Dermatologic manifestations of coronavirus disease 2019 (COVID-19)

ANALES RANM ◽  
2020 ◽  
Vol 137 (137(02)) ◽  
pp. 213-221
Keyword(s):  
Skin Lesions ◽  
Coagulation Cascade ◽  
Cutaneous Manifestations ◽  
Skin Manifestations ◽  
Viral Particles ◽  
Polymerase Chain ◽  
Immunohistochemical Techniques ◽  
Dermatologic Manifestations ◽  
Pcr Techniques ◽  
Maculopapular Exanthema

The cutaneous manifestations associated with coronavirus disease 2019 (COVID-19) are frequent and varied. Knowing these manifestations facilitates the diagnosis of asymptomatic or mildly symptomatic cases, contributing to reduce the spread of the virus. There are 5 main presentation patterns: acral areas of erythema-oedema with vesicles or pustules (pseudo-perniosis), other vesicular eruptions, urticarial lesions, maculopapular eruptions and livedo or necrosis. Most patterns can be further subdivided. The prognosis depends on the age of the patient and the severity of the respiratory clinic, not on the skin manifestation itself. Pseudo-chilblain lesions and vesicular eruptions are considered suggestive of COVID-19, while the rest of manifestations are unspecific and could occur in the context of other diseases. The physiopathological mechanisms involved in the appearance of skin lesions have yet to be categorized. There are 3 main hypotheses: hyperactive immune response, activation of the complement pathway and alterations in the coagulation cascade. Different alterations in each pathway would justify the great variety in the way that the different skin manifestations are presented. The causal relationship between some of the skin manifestations and COVID-19 is not yet fully demonstrated, since there are other factors such as drugs or fever that could be confounding factors. The presence of viral particles has been demonstrated by immunohistochemical techniques in pseudo-chilblain lesions, purpuric maculopapular exanthema and erythema multiforme. However, polymerase chain reaction (PCR) techniques from the skin samples have been negative in every conducted study.

scholarly journals Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries

Biology ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 54
Author(s):  
Carmen Rodriguez-Cerdeira ◽  
Brianda I. Uribe-Camacho ◽  
Lianet Silverio-Carrasco ◽  
Wennia Méndez ◽  
Ashwini R. Mahesh ◽  
...  
Keyword(s):  
Case Series ◽  
Skin Lesions ◽  
Close Monitoring ◽  
Livedo Racemosa ◽  
Cutaneous Manifestations ◽  
Causal Factors ◽  
Qrt Pcr ◽  
Previous Contact ◽  
Maculopapular Rashes ◽  
Dermatologic Manifestations

The increasingly frequent cutaneous manifestations of coronavirus disease (COVID-19) remain to pose a problem to clinicians. Herein, we aimed to describe the clinical and pathological findings of skin lesions in patients with COVID-19. The case series, which was based on the International Dermatological Registry circulated to dermatologists worldwide, was conducted across organizations and societies belonging to five different countries. We documented 31 patients with dermatologic manifestations associated with COVID-19, including maculopapular rashes (16.10%), urticarial lesions (26.80%), pseudochilblains (22.60%), petechiae/purpura (6.50%), distal ischaemia and necrosis (6.50%), livedo racemosa (12.90%), and others (9.70%). Twenty-six cases (83.90%) were qRT-PCR-confirmed COVID-19 cases, two (6.50%) were serologically confirmed, while two others (9.7%) were suspected cases owing to previous contact with COVID-19-positive patients. Therefore, our findings indicate that a febrile rash or even a rash in an afebrile state in the early stages of the disease may be the only clinical manifestation of COVID-19. In the future, we recommend close monitoring of all patients with skin lesions not attributable to other causal factors; in the diagnostic perspective, clinicians should aim to confirm if the skin lesions are associated with COVID-19.

scholarly journals Cutaneous manifestations in COVID-19 patients in a district COVID care centre

2021 ◽  
Vol 7 (6) ◽  
pp. 805
Author(s):  
Prathyusha Dasari ◽  
Swetha A. Chowdary ◽  
Haritha Samanthula ◽  
Soumya Ruvva
Keyword(s):  
Case Reports ◽  
Severe Disease ◽  
Respiratory Illness ◽  
Maculopapular Rash ◽  
Skin Lesions ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Cutaneous Manifestations ◽  
Skin Manifestations ◽  
Indian Scenario

