Are Cutaneous Manifestations Helpful for Diagnosing COVID-19?

Several reports have been published about cutaneous manifestations in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus responsible for coronavirus disease 2019 (COVID-19), but no specific skin manifestation helpful for diagnosing COVID-19 has yet to be identified, according to study findings published in Dermatologic Therapy. A few severe skin conditions, however, may help in identifying signs of severe systemic disease in some patients.

A small team of Italian researchers conducted a literature review to examine the reported skin manifestations in patients with a SARS-CoV-2 infection. Overall, the review included 36 case reports with 1340 patients with SARS-CoV-2 cutaneous manifestations.

Patients in these papers experienced vesicular eruption (n=88), urticarial eruptions (n=86), erythematous and maculopapular exanthemas (n=451), vascular skin lesions (n=715), livedo, purpuric lesions (n=23), and chilblain-like and erythema multiforme-like lesions (n=692).

Chicken-like vesicular eruptions in some patients with confirmed SARS-CoV-2 infections featured histologic findings consistent with viral infection. The eruptions were unable to predict outcomes in these patients. Another case study reported vesicular skin lesions that developed after the onset of COVID-19 symptoms in 79% of patients.

Studies from Italy have reported urticarial eruptions in patients with COVID-19. In a hospital in India, wheals were the most frequent skin manifestations in patients with COVID-19.

Erythematous macular and popular exanthemas have also been widely reported throughout the COVID-19 case study literature. Approximately half of skin manifestations in a study of patients with COVID-19 were maculopapular rashes.

Vascular cutaneous lesions have also been reported in some patients with COVID-19. Acral chilblain-like lesions have been described, for instance, but these lesions have not been able to prove a SARS-CoV-2 infection.

Limitations of the case studies and reports in this review were testing for COVID-19 in most but not all patients as well as the performance of skin biopsies in a small number of cases.

The researchers concluded that additional “studies on confirmed cases of infection are needed to demonstrate a certain relation between cutaneous manifestations and SARS-CoV-2 infection.”

Reference

Burlando M, Russo R, Cozzani E, Parodi A. Six months into the pandemic. A review of skin manifestations in SARS-CoV-2 infection. Published online December 5, 2020. Dermatol Ther. doi:10.1111/dth.14641