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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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2
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Nyasulu PS, Tamuzi JL. Epidemiology, clinical profiles, and prognostic value of COVID-19-related cutaneous manifestations in African populations: a rapid narrative review. Int J Dermatol 2024; 63:10-22. [PMID: 37965793 DOI: 10.1111/ijd.16872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Skin manifestations' true prognostic value, and clinical and epidemiological pictures in SARS-CoV-2 infection in African populations are poorly described and understudied. More familiarity with COVID-19 cutaneous manifestations may aid in early clinical diagnosis or guide prognosis. METHODS In this literature review, we looked for potential studies published from December 2019 to March 2023 on COVID-19 cutaneous lesions in African populations. Our key questions were focused on the prognostic values of cutaneous manifestations related to COVID-19. RESULTS Our findings show that cutaneous manifestations of COVID-19 vary by country and severity of COVID-19, primarily multisystem inflammatory syndrome (MIS). Significant differences were also found between various dermatological lesions, primarily MIS, erythema multiforme-like, livedoid, vesicular, or varicella-like rashes, urticarial, maculopapular or morbilliform rashes, and chilblain-like or pernio-like rashes. There were 47.5% (115/242) of MIS cases reported in nine published African studies. Our findings also revealed that MIS may be diagnosed in 2-7 days due to early onset rash. Advanced age, obesity, diabetes, cardiovascular disease, HIV, tuberculosis, asthma, atopic disease, underweight, malnutrition, and malignancy were found to be associated with COVID-19 cutaneous manifestations in African populations. CONCLUSIONS COVID-19-related skin manifestations in African populations are important as a driving force in COVID-19 prognosis.
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Affiliation(s)
- Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Craffert V, Day C, Peter J. New-onset chronic spontaneous urticaria post-COVID-19 vaccination-South African case series. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100154. [PMID: 37781658 PMCID: PMC10509972 DOI: 10.1016/j.jacig.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 10/03/2023]
Abstract
Background Chronic spontaneous urticaria (CSU) is defined as the spontaneous occurrence of hives, angioedema, or both for more than 6 weeks; several inciting triggers including vaccines have been implicated. Coronavirus disease 2019 (COVID-19) vaccinations have been well tolerated by patients with CSU. However, reports have emerged of CSU triggered by COVID-19 vaccination and this study describes a South African case series. Objective To provide details of the first case series of new-onset CSU post-COVID-19 vaccination in Africa and summarize the global literature of reported cases to date. Methods All patients referred to our Urticaria Center of Excellence in Cape Town from the initiation of the COVID-19 vaccine rollout in South Africa (from February 2021 to August 2022) were reviewed to identify patients who developed new-onset CSU within 12 weeks of receiving a COVID-19 vaccine. Medical history, physical examinations, and laboratory investigations were reviewed. Results More than 20 million adults received COVID-19 vaccinations in South Africa during the study period. Eight patients had new-onset chronic urticaria post-COVID-19 vaccination; 6 of the 8 patients were female, the median age was 41 years (interquartile range [IQR], 38-44), and all had a history of atopy. Only 1 reported COVID-19 infection post vaccination. Chronic urticaria occurred following Pfizer-BioNTech, AstraZeneca, and Janssen Ad26.COV2.S vaccination in 6, 1, and 1 patient, respectively, with a median of 12 days (IQR, 3-38) from vaccination to symptoms onset. The baseline median score for Urticarial Activity Score 7 was 34 (IQR, 29-40), and 5 of the 8 patients (63%) had a total IgE level of more than 43 IU/L. All patients received high-dose antihistamines, with only 3 patients controlled. Conclusions New-onset CSU can rarely be triggered by COVID-19 vaccinations, most commonly mRNA vaccines. COVID-19 vaccine-triggered CSU appears to have a phenotype similar to that triggered by other inciting agents and across populations.