<p class="abstract"><strong>Background:</strong> COVID-19, initially started as respiratory illness and evolved to involve various systems. Skin has been the least targeted organ with manifestations limited to case reports and series in a foreign scenario. Here, we tried to understand a same in an Indian scenario.</p><p class="abstract"><strong>Methods:</strong> This was cross-sectional study done in district COVID centre among patients with a confirmed diagnosis of COVID-19 with cutaneous manifestations for 3 months. A detailed history, complete cutaneous examination was carried out. Timing in relation to other symptoms and severity was assessed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among the 1603 patients, 39 (2.4%) had skin manifestations. Urticaria (20.5%), petechiae/purpura (17.9%), pruritis (15.4%) were the most common followed by maculo-papular rash (7.7%), manifestations secondary to drugs (7.7%), diffuse hair fall (7.7%), pseudo-chilblains (5.1%), vesicular eruptions (5.1%), infections (5.1%), cellulitis, gangrene and livedoid vasculitis. Timing of skin lesions ranged from 2 days before (10.3%) onset of COVID-19 symptoms or diagnosis to 10 days after (69.2%). Urticaria, petechiae, maculopapular rash were seen more commonly in patients with fever and respiratory symptoms. Asymptomatic cases showed urticaria, petechiae and pseudo-chilblains. Majority were in mild and moderate disease and livedoid vasculitis patient had severe disease.</p><p class="abstract"><strong>Conclusions:</strong> Skin manifestations in COVID-19 are relatively uncommon in Indian scenario. However, few of the manifestations give a hint of infection while some correlate with the severity of disease.</p>

Guinea pig seborrheic dermatitis model of Malassezia restricta and the utility of luliconazole

2019 ◽  
Vol 58 (6) ◽  
pp. 820-826 ◽  
Author(s):  
Hiroyasu Koga ◽  
Yukimi Munechika ◽  
Hiroko Matsumoto ◽  
Yasuko Nanjoh ◽  
Kazutoshi Harada ◽  
...  
Keyword(s):  
Guinea Pig ◽  
Quantitative Polymerase Chain Reaction ◽  
Seborrheic Dermatitis ◽  
Skin Lesions ◽  
Antifungal Drugs ◽  
Pathogenic Factor ◽  
Skin Manifestations ◽  
Polymerase Chain ◽  
Guinea Pig Model ◽  
Malassezia Restricta

Abstract Seborrheic dermatitis (SD) is a multifactorial disease in which Malassezia restricta has been proposed as the predominant pathogenic factor. However, experimental evidence supporting this hypothesis is limited. A guinea pig SD model using a clinical isolate of M. restricta was used to elucidate the pathogenicity of M. restricta. Also, the efficacy of 1% luliconazole (LLCZ) cream, a topical imidazole derivative, against M. restricta was compared with that of a 2% ketoconazole (KCZ) cream in the same guinea pig model. Dorsal skin hairs of guinea pig were clipped and treated with M. restricta by single or repeated inoculations without occlusion. Skin manifestations were examined macroscopically and histologically. A quantitative polymerase chain reaction (PCR) assay was also performed for mycological evaluation. An inflammatory response mimicking SD occurred after repeated as well as single inoculation but not in abraded skin. The inflammation score attained its maximum on day 11 and persisted until day 52. The yeast form of the fungal elements was distributed on the surface of stratum corneum and around the follicular orifices, and an epidermal and dermal histological reaction was observed. Application of 1% LLCZ or 2% KCZ cream significantly improved the skin manifestations and decreased the quantity of M. restricta rDNA in the skin lesions. The efficacy of topical antifungal drugs suggested that M. restricta is a pathogenic factor contributing to SD.

scholarly journals Skin manifestations of hematologic malignancies

2016 ◽  
Vol 43 (3) ◽  
pp. 121-124 ◽  
Author(s):  
AKM Rejaul Haque ◽  
ASM Zakaria ◽  
Abida Sultana ◽  
Md Rafiquzzaman Khan
Keyword(s):  
Hematologic Malignancies ◽  
Skin Lesions ◽  
Gingival Hyperplasia ◽  
Cutaneous Lesions ◽  
Cross Sectional ◽  
Cutaneous Manifestations ◽  
Skin Manifestations ◽  
Aleukemic Leukemia Cutis ◽  
Leukemia Cutis ◽  
One Year

