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Akl J, El-Kehdy J, Salloum A, Benedetto A, Karam P. Skin disorders associated with the COVID-19 pandemic: A review. J Cosmet Dermatol 2021; 20:3105-3115. [PMID: 34077629 PMCID: PMC8242622 DOI: 10.1111/jocd.14266] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/26/2021] [Indexed: 12/16/2022]
Abstract
Introduction In December 2019, a new coronavirus has emerged out of China, the SARS‐CoV‐2 virus, causing a disease known as COVID‐19, which steadily has progressed into a pandemic. This coronavirus affects many organs, including the skin, whose manifestations are a consequence of the disease itself, as well as the preventative measures taken to avoid the infection. This paper reviews the cutaneous manifestations which currently have been encountered during this pandemic. Methods A search was conducted on PubMed, and all relevant articles were included. Results The results show the occurrence of many cutaneous findings, ranging from those related to the infection itself and to various dermatitides related to the use of personal protective equipment (PPE) utilized by healthcare workers while attending to infected patients. Discussion Recognizing these findings is important for the accurate diagnosis of those infected with COVID‐19 as well as the prompt treatment of the side effects caused by PPE that might further impair the effectiveness of healthcare workers.
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Affiliation(s)
- Jennifer Akl
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Jessica El-Kehdy
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Antoine Salloum
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon.,Dermatologic SurgiCenter, Philadelphia, PA, USA
| | - Anthony Benedetto
- Dermatologic SurgiCenter, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paula Karam
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
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2
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Gisondi P, Di Leo S, Bellinato F, Cazzaniga S, Piaserico S, Naldi L. Time of Onset of Selected Skin Lesions Associated with COVID-19: A Systematic Review. Dermatol Ther (Heidelb) 2021; 11:695-705. [PMID: 33811315 PMCID: PMC8018690 DOI: 10.1007/s13555-021-00526-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Distinct skin lesions associated with coronavirus disease 2019 (COVID-19) have been described, but data regarding their time of onset during the COVID-19 course are scant. Our objective was to systematically review the studies reporting the time of onset of selected skin lesions with respect to the reported onset of the COVID-19 core symptoms. METHODS A comprehensive search of studies published before 21 January 2021 was performed on MEDLINE via PubMed database using a predefined strategy to identify relevant articles. RESULTS Out of 354 references, 87 were selected, reporting a total of 895 patients with skin lesions associated with COVID-19. The most frequent pattern was exanthema (n = 430, 48%), followed by vascular (n = 299, 33%), urticarial (n = 105, 12%) and others (n = 66, 7%). Skin lesions occurred more frequently in the first 4 weeks from the COVID-19 onset (n = 831, 92%), whereas prodromal or late lesions were rarer (n = 69, 8%). The urticarial and exanthema patterns were more frequent in the first 2 weeks. About the vascular pattern some differences were noted among its subtypes. Livedoid lesions occurred mainly in the first 2 weeks, while chilblain-like lesions between weeks 2 and 4. Purpuric/petechial lesions were equally distributed during the first 4 weeks. Several skin manifestations did not fall into the pattern classification, including erythema multiforme, generalized pruritus, Kawasaki disease and others. CONCLUSION The diversity in the time of onset of skin lesions as well as their polymorphic nature likely reflects the diversity of the pathogenetic underlying mechanisms. PROSPERO DATABASE REGISTRATION NUMBER CRD42021236331.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
| | - Sara Di Leo
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Stefano Piaserico
- Section of Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
- Centro Studi GISED, Bergamo, Italy
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3
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Sharma S, Raby E, Prasad Kumarasinghe S. Cutaneous manifestations and dermatological sequelae of Covid-19 infection compared to those from other viruses. Australas J Dermatol 2021; 62:141-150. [PMID: 33595840 PMCID: PMC8014733 DOI: 10.1111/ajd.13561] [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: 08/24/2020] [Revised: 11/21/2020] [Accepted: 01/02/2021] [Indexed: 01/07/2023]
Abstract
In the last few months, there have been numerous reports describing a variety of cutaneous signs associated with COVID-19. Clinicians from Italy were the first to describe the cutaneous manifestations of COVID-19, which were later observed in other parts of the globe. In some cases, cutaneous signs were the only manifestation of COVID-19 rather than the typical syndrome of fever and upper respiratory tract symptoms. However, there is considerable heterogeneity amongst the cutaneous signs described so far, which has been published extensively. Our aim is to summarise the latest studies that have reported the early and late cutaneous signs of COVID-19 and compare them to the most common established viral exanthems.