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Affiliation(s)
- Valmy Craffert
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa
| | - Cascia Day
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa
- Division of Allergology and Clinical Immunology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Jonny Peter
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa
- Division of Allergology and Clinical Immunology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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4
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da Silva SJR, do Nascimento JCF, Germano Mendes RP, Guarines KM, Targino Alves da Silva C, da Silva PG, de Magalhães JJF, Vigar JRJ, Silva-Júnior A, Kohl A, Pardee K, Pena L. Two Years into the COVID-19 Pandemic: Lessons Learned. ACS Infect Dis 2022; 8:1758-1814. [PMID: 35940589 PMCID: PMC9380879 DOI: 10.1021/acsinfecdis.2c00204] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and virulent human-infecting coronavirus that emerged in late December 2019 in Wuhan, China, causing a respiratory disease called coronavirus disease 2019 (COVID-19), which has massively impacted global public health and caused widespread disruption to daily life. The crisis caused by COVID-19 has mobilized scientists and public health authorities across the world to rapidly improve our knowledge about this devastating disease, shedding light on its management and control, and spawned the development of new countermeasures. Here we provide an overview of the state of the art of knowledge gained in the last 2 years about the virus and COVID-19, including its origin and natural reservoir hosts, viral etiology, epidemiology, modes of transmission, clinical manifestations, pathophysiology, diagnosis, treatment, prevention, emerging variants, and vaccines, highlighting important differences from previously known highly pathogenic coronaviruses. We also discuss selected key discoveries from each topic and underline the gaps of knowledge for future investigations.
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Affiliation(s)
- Severino Jefferson Ribeiro da Silva
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil.,Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Jessica Catarine Frutuoso do Nascimento
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Renata Pessôa Germano Mendes
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Klarissa Miranda Guarines
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Caroline Targino Alves da Silva
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Poliana Gomes da Silva
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
| | - Jurandy Júnior Ferraz de Magalhães
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil.,Department of Virology, Pernambuco State Central Laboratory (LACEN/PE), 52171-011 Recife, Pernambuco, Brazil.,University of Pernambuco (UPE), Serra Talhada Campus, 56909-335 Serra Talhada, Pernambuco, Brazil.,Public Health Laboratory of the XI Regional Health, 56912-160 Serra Talhada, Pernambuco, Brazil
| | - Justin R J Vigar
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Abelardo Silva-Júnior
- Institute of Biological and Health Sciences, Federal University of Alagoas (UFAL), 57072-900 Maceió, Alagoas, Brazil
| | - Alain Kohl
- MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, United Kingdom
| | - Keith Pardee
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8, Canada
| | - Lindomar Pena
- Laboratory of Virology and Experimental Therapy (LAVITE), Department of Virology, Aggeu Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz), 50670-420 Recife, Pernambuco, Brazil
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Mohammed GF, Al-Dhubaibi MS, Atef L. Cutaneous Manifestations of Coronavirus Disease 2019: Skin Narratives and Dialogues. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:E77-E81. [PMID: 35642227 PMCID: PMC9122281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily responsible for respiratory symptoms, an increasing number of cutaneous manifestations have been reported. Cutaneous manifestations are reported by patients following disease recovery. Objective We sought to document various skin lesions relating to COVID-19 symptoms either before, during, or after infection with severe acute respiratory syndrome coronavirus 2. Methods This was a descriptive study with 273 patients who had cutaneous manifestations after recovering from COVID-19. Each patient provided a thorough medical history and underwent a general physical examination. Following polymerase chain reaction analysis, all participants were confirmed to be COVID-19 patients. Results Acral lesions were the most common, accounting for 39% of all cases. An erythematous maculopapular rash was found in 21% of cases and was the second most common after urticaria, with fewer cases of erythema multiform, vesicular rash (9%), vascular livedo reticularis, figurate erythema, and flexural rash documented. Conclusion The most common cutaneous changes seen in patients with COVID-19 were pseudo-chilblain acral lesions, which had a good prognosis. Vascular rashes within the spectrum of livedo/purpura/necrosis were seen with severe forms of COVID-19.