Hematologic malignancies can present with various cutaneous manifestations. These include specific cutaneous diseases & non-specific cutaneous lesions. Non-specific skin lesions are more common in patients with hodgkins diseases. Generalized severe pruritus may precede other findings of Hodgkins disease by many months . So an evaluation for underlying lymphoma should be considered in patient with severe itching. Leukemia cutis (specific skin lesions of Leukemia) most commonly occurs concomitant with or following the diagnosis of leukemia. The skin may also be the site of relapse of leukemia after chemotherapy. Uncommonly leukemia cutis may be identified while the bone marrow & peripheral blood are normal. Those patients are classified as aleukemic leukemia cutis. This cross sectional observational study was carried out in the Hematology department of Bangabandhu Sheikh Mujib Medical University from January 2012 to January 2013 with the intention to know the prevalence of skin manifestations of hematologic malignancies & to help diagnose and manage hematologic malignancies in some extent. Total 127 consecutive patients who were already diagnosed as haematological malignancies & hospitalized were evaluated at the period of one year. Different types of cutaneous lesions were found in our study population, Infections were the highest number, 32(25.19%) patients suffering from various infections. Other findings includemalignant infiltration, 10(7.87%); hemorrhagic 121 lesions (petechia and ecchymosis), 17(13.38%); drug reaction, 5(3.93%); gingival hyperplasia, 3(2.36%); pruritus, 23(18.11%); pigmentation, 20(15.74%); prurigo, 8(6.29%) and ichthyosiform lesion, 19(14.96%).Bangladesh Med J. 2014 Sep; 43 (3): 121-124

scholarly journals Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Parnian Jamshidi ◽  
Bahareh Hajikhani ◽  
Mehdi Mirsaeidi ◽  
Hassan Vahidnezhad ◽  
Masoud Dadashi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Disease Severity ◽  
Severe Disease ◽  
Maculopapular Rash ◽  
Skin Lesions ◽  
Vascular Lesions ◽  
Cutaneous Manifestations ◽  
Skin Manifestations ◽  
Severity Of The Disease

Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19.Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: “SARS-CoV-2” or “COVID-19” or “new coronavirus” or “Wuhan Coronavirus” or “coronavirus disease 2019” and “skin disease” or “skin manifestation” or “cutaneous manifestation.”Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1,847 patients with confirmed COVID-19 were examined. The overall frequency of cutaneous manifestations in COVID-19 patients was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. Forty-eight percentage of the patients had a mild, 32% a moderate, and 20% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. Seventy-two percentage of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%).Conclusion: The mere occurrence of skin manifestations in COVID-19 patients is not an indicator for the disease severity, and it highly depends on the type of skin lesions. Chilblain-like and vascular lesions are the ends of a spectrum in which from chilblain-like to vascular lesions, the severity of the disease increases, and the patient's prognosis worsens. Those with vascular lesions should also be considered as high-priority patients for further medical care.

scholarly journals Cutaneous manifestations of endocrine disorders

2018 ◽  
Vol 4 (2) ◽  
pp. 234
Author(s):  
Kirthi Sampath K. ◽  
Haritha S. ◽  
Mahesh B.
Keyword(s):  
Diabetes Mellitus ◽  
Thyroid Disease ◽  
Addison’S Disease ◽  
Skin Lesions ◽  
The Body ◽  
Addison's Disease ◽  
Thyroid Disorder ◽  
Cutaneous Manifestations ◽  
Skin Manifestations ◽  
Wide Range

<p class="abstract"><strong>Background:</strong> It is a well-known fact that the skin is referred to as a window or mirror to the body. The present study was undertaken to know the spectrum of cutaneous manifestations in endocrinological disorders.</p><p class="abstract"><strong>Methods:</strong> A total of 500 patients with endocrinological disorders attending the Medical and Dermatology OPD at Dr. PSIMS&amp;RF were studied. Among the 500 cases studied, 417 patients had diabetes, 81 cases had thyroid disorder and 2 patients had Addison’s disease.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most common dermatoses observed in patients with diabetes mellitus were infections {(fungal 25.3%), bacterial (6.92%), viral (5.42%)} followed by eczemas (13.2%), psoriasis (8.13%). Among 81 patients with thyroid disease, 78 patients were hypothyroid and 3 patients had hyperthyroidism and skin manifestations were observed in 55 (67%) of the patients with thyroid disorders. Most common dermatoses observed in patients with hypothyroidism were fungal infections (23.07%), urticaria (19.23%), xerosis (13.46%), bacterial infections (13.46%), psoriasis (11.53%). All 3 hyperthyroid patients have shown skin manifestations. 2 patients had diffuse hair loss and 1 patient had vitiligo. 2 cases of Addison’s disease were observed and both of them showed diffuse hyperpigmentation with accentuation over palmar creases, knuckles and gums.</p><p><strong>Conclusions:</strong> The present study shows the wide range of skin lesions in patients with endocrinological disorders paerticularly diabetes mellitus and thyroid disease. Through knowledge of the associated skin lesions helps in early diagnosis of underlying endocrine abnormality and thereby appropriate treatment provided at the earliest helps in preventing complications. </p>