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Affiliation(s)
- Surabhi Sharma
- Willetton Medical CentreWillettonWestern AustraliaAustralia
| | - Edward Raby
- Fiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Sujith Prasad Kumarasinghe
- Fiona Stanley HospitalMurdochWestern AustraliaAustralia,Faculty of Health and Medical SciencesSchool of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
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Cazzato G, Foti C, Colagrande A, Cimmino A, Scarcella S, Cicco G, Sablone S, Arezzo F, Romita P, Lettini T, Resta L, Ingravallo G. Skin Manifestation of SARS-CoV-2: The Italian Experience. J Clin Med 2021; 10:jcm10081566. [PMID: 33917774 PMCID: PMC8068198 DOI: 10.3390/jcm10081566] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/26/2021] [Accepted: 04/05/2021] [Indexed: 02/05/2023] Open
Abstract
At the end of December 2019, a new coronavirus denominated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified in Wuhan, Hubei province, China. Less than three months later, the World Health Organization (WHO) declared coronavirus disease-19 (COVID-19) to be a global pandemic. Growing numbers of clinical, histopathological, and molecular findings were subsequently reported, among which a particular interest in skin manifestations during the course of the disease was evinced. Today, about one year after the development of the first major infectious foci in Italy, various large case series of patients with COVID-19-related skin manifestations have focused on skin specimens. However, few are supported by histopathological, immunohistochemical, and polymerase chain reaction (PCR) data on skin specimens. Here, we present nine cases of COVID-positive patients, confirmed by histological, immunophenotypical, and PCR findings, who underwent skin biopsy. A review of the literature in Italian cases with COVID-related skin manifestations is then provided.
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Affiliation(s)
- Gerardo Cazzato
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
| | - Caterina Foti
- Section of Dermatology and Venereology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (C.F.); (P.R.)
| | - Anna Colagrande
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
| | - Antonietta Cimmino
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
| | - Sara Scarcella
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
| | - Gerolamo Cicco
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
| | - Sara Sablone
- Section of Forensic Medicine, University of Bari ‘Aldo Moro’, 70121 Bari, Italy;
| | - Francesca Arezzo
- Section of Gynecologic and Obstetrics Clinic, University of Bari ‘Aldo Moro’, 70121 Bari, Italy;
| | - Paolo Romita
- Section of Dermatology and Venereology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (C.F.); (P.R.)
| | - Teresa Lettini
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
| | - Leonardo Resta
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
| | - Giuseppe Ingravallo
- Section of Pathology, University of Bari ‘Aldo Moro’, 70121 Bari, Italy; (G.C.); (A.C.); (A.C.); (S.S.); (G.C.); (T.L.); (L.R.)
- Correspondence:
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Shams S, Rathore SS, Anvekar P, Sondhi M, Kancherla N, Tousif S, Rojas GA, Ahmed NK, Munawwar M, Noman M. Maculopapular skin eruptions associated with Covid-19: A systematic review. Dermatol Ther 2021; 34:e14788. [PMID: 33481314 PMCID: PMC7995033 DOI: 10.1111/dth.14788] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/01/2021] [Accepted: 01/17/2021] [Indexed: 01/08/2023]
Abstract
In this systematic review, we anticipated in summarizing clinical features, histopathological hallmarks, and possible pathology behind the maculopapular skin eruptions occurring in Covid-19 patients. A literature search was executed using MEDLINE/PubMed and Embase databases for articles published till 20 November 2020. All eligible articles including observational studies, case reports, and case series reporting the maculopapular skin lesion in Covid-19 patients were included. Data were obtained for 354 Covid-19 patients presenting with maculopapular lesions from 40 studies. The mean age of these patients was 53 years, and with 42% of them being male. These maculopapular lesions differed considerably in terms of distribution and appearance, ranging from diffuse erythematous maculopapular lesions to scattered erythematous macules coalescing into papules to maculopapular lesions in plaques. The mean duration of the lesion was 8 days. These lesions were frequently localized on trunks and extremities. Superficial perivascular dermatitis with lymphocytic infiltrate was a histopathological hallmark of these lesions. As these skin lesions may have a possible association with diagnosis, management, prognosis, and severity of the disease, all health practitioners need to be well acquainted with these Covid-19 skin lesions. Also, in the middle of this worldwide pandemic, early identification of this eruption may help manage this infection's further spread.