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Affiliation(s)
- Ghada Farouk Mohammed
- Drs. Mohammed and Atef are with the Department of Dermatology and Venereology, Faculty of Medicine at the Suez Canal University in Ismailia, Egypt
| | - Mohammed Saleh Al-Dhubaibi
- Dr. Al-Dhubaibi is with the Department of Dermatology, College of Medicine at Shaqra University in Dawadmi, Saudi Arabia
| | - Lina Atef
- Drs. Mohammed and Atef are with the Department of Dermatology and Venereology, Faculty of Medicine at the Suez Canal University in Ismailia, Egypt
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Parmar S, De Silva B. Skin manifestations in patients with COVID-19: a prospective observational study during the first wave of the pandemic in the UK and review of the recent literature. Eur J Dermatol 2022; 32:77-85. [PMID: 35171793 PMCID: PMC9170556 DOI: 10.1684/ejd.2022.4202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 11/24/2022]
Abstract
Background COVID-19 (SARS-CoV-2) is a viral infection that presents in heterogeneous forms with effects on multiple organ systems including the skin. Objectives The objectives of this prospective observational study were to identify cutaneous lesions in confirmed COVID-19-positive patients admitted to a district general hospital in the eastern region of England, to determine the prevalence of these lesions and compare the findings with the current literature. Materials & Methods The study was conducted at the Luton and Dunstable University Hospital during the first peak of the pandemic in the United Kingdom to identify skin manifestations in patients infected with COVID-19. Several variables were taken into consideration and photographs of skin lesions were taken. Unlike previous similar studies, all patients included in this study had a positive nasopharyngeal PCR swab for SARS-CoV-2. All photographs were analysed by a dermatology consultant. Results A total of 93 patients were included in the study; 40% (n = 37) had cutaneous lesions but only 5.5% of the total patients (n = 6) presented with likely coronavirus-related skin changes. Lesions identified were pseudochilblain and purpuric/livedoid type. We also noted several coagulation abnormalities in these patients. Conclusion COVID-19 can present with a variety of skin manifestations. Pseudochilblain lesions and purpuric livedoid lesions have been described in the literature and although the underlying mechanism is not fully understood, it is possible that these lesions represent thromboinflammatory processes as a result of the hypercoagulability state associated with COVID-19. More research is required to better understand the pathophysiology and epidemiology of these manifestations. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi: 10.1684/ejd.2022.4202.
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Affiliation(s)
- Shivani Parmar
- Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Bernadette De Silva
- Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
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7
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Sarkar R, Bhargava S, Mendiratta V. Virology and Etiopathogenesis of COVID-19 with Special Reference to Cutaneous Implications. Indian J Dermatol 2021; 66:231-236. [PMID: 34446945 PMCID: PMC8375542 DOI: 10.4103/ijd.ijd_467_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Severe Acute Respiratory Virus Corona Virus 2 (SARS-CoV-2) has got its name Corona from Latin meaning “crown.” It has crown-like spikes present on the surface, which encloses the RNA, genetic material of this deadly virus. The virus attacks pneumocytes after binding with the angiotensin-converting enzyme 2 (ACE2) of the cell surface, which ultimately leads to chemotaxis followed by leukocyte infiltration, increased permeability of blood vessels and alveolar walls, and decreased surfactant in the lung leading to various symptoms. Skin provides a window to the internal changes of the body and also to mechanisms that are not readily visible. Commonly observed skin manifestations include vesicular lesions, maculopapular exanthema, urticarial eruptions, livedo or necrosis, and other forms of vasculitis, chilblain-like lesions. The skin lesions are attributed to either the virus directly affecting the skin or interferon dysregulation due to viral RNA or vascular involvement associated with alteration in coagulation or drug-induced skin manifestations. Observation of skin involvement and the vasculature due to SARS-CoV-2 illustrates the need for a precise stratification and differential diagnostic valuation so that the mechanisms of this novel virus are clearer for better management of the condition in the future. Vascular skin lesions are not seen in all the patients of COVID, but certain lesions should definitely alarm us to evaluate for coagulation abnormalities, complement levels, and skin biopsy, especially in critically ill patients. This review attempts to outline the pathogen briefly and the pathomechanism behind the development of various cutaneous manifestations.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College and Associated KSCH and SSK Hospital, New Delhi, India
| | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India
| | - Vibhu Mendiratta
- Department of Dermatology, Lady Hardinge Medical College and Associated KSCH and SSK Hospital, New Delhi, India
