found a similar prevalence of urticaria (16%) in their series of 716 cases, in which urticarial lesions predominantly involved the trunk and limbs, relatively sparing the acral sites. Moreover, itch was almost always present. stated that urticarial rash occurred in 19% of their cohort, tended to appear simultaneously with systemic symptoms, lasted approximately 1 week and was associated with medium-high severity of COVID-19. Urticaria-like eruptions have been subsequently described in other cohort studies. Urticarial eruptions associated with COVID-19 have been first reported by Recalcati in his cohort of hospitalized patients, accounting for 16.7% of total skin manifestations. However, establishing a cause-effect relationship may be difficult in single cases. It is well known that urticaria and angioedema can be triggered by viral and bacterial agents, such as cytomegalovirus, herpesvirus, and Epstein-Barr virus and mycoplasma. Finally, distinguishing nosological entities “truly” associated with COVID-19 from cutaneous drug reactions or exanthems due to viruses other than SARS-CoV-2 remains a frequent open problem.Ĭlinical Features and Association with COVID-19 Severity Other authors have attempted to bring clarity in this field, suggesting possible classifications of COVID-19-associated cutaneous manifestations. In this regard, our group proposed the following six main clinical patterns of COVID-19-associated cutaneous manifestations in a recently published review article: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric “vasculitic” pattern (shown in Fig. Furthermore, evidence is accumulating that skin manifestations associated with COVID-19 are extremely polymorphic. Whilst the COVID-19-associated cutaneous manifestations have been increasingly reported, their exact incidence has yet to be estimated, their pathophysiological mechanisms are largely unknown, and the role, direct or indirect, of SARS-CoV-2 in their pathogenesis is still debated. Although COVID-19 is best known for causing fever and respiratory symptoms, it has been reported to be associated also with different extrapulmonary manifestations, including dermatological signs. Since then, the disease caused by this virus, called “coronavirus disease-19” (COVID-19), has spread throughout the world at a staggering speed becoming a pandemic emergency. All rights reserved.In December 2019, a novel zoonotic RNA virus named “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) was isolated in patients with pneumonia in Wuhan, China. Knowledge of the components is important to help identify potential COVID-19 patients and properly treat complications.ĬOVID-19 Coronavirus Dermatology Emergency medicine SARS-CoV-2 Skin.Ĭopyright © 2020 Elsevier Inc. It is important to be aware of the dermatologic manifestations and complications of COVID-19. While most of these dermatologic findings are self-resolving, they can help increase one's suspicion for COVID-19. These include maculopapular rashes, urticaria, vesicles, petechiae, purpura, chilblains, livedo racemosa, and distal limb ischemia. There are several types of skin findings described in association with COVID-19. The primary etiologies include vasculitis versus direct viral involvement. This brief report summarizes the dermatologic manifestations and complications associated with COVID-19 with an emphasis on Emergency Medicine clinicians.ĭermatologic manifestations of COVID-19 are increasingly recognized within the literature. While much of the focus has been on the cardiac and pulmonary complications, there are several important dermatologic components that clinicians must be aware of. The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality.
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