scholarly journals Dermatologic manifestation of COVID-19: a systematic review

2021 ◽  
Vol 7 (4) ◽  
pp. 565
Author(s):  
Annisa Alviariza ◽  
Luh M. Budiani
Keyword(s):  
Descriptive Analysis ◽  
Case Series ◽  
Signs And Symptoms ◽  
Maculopapular Rash ◽  
Cutaneous Manifestations ◽  
Literature Searches ◽  
Associated Symptoms ◽  
Vesicular Rash ◽  
Polymerase Chain ◽  
Dermatologic Manifestations

<p class="abstract">Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections, causing disease known as COVID-19, has been associated with a myriad of symptoms, including dermatological ones. Despite there has been a consensus on pulmonary and systemic signs and symptoms of COVID-19, the same cannot be said of dermatological ones. We write in attempt to find a common theme of dermatological manifestations of COVID-19. We conducted literature searches from Medline databases as well as Google Scholar using keywords “cutaneous manifestations of COVID-19” and “dermatologic manifestations of COVID-19”. We included case series in our pooled descriptive analysis to describe types of cutaneous eruptions, localizations, and associated symptoms among COVID-19 patients with confirmed real time-polymerase chain reaction (RT-PCR) results. We included 12 case series in our pooled analyses with 2 more analyzed separately due to non-comparable data presentations. The results identified common types of cutaneous eruptions associated with COVID-19 to be maculopapular rash, urticaria, vesicular rash, vascular rash. Eruptions tend to be localized on the trunks, with lesser frequency found on extremities, and eruptions are often accompanied by pruritus of varying intensity. These various eruptions are associated with two distinct pathological pathways, namely inflammation of skin tissues, causing inflammatory rashes, and hypercoagulable state which is associated with vascular rashes. Our literature review identified several common types of cutaneous eruptions associated with COVID-19 with different proposed pathophysiological mechanisms for inflammatory and vascular rashes. This review is limited by its data sources which includes only case series as well as the fact that at this stage in the pandemic, little biomolecular research has been conducted to definitively associate SARS-CoV-2 infection with cutaneous manifestations.</p>

scholarly journals Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199719
Author(s):  
Juan Carlos Palomo-Pérez ◽  
Maria Elisa Vega-Memije ◽  
David Aguilar-Blancas ◽  
Erik González-Martínez ◽  
Lucia Rangel-Gamboa
Keyword(s):  
Respiratory Symptoms ◽  
Case Series ◽  
Signs And Symptoms ◽  
Skin Lesions ◽  
World Health ◽  
Medical Community ◽  
Atypical Pneumonia ◽  
Cutaneous Lesions ◽  
Cutaneous Manifestations ◽  
Mexican Patients

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

scholarly journals Complicated cutaneous leishmaniasis caused by an imported case of Leishmania tropica in Japan: a case report

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Hiroyuki Kitano ◽  
Chizu Sanjoba ◽  
Yasuyuki Goto ◽  
Kazumasa Iwamoto ◽  
Hiroki Kitagawa ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Skin Lesions ◽  
Leishmania Tropica ◽  
Case Presentation ◽  
Imported Case ◽  
Imported Cases ◽  
History Of ◽  
Hematoxylin And Eosin ◽  
Polymerase Chain ◽  
Positive Results

Abstract Background Leishmaniasis is not endemic in Japan, and imported cases are rare. However, there are increasing concerns regarding imported cases of cutaneous leishmaniasis from endemic countries to Japan. This report describes a case of imported cutaneous leishmaniasis that was diagnosed and treated in Japan. Case presentation A 53-year-old Pakistani man presented with skin lesions on both malleoli of his right ankle and the dorsum of the left foot. The skin lesions manifested as erythematous nodules surrounding an ulcer in the center of the lesion. The lesions of the malleoli of his right ankle each measured 3 × 3 cm, and the lesion on the top of his left foot measured 5 × 4 cm. He had been living and working in Japan but had a history of a visit to Pakistan for about 2 months in 2018. The skin lesions were biopsied. Giemsa and hematoxylin and eosin staining of biopsy samples showed amastigotes of Leishmania in macrophages, and the presence of Leishmania was confirmed by skin tissue culture. Polymerase chain reaction using biopsy specimens identified Leishmania parasites, and DNA sequence analysis revealed that the species was Leishmania tropica. The patient was treated with intravenous liposomal amphotericin B for 6 days. The erythema disappeared, and the erythematous nodules resolved within 3 weeks. Conclusion This is the first report of imported cutaneous leishmaniasis caused by L. tropica from Pakistan, and it is interesting that all three testing modalities showed positive results in this case.

