Cutaneous manifestations of COVID-19: Report of three cases and a review of literature

doi:10.1016/j.jdermsci.2020.04.011

Review

. 2020 May;98(2):75-81.

doi: 10.1016/j.jdermsci.2020.04.011. Epub 2020 Apr 29.

Cutaneous manifestations of COVID-19: Report of three cases and a review of literature

Muskaan Sachdeva¹, Raffaele Gianotti², Monica Shah¹, Lucia Bradanini³, Diego Tosi⁴, Stefano Veraldi⁵, Michael Ziv⁶, Eyal Leshem⁷, Roni P Dodiuk-Gad⁸

Affiliations

¹ Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Institute of Dermatological Sciences, University of Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
³ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy.
⁴ Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy.
⁵ Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁶ Dermatology Department, Emek Medical Center, Israel.
⁷ Institute for Travel and Tropical Medicine, Sheba Medical Centre, Israel; School of Medicine, Tel Aviv University, Israel.
⁸ Dermatology Department, Emek Medical Center, Israel; Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Israel; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: rdodiukgad@gmail.com.

PMID: 32381430
PMCID: PMC7189855
DOI: 10.1016/j.jdermsci.2020.04.011

Free PMC article

Review

Cutaneous manifestations of COVID-19: Report of three cases and a review of literature

Muskaan Sachdeva et al. J Dermatol Sci. 2020 May.

Free PMC article

. 2020 May;98(2):75-81.

doi: 10.1016/j.jdermsci.2020.04.011. Epub 2020 Apr 29.

Authors

Muskaan Sachdeva¹, Raffaele Gianotti², Monica Shah¹, Lucia Bradanini³, Diego Tosi⁴, Stefano Veraldi⁵, Michael Ziv⁶, Eyal Leshem⁷, Roni P Dodiuk-Gad⁸

Affiliations

¹ Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Institute of Dermatological Sciences, University of Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
³ Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy.
⁴ Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy.
⁵ Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁶ Dermatology Department, Emek Medical Center, Israel.
⁷ Institute for Travel and Tropical Medicine, Sheba Medical Centre, Israel; School of Medicine, Tel Aviv University, Israel.
⁸ Dermatology Department, Emek Medical Center, Israel; Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Israel; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: rdodiukgad@gmail.com.

PMID: 32381430
PMCID: PMC7189855
DOI: 10.1016/j.jdermsci.2020.04.011

Abstract

Background: Various cutaneous manifestations have been observed in patients with COVID-19 infection. However, overall similarities in the clinical presentation of these dermatological manifestations have not yet been summarized.

Objective: This review aims to provide an overview of various cutaneous manifestations in patients with COVID-19 through three case reports and a literature review.

Methods: A literature search was conducted using PubMed, OVID, and Google search engines for original and review articles. Studies written in the English language that mentioned cutaneous symptoms and COVID-19 were included.

Results: Eighteen articles and three additional cases reported in this paper were included in this review. Of these studies, 6 are case series and 12 are case report studies. The most common cutaneous manifestation of COVID-19 was found to be maculopapular exanthem (morbilliform), presenting in 36.1% (26/72) patients. The other cutaneous manifestations included: a papulovesicular rash (34.7%, 25/72), urticaria (9.7%, 7/72), painful acral red purple papules (15.3%, 11/72) of patients, livedo reticularis lesions (2.8%, 2/72) and petechiae (1.4%, 1/72). Majority of lesions were localized on the trunk (66.7%, 50/72), however, 19.4% (14/72) of patients experienced cutaneous manifestations in the hands and feet. Skin lesion development occurred before the onset of respiratory symptoms or COVID-19 diagnosis in 12.5% (9/72) of the patients, and lesions spontaneously healed in all patients within 10 days. Majority of the studies reported no correlation between COVID-19 severity and skin lesions.

Conclusion: Infection with COVID-19 may result in dermatological manifestations with various clinical presentations, which may aid in the timely diagnosis of this infection.

Keywords: COVID-19; Cutaneous manifestations; Review; Skin.