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Affiliation(s)
- Saad Shams
- Internal MedicineRoss University School of MedicineMiramarFloridaUSA
| | | | - Priyanka Anvekar
- Internal MedicineMGM Medical College and HospitalAurangabadIndia
| | - Manush Sondhi
- Internal MedicineKasturba Medical CollegeManipalIndia
| | | | - Sohaib Tousif
- Internal MedicineZiauddin Medical UniversityKarachiPakistan
| | - Gianpier Alonzo Rojas
- Internal Medicine, School of medicineUniversidad Peruana Cayetano HerediaLimaPeru,Scientific Society of Medical StudentsCayetano HerediaLimaPeru
| | | | - Mehwish Munawwar
- Internal MedicineLiaquat College of Medicine and DentistryKarachiPakistan
| | - Muhammad Noman
- Internal MedicineZiauddin Medical CollegeKarachiPakistan
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Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2020; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain–Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis. The immune system plays a major role in the acute progression of COVID-19. SARS-CoV-2 infection shares features with autoimmune diseases. SARS-CoV-2 can induce Guillain-Barré syndrome, arthritis, chilblain-like lesions.
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Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
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7
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Conforti C, Dianzani C, Agozzino M, Giuffrida R, Marangi GF, di Meo N, Morariu SH, Persichetti P, Segreto F, Zalaudek I, Neagu N. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. BIOLOGY 2020; 9:E449. [PMID: 33291502 PMCID: PMC7762103 DOI: 10.3390/biology9120449] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/07/2023]
Abstract
There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Caterina Dianzani
- Dermatology Section, Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy;
| | - Marina Agozzino
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy;
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Nicola di Meo
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Silviu-Horia Morariu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy; (G.F.M.); (P.P.); (F.S.)
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Piazza Ospitale 1, 34125 Trieste, Italy; (C.C.); (M.A.); (N.d.M.); (I.Z.)
| | - Nicoleta Neagu
- Dermatology Clinic, Mureș County Hospital, Nr. 12 Gheorghe Doja Street, 540015 Tîrgu Mureș, Romania;
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Mawhirt SL, Frankel D, Diaz AM. Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers. Curr Allergy Asthma Rep 2020; 20:75. [PMID: 33047260 PMCID: PMC7549735 DOI: 10.1007/s11882-020-00974-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW COVID-19 (coronavirus viral disease 2019), due to the novel SARS-CoV-2, may present with different types of cutaneous manifestations of varying pathophysiology. During the ongoing pandemic, publications reporting dermatologic findings in COVID-19 continue to emerge. RECENT FINDINGS Cutaneous vasculopathy and microthrombus-related changes including acral and sacral lesions, retiform purpura, livedo reticularis, and cutaneous vasculitis are notable findings in adult patients. Other exanthems include urticaria or angioedema, morbilliform/maculopapular exanthems, erythema multiforme, and vesicular eruptions. Increased recognition of these findings, especially those consistent with cutaneous microthrombi or vasculitis, is of particular importance. Additionally, occupational dermatologic disease related to extended personal protective equipment (PPE) use, such as skin damage and irritant or allergic contact dermatitis (ACD), represents another emerging problem amidst the pandemic. In this review, we highlight the various cutaneous manifestations associated with COVID-19 in adult patients and occupational dermatitis in health care workers (HCWs) caring for this patient population.
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Affiliation(s)
- Stephanie L Mawhirt
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA.
| | - David Frankel
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA
| | - Althea Marie Diaz
- Department of Medicine, 222 Station Plaza North, Suite 509, Mineola, New York, USA
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Paracetamol. REACTIONS WEEKLY 2020. [PMCID: PMC7366477 DOI: 10.1007/s40278-020-80944-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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