The protean phenotype of MSH6 pathogenic variants (PV) in Lynch syndrome (LS) patients (pts).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10537-10537
Author(s):  
Michelle J McSweeny ◽  
Susan Montgomery ◽  
Kristen Danielle Whitaker ◽  
Mary Beryl Daly ◽  
Michael J. Hall
Keyword(s):  
Skin Disease ◽  
Early Onset ◽  
Skin Lesions ◽  
Published Data ◽  
Pedigree Data ◽  
Skin Manifestations ◽  
Pathogenic Variants ◽  
Ca 50 ◽  
Uncertain Variant ◽  
Histologic Types

10537 Background: LS is among the most common hereditary cancer (CA) syndromes. PVs in MSH6 are 2-4 fold more common in the population (1/758) than those in MLH1 (1/1946) or MSH2 (1/2841), and are increasingly regarded as lower penetrance for CRC due to published data supporting later mean age of CRC onset and lower CRC risk. Unlike for MLH1/MSH2, NCCN 2020 CA risk estimates recognize only endometrial CA (EC) and CRC risks in MSH6+ carriers as clearly above SEER population estimates. Further, risks of other LS manifestations such as skin disease/Muir-Torre, ovarian CA (OC), and possible rare tumors in LS like sarcoma, have been minimally characterized in MSH6+ carriers. Methods: Pedigree data for 44 MSH6+ index (first-evaluated family member by our program) pts consecutively ascertained since 2009 at Fox Chase (FCCC) were reviewed. 1 pt w/a rare MSH6 uncertain variant w/personal history (PHx) of MSH6-expression deficient EC (age 50) and MSH6-deficient sebaceous skin CA (age 50) and a strong family history (FHx) c/w LS is also included here. 34% (15/44) index pts were referred to FCCC for cascade testing due to a known MSH6 PV in the family. Of the remaining 29 index pts, ascertainment included: 14% w/positive universal LS tumor screening, 21% w/early-onset or synchronous LS CA, 14% w/multi-gene panel for PHx of OC, 10% w/incidental MSH6+ result (2 had testing for PHx breast CA, 1 tumor genomic profiling), and 28% w/PHx and/or FHx of LS CA warranting genetic testing. Age of CA onset and path data were verified in > 90% index pts. Results: Index pts had a mean age of 55.5 yrs, and 77% were female. Overall, 11% (5/44) of MSH6+ index pts were found to have LS at diagnosis of synchronous primary CAs (3 EC/OC, 1 CRC/CRC, 1 CRC/EC), and 4/5 of these occurred <50 yrs. An additional 20% (9/44) index pts reported PHx of >2 metachronous LS CAs. OC was the presenting CA in 14% (6/44) female index pts; 2 additional index pts had rarer OC variants (Mullerian duct @ 41, primary peritoneal CA @ 50). Skin manifestations of LS were documented in 9.1% (4/44) index pts (3 sebaceous, 1 SCC in-situ/Bowen’s disease); 1 other family had documented sebaceous CAs in an FDR (father) but the 2 daughters seen @FCCC (both 30s) had yet to develop skin lesions. 2 index pts were found to have LS after developing early-onset breast CA (age 39) and contralateral breast CA (ages 50 and 54). Finally, 7% (3/44) index pts had a PHx of sarcoma: 2 were liposarcomas (ages 57 and 67), and 1 was a dermatofibrosarcoma. 2 other index pts had siblings w/childhood sarcomas. Conclusions: Our data, encompassing 44 MSH6+ pts evaluated in our clinic and consecutively ascertained, suggest MSH6 PV carriers develop synchronous primaries (11%), common and rare OC histologic types (18%), sarcomas (7%) and skin disease/Muir-Torre (9%). While common in the population and lower penetrance for CRC, MSH6 PV can behave in uncommon ways and may have significant extra-colonic CA risks such as OC, sarcoma and skin manifestations.

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