Conflict of interest statement

Declaration of Competing Interest None. The authors have no conflict of interest to declare.

Figures

**Fig. 1**
Cutaneous manifestation of COVID-19 in Case 1.

**Fig. 2**
(a) Cutaneous manifestation of COVID-19 on trunk in Case 2. (b) Cutaneous manifestation of COVID-19 on legs in Case 2.

**Fig. 3**
Cutaneous manifestation of COVID-19 in Case.

See this image and copyright information in PMC

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References

1. Guo Y.R., Cao Q.D., Hong Z.S., Tan Y.Y., Chen S.D., Jin H.J., Tan K.S., Wang D.Y., Yan Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil. Med. Res. 2020;13(March (1)):11. - PMC - PubMed
1. World Health Organization . World Health Organization; 2020. Coronavirus Disease (COVID-19) Outbreak Situation [Internet]https://covid19.who.int/ [cited 2020 Apr 22]. Available from:
1. Han Y., Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID‐19): a Chinese perspective. J. Med. Virol. 2020;6(March) doi: 10.1002/jmv.25749. [Epub ahead of print] - DOI - PMC - PubMed
1. World Health Organization; 2020. Coronavirus Disease (COVID-19) - Events as They Happen [Internet]. Rolling Updates on Coronavirus Disease (COVID-19).https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-a... [cited 2020 Apr 13]. Available from:
1. Zhai P., Ding Y., Wu X., Long J., Zhong Y., Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int. J. Antimicrob. Agents. 2020;28(March):105955. doi: 10.1016/j.ijantimicag.2020.105955. [Epub ahead of print] - DOI - PMC - PubMed

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[1] Guo Y.R., Cao Q.D., Hong Z.S., Tan Y.Y., Chen S.D., Jin H.J., Tan K.S., Wang D.Y., Yan Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil. Med. Res. 2020;13(March (1)):11. - PMC - PubMed

[2] Guo Y.R., Cao Q.D., Hong Z.S., Tan Y.Y., Chen S.D., Jin H.J., Tan K.S., Wang D.Y., Yan Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Mil. Med. Res. 2020;13(March (1)):11. - PMC - PubMed

[3] World Health Organization . World Health Organization; 2020. Coronavirus Disease (COVID-19) Outbreak Situation [Internet]https://covid19.who.int/ [cited 2020 Apr 22]. Available from:

[4] World Health Organization . World Health Organization; 2020. Coronavirus Disease (COVID-19) Outbreak Situation [Internet]https://covid19.who.int/ [cited 2020 Apr 22]. Available from:

[5] Han Y., Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID‐19): a Chinese perspective. J. Med. Virol. 2020;6(March) doi: 10.1002/jmv.25749. [Epub ahead of print] - DOI - PMC - PubMed

[6] Han Y., Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID‐19): a Chinese perspective. J. Med. Virol. 2020;6(March) doi: 10.1002/jmv.25749. [Epub ahead of print] - DOI - PMC - PubMed

[7] World Health Organization; 2020. Coronavirus Disease (COVID-19) - Events as They Happen [Internet]. Rolling Updates on Coronavirus Disease (COVID-19).https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-a... [cited 2020 Apr 13]. Available from:

[8] World Health Organization; 2020. Coronavirus Disease (COVID-19) - Events as They Happen [Internet]. Rolling Updates on Coronavirus Disease (COVID-19).https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-a... [cited 2020 Apr 13]. Available from:

[9] Zhai P., Ding Y., Wu X., Long J., Zhong Y., Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int. J. Antimicrob. Agents. 2020;28(March):105955. doi: 10.1016/j.ijantimicag.2020.105955. [Epub ahead of print] - DOI - PMC - PubMed

[10] Zhai P., Ding Y., Wu X., Long J., Zhong Y., Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int. J. Antimicrob. Agents. 2020;28(March):105955. doi: 10.1016/j.ijantimicag.2020.105955. [Epub ahead of print] - DOI - PMC - PubMed

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