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8
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Kashetsky N, Mukovozov IM, Bergman J. Chilblain-Like Lesions (CLL) Associated With COVID-19 ("COVID Toes"): A Systematic Review. J Cutan Med Surg 2021; 25:627-633. [PMID: 33849305 DOI: 10.1177/12034754211004575] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Reports of chilblain-like lesions (CLL) coinciding with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been described in the literature, but this phenomenon has not been critically summarized. The aim of this paper is to summarize reports of CLL coinciding with SARS-CoV-2 infection to clarify the prevalence, clinical relevance, and prognostic value of these lesions. A literature search was conducted using the Embase, Pubmed, and Scopus databases from December 2019 to June 16, 2020 using the search terms ("COVID-19" OR "coronavirus" OR "2019-nCoV" OR "SARS-CoV-2") AND ("chilblain-like" OR "COVID toes" OR "acral"). Papers that described skin changes in patients with suspected or confirmed COVID-19 were included. A total of 31 papers were summarized, representing 813 cases of CLL. Available data suggests an equal gender distribution, mean age of 21 years, and median age of 14 years. Mild extracutaneous symptoms were reported in 53% of cases and 47% were asymptomatic. CLL occurred an average of 16 days after extracutaneous symptoms. Patients with CLL were positive for SARS-CoV-2 in 15% of cases. Lesions were mainly described as asymptomatic and/or pruritic erythematous to violaceous acral macules and plaques. Partial or complete resolution occurred in 85% of cases in a mean of 13 days. The most common histologic findings were perivascular and perieccrine superficial and deep lymphocytic infiltrates. Although a causal relationship between CLL and SARS-CoV-2 has not been confirmed, the temporal association and 15% positive SARS-CoV-2 rate in affected individuals should not be ignored.
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Affiliation(s)
- Nadia Kashetsky
- 7512 Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ilya M Mukovozov
- 12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - James Bergman
- 12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
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9
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Brancaccio G, Gussetti N, Sasset L, Alaibac M, Tarantello M, Salmaso R, Trevenzoli M, Cattelan AM. Cutaneous manifestations in a series of 417 patients with SARS-CoV-2 infection: epidemiological and clinical correlates of chilblain like lesions. Pathog Glob Health 2021; 115:483-486. [PMID: 33729097 DOI: 10.1080/20477724.2021.1901040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A variety of dermatological lesions have been described in COVID-19, although the prevalence and pathogenic relationship remain unclear particularly for chilblain-like lesions. Dermatological examination was performed in a prospective cohort of consecutive patients seen at the service for SARS-CoV-2 infection. Out of 417 patients with confirmed SARS-CoV-2 infection [median age 29.5 years (range 15-65); 62.5% males], dermatological lesions were detected in 7 (1.7%). Three patients had acral lesions; their age (range) was 15-29 years; all had a negative nasopharyngeal swab and developed IgG and/or IgM-specific antibodies; all presented none or mild symptoms. A fourth patient remained negative at repeated testing; mother, father and sister had a documented mild COVID-19. Non-acral lesions were observed in four older patients, with severe COVID-19. Chilblain-like lesions may be the sole manifestation of SARS-CoV-2 infection; their presence in asymptomatic school children and adolescents should be considered a potential signal of familial or community spread of the virus.
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Affiliation(s)
- G Brancaccio
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - N Gussetti
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - L Sasset
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - M Alaibac
- Unit of Dermatology, University of Padua, Padua, Italy
| | - M Tarantello
- Unit of Dermatology, University of Padua, Padua, Italy
| | - R Salmaso
- Unit of Pathology, University of Padua, Padua, Italy
| | - M Trevenzoli
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
| | - A M Cattelan
- Unit of Infectious Diseases, University Hospital of Padua, Padua, Italy
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10
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Demirbaş A, Eker H, Elmas ÖF, Ulutaş Demirbaş G, Atasoy M, Türsen Ü, Lotti T. COVID-19 and human papillomavirus: Paradoxical immunity. J Cosmet Dermatol 2021; 20:2001-2003. [PMID: 33626241 PMCID: PMC8014313 DOI: 10.1111/jocd.14022] [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: 02/07/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) is a multisystemic disease that can cause progressive lung failure, organ dysfunction, and coagulation disorder associated with high mortality and morbidity. COVID‐19 is known to either primarily cause skin symptoms or increase existing skin diseases. Human papillomavirus (HPV) is a DNA virus that can cause benign and malignant neoplasms. Mucocutaneous verruca vulgaris are common benign lesions of HPV. Here, we report a case of verruca vulgaris regressed after COVID‐19.
