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINapoliItaly
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Li J, Wen W, Mu Z, Du X, Han X. Prevalence of cutaneous manifestations in COVID-19: A meta-analysis. J Dermatol 2022; 50:622-636. [PMID: 36540031 PMCID: PMC9878074 DOI: 10.1111/1346-8138.16672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/31/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
The global epidemic of coronavirus disease 2019 (COVID-19) endangers more and more people. Many studies on cutaneous manifestations related to COVID-19 have emerged, but their prevalence has varied widely. The objective of this study was to conduct a meta-analysis estimating the prevalence of skin manifestations in COVID-19. Four databases PubMed, Web of Science, CBM, and CNKI were searched, and the results were screened by two reviewers. A random-effects model was used to evaluate the overall prevalence. Heterogeneity was assessed by I2 . Further subgroup analyses were conducted by region, sample size, sex, age, and severity of COVID-19. A funnel plot and Egger's test were performed to assess publication bias. The pooled prevalence of cutaneous manifestation of 61 089 patients in 33 studies was 5.6% (95% confidence intervals [CI] = 0.040-0.076, I2 = 98.3%). Severity of COVID-19 was probably the source of heterogeneity. Studies with sample size <200 report higher prevalence estimates (10.2%). The prevalence of detailed types was as follows: maculopapular rash 2%, livedoid lesions 1.4%, petechial lesions 1.1%, urticaria 0.8%, pernio-like lesions 0.5%, vesicular lesions 0.3%. Petechial lesions and livedoid lesions contain a higher proportion of severe patients than other skin manifestations. The prevalence rates of pernio-like lesions, urticaria and petechial lesions vary greatly in different regions.
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Affiliation(s)
- Jingmin Li
- Department of Dermatology, Shengjing HospitalChina Medical UniversityShenyangChina
| | - Weijing Wen
- Department of Emergency Medical CenterFirst Affiliated Hospital of Shanxi Medical UniversityShanxiChina
| | - Zhenzhen Mu
- Department of Dermatology, Shengjing HospitalChina Medical UniversityShenyangChina
| | - Xuefei Du
- Department of Dermatology, Shengjing HospitalChina Medical UniversityShenyangChina
| | - Xiuping Han
- Department of Dermatology, Shengjing HospitalChina Medical UniversityShenyangChina
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Atay N, Kara Ulu N, Polat M. Acute Haemorrhagic Oedema of Infancy as a manifestation of COVID-19 Infection. J Paediatr Child Health 2022; 58:1282-1283. [PMID: 35707909 DOI: 10.1111/jpc.16056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nursel Atay
- Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
| | - Nursel Kara Ulu
- Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
| | - Meltem Polat
- Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
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