Cutaneous manifestations and considerations in COVID-19 pandemic: A systematic review

Dermatol Ther. 2020 Nov;33(6):e13986. doi: 10.1111/dth.13986. Epub 2020 Aug 6.


COVID-19 had a great impact on medical approaches among dermatologist. This systematic review focuses on all skin problems related to COVID-19, including primary and secondary COVID-related cutaneous presentations and the experts recommendations about dermatological managements especially immunomodulators usage issues. Search was performed on PubMed, Scopus, Embase and ScienceDirect. Other additional resources were searched included Cochrane, WHO, Medscape and coronavirus dermatology resource of Nottingham university. The search completed on May 3, 2020. Three hundred seventy-seven articles assigned to the inclusion and exclusion groups. Eighty-nine articles entered the review. Primary mucocutaneous and appendageal presentations could be the initial or evolving signs of COVID-19. It could be manifest most commonly as a maculopapular exanthamatous or morbiliform eruption, generalized urticaria or pseudo chilblains recognized as "COVID toes" (pernio-like acral lesions or vasculopathic rashes). During pandemic, Non-infected non-at risk patients with immune-medicated dermatologic disorders under treatment with immunosuppressive immunomodulators do not need to alter their regimen or discontinue their therapies. At-risk o suspected patients may need dose reduction, interval increase or temporary drug discontinuation (at least 2 weeks). Patients with an active COVID-19 infection should hold the biologic or non-biologic immunosuppressives until the complete recovery occur (at least 4 weeks).

Keywords: COVID-19; alopecia; biologic; collagen vascular disorder; corona virus; cosmetic procedure; cutaneous; cutaneous manifestation; dermatitis; dermatology; drug reaction; eczema; health care staff; hidradenitis suppurativa; immunobullous; immunomodulator; immunosupressant; immunosupressive; novel human coronavirus (SARS-CoV-2); pandemic considerations; papulosquamous; pemphigus; psoriasis; recommendation; skin; skin manifestation; skin rheumatologic disorder; special; specific skin diseases; surgical procedure; systematic review; systemic treatment; teledermatology; visits.

Publication types

  • Systematic Review

MeSH terms

  • COVID-19 / complications*
  • Chilblains / virology
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / adverse effects
  • Skin Diseases / drug therapy
  • Skin Diseases / immunology
  • Skin Diseases, Viral / drug therapy
  • Skin Diseases, Viral / etiology*
  • Skin Diseases, Viral / physiopathology


  • Immunosuppressive Agents