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Affiliation(s)
- Abdullah Demirbaş
- Department of Dermatology, Evliya Çelebi Training and Research Hospital, Kütahya Health Sciences University, Kütahya, Turkey
| | - Hediye Eker
- Department of Dermatology, Selçuk University, Konya, Turkey
| | - Ömer Faruk Elmas
- Department of Dermatology, Kırıkkale University, Kırıkkale, Turkey
| | | | - Mustafa Atasoy
- Department of Dermatology, Kayseri City Hospital, Health Science University, Kayseri, Turkey
| | - Ümit Türsen
- Department of Dermatology, Mersin University, Mersin, Turkey
| | - Torello Lotti
- Department of Dermatology, Guglielmo Marconi University, Rome, Italy
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11
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Meshref M, A Alshammari H, Khairat SM, Khan R, Khan I. Guillain-Barre Syndrome Associated With COVID-19 Infection: A Case Report With Review of Literature. Cureus 2021; 13:e13096. [PMID: 33728118 PMCID: PMC7935237 DOI: 10.7759/cureus.13096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 has become a pandemic. It affects multiple systems of the body including the nervous system. It invades the nervous systems through multiple routes - either olfactory tract, bloodstream (by binding to endothelial receptors) or via ACE-2 receptors in the brain. We report a case of Guillain-Barré syndrome (GBS) variant (acute motor axonal neuropathy (AMAN type)) associated with COVID-19 infection with positive polymerase chain reaction (PCR) test for COVID-19 and positive contact history with infected family member. GBS and its variants like AMAN can occur due to COVID-19 infection through its immune-mediated effects. Diagnosis of GBS should depend on the clinical and supportive criteria. The treatment should be started early to prevent progression and disease co-morbidities.
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Affiliation(s)
| | | | | | - Roohi Khan
- Internal Medicine, King Khaled Hospital, Hail, SAU
| | - Imran Khan
- Internal Medicine, King Khaled Hospital, Hail, SAU
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12
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Abstract
The emergence of the coronavirus disease 2019 (COVID-19) worldwide pandemic has been associated with a new constellation of cutaneous features in children. Among the unusual dermatologic presentations are the so-called COVID toes, inflammatory nodules of the feet and toes, sometimes involving the hands and fingers. These lesions mimic acral pernio, the synonym being chilblains. Unlike adult patients with COVID toes, children are less likely to manifest symptomatic COVID-19. Although a few studies have found some linkage to COVID-19 through the serum IgA or IgG severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, other studies have no demonstrable linkage suggesting that barefoot children in cold weather develop such lesions. It appears that the chilblain-like lesions related to the period of the COVID-19 pandemic may reflect a brisk immune response portending a good prognosis and perhaps some form of innate immunity. The possible need to screen for coagulopathy is unclear, but this has been suggested in one report. Until we fully understand the pattern of immune response to COVID-19, questions may persist as to how disease manifestations are linked to SARS-CoV-2 exposures.
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Affiliation(s)
- Merav Koschitzky
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Ryan Rivera Oyola
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Mary Lee-Wong
- Division of Allergy and Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Brian Abittan
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York; Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, New York.
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Zheng Y, Gong Z, Chen J, Lin Y, Liu Y. Inflammation and Vascular Injury as the Basis of COVID-19 Skin Changes: Preliminary Analysis of 23 Patients from the Literature. Clin Cosmet Investig Dermatol 2021; 14:1-7. [PMID: 33442282 PMCID: PMC7797295 DOI: 10.2147/ccid.s278833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/02/2020] [Indexed: 12/30/2022]
Abstract
Background COVID-19 can affect various organ systems including the skin. Cutaneous manifestations of COVID-19 in infected patients are poorly characterized. Objective To summarize retrospectively the skin features of COVID-19 infection and to analyze the skin rash incidence rate, clinical onset time, cutaneous manifestations, pathological characteristics and relationship with the novel coronavirus pneumonia severity. Methods The literature up to Sep 20, 2020, were searched and analyzed. Information on clinical features including skin manifestations, disease severity, stage and onset day, and cutaneous pathological characteristics was extracted. Data were analyzed using descriptive non-parametric statistics. For categorical data, the number and percentage of patients are presented. A Spearman correlation test was used to analyze the associations between rash type, rash onset and severity of COVID-19. All statistical analysis was performed with IBM SPSS software (version 20) using two-tailed tests. P values <0.05 were considered statistically significant. Results Twenty-three cases of COVID-19 patients with cutaneous manifestations from seven reports were collected. Inflammatory dermatosis, skin vasculitis and vascular dermatosis were the main lesion types of COVID-19 patients. Microvascular and endothelial cell injury, perivascular lymphocytic infiltrate, thrombosis, extremely dilated vessels and prominent deposits of C5b-9 were the main dermatologic pathological changes. The onset day analysis showed that out of 19 patients, 63.2% of cutaneous manifestations were within 10 days, 21.1% in 10–20 days and 15.8% were 20 days after the time the patient presented with COVID-19 main symptoms. Spearman rho analysis found no correlation between skin rash type, onset day and COVID-19 severity. Conclusion COVID-19 induced skin changes are one of the manifestations of immune responses to the novel coronavirus. Clinical and pathological characteristics were identified as dermal inflammatory reactions and/or skin vascular injury. External or systematic use of anti-inflammatories, protection of blood vessels and circulation-improving medicines should be considered in the skin treatments for novel coronavirus pneumonia patients.
