New-onset skin disease following COVID-19 infection can resolve spontaneously without medication, and the most common of such diseases is telogen effluvium (TE), according to findings from a systematic review letter-to-the-editor published in The Journal of Dermatology. Neither exacerbations nor new-onset of chilblains, urticaria, vasculitis, or livedo lesions are anticipated following COVID-19 infection.
Investigators sought to evaluate the association between COVID-19 infection and persistent or new-onset rash following infection. They conducted a systematic review of 52 case reports, 8 case series, and 5 cross-sectional studies that included 345 patients of whom 20 had pre-existing skin disease flare-ups and 325 of whom had developed new-onset skin diseases following COVID diagnosis.
Among the new-onset patients, skin disease symptoms appeared 14 to210 days following COVID-19 diagnosis. Almost 85% were patients with hair disorders (47.0±7.6 years of age; 77.7% women) almost 85% of which were distinguished by mild symptoms. TE was the most common of these disorders, followed by alopecia (androgenetic alopecia was the most common) and alopecia areata. Patients with alopecia areata and androgenetic alopecia had pre-existing diseases in almost all cases, and no patients with TE had pre-existing TE. Investigators found the mean duration of TE following COVID-19 infection was about 57 days, and that best treatment was clinician-offered reassurance for spontaneous resolution.
Psoriasis was exacerbated (45%) with skin flare-ups as long as 4 months after COVID-19 diagnosis. Stress, COVID-19 itself, and medications used to treat COVID-19 are all triggers for psoriasis, possibly explaining psoriasis as the most common exacerbated skin disease.
Study limitations include that neither cutaneous manifestations nor aggravating skin diseases related to COVID-19 were accounted for.
Reviewers concluded that, “TE is the most common new-onset skin disease after COVID-19 infection that can resolve spontaneously without medications.” More serious non-spontaneously resolving issues of vasculitis, urticaria, and livedo lesions, “are not expected as either new-onset or exacerbated cases after COVID-19.”
Chularojanamontri L, Tuchinda P, Rujitharanawong C, et al. New-onset and exacerbated skin diseases after COVID-19 infection: A systematic review. J Dermatol. Published online July 1, 2022. doi:10.1111/1346-8138.16501