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Affiliation(s)
- Yue Zheng
- Dermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou, People's Republic of China
| | - Zijian Gong
- Dermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou, People's Republic of China
| | - Jian Chen
- Dermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou, People's Republic of China
| | - Yao Lin
- Dermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou, People's Republic of China
| | - Yufang Liu
- Dermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou, People's Republic of China
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14
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Català A, Galván‐Casas C, Carretero‐Hernández G, Rodríguez‐Jiménez P, Fernández‐Nieto D, Rodríguez‐Villa A, Navarro‐Fernández Í, Ruiz‐Villaverde R, Falkenhain‐López D, Llamas‐Velasco M, Carnero‐Gonzalez L, García‐Gavin J, Baniandrés O, González‐Cruz C, Morillas‐Lahuerta V, Cubiró X, Figueras I, Selda‐Enriquez G, Fustà‐Novell X, Roncero‐Riesco M, Burgos‐Blasco P, Romaní J, Solà‐Ortigosa J, García‐Doval I. Maculopapular eruptions associated to COVID-19: A subanalysis of the COVID-Piel study. Dermatol Ther 2020; 33:e14170. [PMID: 32779280 PMCID: PMC7436694 DOI: 10.1111/dth.14170] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/07/2023]
Abstract
A previous study has defined the maculopapular subtype of manifestations of COVID-19. The objective of our study was to describe and classify maculopapular eruptions associated with COVI-19. We carried out a subanalysis of the maculopapular cases found in the previous cross-sectional study. Using a consensus, we defined seven clinical patterns. We described patient demographics, the therapy received by the patient and the characteristics of each pattern. Consensus lead to the description of seven major maculopapular patterns: morbilliform (45.5%), other maculopapular (20.0%), purpuric (14.2%), erythema multiforme-like (9.7%), pytiriasis rosea-like (5.7%), erythema elevatum diutinum-like (2.3%), and perifollicular (2.3%). In most cases, maculopapular eruptions were coincident (61.9%) or subsequent (34.1%) to the onset of other COVID-19 manifestations. The most frequent were cough (76%), dyspnea (72%), fever (88%), and astenia (62%). Hospital admission due to pneumonia was frequent (61%). Drug intake was frequent (78%). Laboratory alterations associated with maculo-papular eruptions were high C-reactive protein, high D-Dimer, lymphopenia, high ferritin, high LDH, and high IL-6. The main limitation of our study was the impossibility to define the cause-effect relationship of each pattern. In conclusion, we provide a description of the cutaneous maculopapular manifestations associated with COVID-19. The cutaneous manifestations of COVID-19 are wide-ranging and can mimic other dermatoses.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ignasi Figueras
- Hospital Universitario de Bellvitge, Hospitalet de LlobregatBarcelonaSpain
| | | | | | | | | | - Jorge Romaní
- Consorci Sanitari Parc TaulíSabadell, BarcelonaSpain
| | | | - Ignacio García‐Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y VenereologíaMadridSpain
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15
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Danarti R, Budiarso A, Rini DLU, Soebono H. Follicular eruption as a cutaneous manifestation in COVID-19. BMJ Case Rep 2020; 13:13/10/e238182. [PMID: 33122237 PMCID: PMC7597470 DOI: 10.1136/bcr-2020-238182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 50-year-old man presented to our dermatology clinic with itchy skin rash. The rash began 5 days after systemic symptoms appeared such as mild fever and mild dyspnoea. The rashes were a characteristic of follicular eruption, which started on his stomach and spread all over his body. After a thorough evaluation, he was diagnosed with COVID-19 and was started on COVID-19 regimens. Skin lesions disappeared on the ninth day of treatment. Our findings contribute to the growing awareness of dermatological manifestations in patients with COVID-19.
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Affiliation(s)
- Retno Danarti
- Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Aries Budiarso
- Department of Dermatology and Venereology, Setjonegoro District Hospital, Wonosobo, Central Java, Indonesia
| | - Dionisia Lintang Unggul Rini
- Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hardyanto Soebono
- Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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16
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Reguero-Del Cura L, Gómez-Fernández C, López Obregón C, López-Sundh AE, González-López MA. Onset of erythema multiforme-like lesions in association with recurrence of symptoms of COVID-19 infection in an elderly woman. Dermatol Ther 2020; 33:e14208. [PMID: 32815261 PMCID: PMC7460869 DOI: 10.1111/dth.14208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Cristina López Obregón
- Division of Dermatology, University Hospital Marqués de Valdecilla (U.H.M.V), Santander, Spain
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17
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da Silva SJR, Silva CTAD, Guarines KM, Mendes RPG, Pardee K, Kohl A, Pena L. Clinical and Laboratory Diagnosis of SARS-CoV-2, the Virus Causing COVID-19. ACS Infect Dis 2020; 6:2319-2336. [PMID: 32786280 PMCID: PMC7441751 DOI: 10.1021/acsinfecdis.0c00274] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Indexed: 01/08/2023]
Abstract
In December 2019, a novel beta (β) coronavirus eventually named SARS-CoV-2 emerged in Wuhan, Hubei province, China, causing an outbreak of severe and even fatal pneumonia in humans. The virus has spread very rapidly to many countries across the world, resulting in the World Health Organization (WHO) to declare a pandemic on March 11, 2020. Clinically, the diagnosis of this unprecedented illness, called coronavirus disease-2019 (COVID-19), becomes difficult because it shares many symptoms with other respiratory pathogens, including influenza and parainfluenza viruses. Therefore, laboratory diagnosis is crucial for the clinical management of patients and the implementation of disease control strategies to contain SARS-CoV-2 at clinical and population level. Here, we summarize the main clinical and imaging findings of COVID-19 patients and discuss the advances, features, advantages, and limitations of different laboratory methods used for SARS-CoV-2 diagnosis.
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Affiliation(s)
| | - Caroline Targino Alves da Silva
- Department of Virology, Aggeu
Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz),
50670-420, Recife, Pernambuco, Brazil
| | - Klarissa Miranda Guarines
- Department of Virology, Aggeu
Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz),
50670-420, Recife, Pernambuco, Brazil
| | - Renata Pessôa Germano Mendes
- Department of Virology, Aggeu
Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz),
50670-420, Recife, Pernambuco, Brazil
| | - Keith Pardee
- Leslie Dan Faculty of Pharmacy,
University of Toronto, Toronto, ON M5S 3M2,
Canada
| | - Alain Kohl
- MRC-University of Glasgow Centre for Virus
Research, Glasgow, Scotland G61 1QH, U.K.
| | - Lindomar Pena
- Department of Virology, Aggeu
Magalhães Institute (IAM), Oswaldo Cruz Foundation (Fiocruz),
50670-420, Recife, Pernambuco, Brazil
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18
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Martinez-Lopez A, Montero-Vilchez T, Arias-Santiago S. Research in dermatology in the COVID-19 era. Dermatol Ther 2020; 33:e13971. [PMID: 32621772 PMCID: PMC7361061 DOI: 10.1111/dth.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Martinez-Lopez
- Dermatology Unit, Virgen de las Nieves University Hospital, Granada, Spain.,TECe19-Clinical and Translational Dermatology Investigation Group, Granada, Spain
| | | | - Salvador Arias-Santiago
- Dermatology Unit, Virgen de las Nieves University Hospital, Granada, Spain.,TECe19-Clinical and Translational Dermatology Investigation Group, Granada, Spain
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