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COVID-19 and cutaneous manifestations: Two cases and a review of the literature

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COVID-19 can affect multiple organs, including skin. A wide range of skin manifestations have been reported in literature. Six main phenotypes have been identified: i) urticarial rash, ii) confluent erythematous/maculopapular/morbilliform rash, iii) papulovesicular exanthem, iv) a chilblain-like acral pattern, v) a livedo reticularis/racemosa-like pattern, and vi) a purpuric vasculitic pattern. The pathogenetic mechanism is still not completely clear, but a role of hyperactive immune response, complement activation and microvascular injury have been postulated. The only correlation between the cutaneous phenotype and the severity of COVID-19 has been observed in the case of chilblain-like acral lesions, that is generally associated with the benign/subclinical course of COVID-19. Herein, we report two cases of SARS-CoV- 2 infection in patients who developed cutaneous manifestations that completely solved with systemic steroids and antihistamines. The first case is a female patient not vaccinated for SARS-CoV-2 with COVID-19 associated pneumonia, while the second case is a vaccinated female patient with only skin manifestations.

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Giorgia Borio, Federica Farolfi (2022)
Fever and acute urticaria in a young male patient. Emergency Care Journal, 18(3),
10.4081/ecj.2022.10742
Molina-Ruiz AM, Santonja C, Rütten A, et al. Immunohistochemistry in the diagnosis of cutaneous viral infections--part I. Cutaneous viral infections by herpesviruses and papillomaviruses. Am J Dermatopathol 2015;37:1-14. DOI: https://doi.org/10.1097/DAD.0000000000000203
Muehlenbachs A, Bhatnagar J, Zaki SR. Tissue tropism, pathology and pathogenesis of enterovirus infection. J Pathol 2015;235:217-28. DOI: https://doi.org/10.1002/path.4438
Keighley CL, Saunderson RB, Kok J, Dwyer DE. Viral exanthems. Curr Opin Infect Dis 2015;28:139-50. DOI: https://doi.org/10.1097/QCO.0000000000000145
Su CJ, Lee CH. Viral exanthem in COVID-19, a clinical enigma with biological significance. J Eur Acad Dermatol Venereol 2020;34:e251-2. DOI: https://doi.org/10.1111/jdv.16469
Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020;34:e212–3. DOI: https://doi.org/10.1111/jdv.16387
Guan WJ, Ni ZY, Hu Y, et al. China medical treatment expert group for Covid-19. Clinical characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382:1708-20. DOI: https://doi.org/10.1056/NEJMc2005203
Hoehl S, Rabenau H, Berger A, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med 2020;382:1278-80. DOI: https://doi.org/10.1056/NEJMc2001899
Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol 2020;82:e177. DOI: https://doi.org/10.1016/j.jaad.2020.03.036
Kamali Aghdam M, Jafari N, Eftekhari K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect Dis (Lond) 2020;52:427-9. DOI: https://doi.org/10.1080/23744235.2020.1747634
Uchonwanit P, Leerunyakul K, Kositkuljorn C. Cutaneous manifestations in COVID-19: Lessons learned from current evidence. J Am Acad Dermatol 2020;83:e57-e60. DOI: https://doi.org/10.1016/j.jaad.2020.04.094
De Giorgi V, Recalcati S, Jia Z, et al. Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): a prospective study from China and Italy. J Am Acad Dermatol 2020;83:674–5. DOI: https://doi.org/10.1016/j.jaad.2020.05.073
Galvan Casas C, Catala A, Carretero Hernandez G, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020;183:71-7. DOI: https://doi.org/10.1111/bjd.19347
Marzano AV, Cassano N, Genovese G, et al. Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue. Br J Dermatol 2020;183:431-42. DOI: https://doi.org/10.1111/bjd.19264
Torrelo A, Andina D, Santonja C, et al. Erythema multiformelike lesions in children and COVID-19. Pediatr Dermatol 2020;37:442-6. DOI: https://doi.org/10.1111/pde.14246
Ehsani AH, Nasimi M, Bigdelo Z. Pityriasis rosea as a cutaneous manifestation of COVID-19 infection. J Eur Acad Dermatol Venereol 2020;34:e436-7. DOI: https://doi.org/10.1111/jdv.16579
Llamas-Velasco M, Chicharro P, Rodríguez Jiménez P, et al. Comment on ‘Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital’. Pseudoherpetic Grover disease seems to occur in patients with COVID-19 infection. Clin Exp Dermatol 2020;45:896–8. DOI: https://doi.org/10.1111/ced.14305
Cepeda-Valdes R, Carrion-Alvarez D, Trejo Castro A, et al. Cutaneous manifestations in COVID-19: familial cluster of urticarial rash. Clin Exp Dermatol 2020;45:895–6. DOI: https://doi.org/10.1111/ced.14290
Freeman EE, McMahon DE, Lipoff JB, et al. The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries. J Am Acad Dermatol 2020;83:1118–29. DOI: https://doi.org/10.1016/j.jaad.2020.06.1016
Najafzadeh M, Shahzad F, Ghaderi N, et al. Urticaria (angioedema) and COVID-19 infection. J Eur Acad Dermatol Venereol 2020;34:e568–70. DOI: https://doi.org/10.1111/jdv.16721
Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J, et al. Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital. Clin Exp Dermatol 2020;45:872–5. DOI: https://doi.org/10.1111/ced.14277
Amatore F, Macagno N, Mailhe M, Demarez B, Gaudy-Marqueste C, Grob JJ, Raoult D, Brouqui P, Richard MA. SARS-CoV-2 infection presenting as a febrile rash. J Eur Acad Dermatol Venereol 2020;34:e304-e306. DOI: https://doi.org/10.1111/jdv.16528
Rodríguez-Jiménez P, Chicharro P, De Argila D, et al. Urticaria-like lesions in COVID-19 patients are not really urticaria - a case with clinicopathological correlation. J Eur Acad Dermatol Venereol 2020;34:e459-60. DOI: https://doi.org/10.1111/jdv.16618
Shanshal M. Low-dose systemic steroids, an emerging therapeutic option for COVID-19-related urticaria. J Dermatolog Treat 2020;16:1-2. DOI: https://doi.org/10.1080/09546634.2020.1795062
Català A, Galván-Casas C, Carretero-Hernández G, et al. Maculopapular eruptions associated to COVID-19: A subanalysis of the COVID-Piel study. Dermatol Ther 2020;33:e14170. DOI: https://doi.org/10.1111/dth.14170
Rivera-Oyola R, Koschitzky M, Printy R, et al. Dermatologic findings in 2 patients with COVID-19. JAAD Case Rep 2020;6:537–9. DOI: https://doi.org/10.1016/j.jdcr.2020.04.027
Jimenez-Cauhe J, Ortega-Quijano D, Prieto-Barrios M, et al. Reply to "COVID-19 can present with a rash and be mistaken for dengue": Petechial rash in a patient with COVID-19 infection. J Am Acad Dermatol 2020;83:e141-2. DOI: https://doi.org/10.1016/j.jaad.2020.04.016
Najarian DJ. Morbilliform exanthem associated with COVID-19. JAAD Case Rep 2020;6:493-4. DOI: https://doi.org/10.1016/j.jdcr.2020.04.015
Gianotti R, Veraldi S, Recalcati S, et al. Cutaneous clinicopathological findings in three COVID-19-positive patients observed in the metropolitan area of Milan, Italy. Acta Derm Venereol 2020;100:adv00124.2. DOI: https://doi.org/10.2340/00015555-3490
Reymundo A, Fernaldez-Bernaldez A, Reolid A, et al. Clinical and histological characterization of late appearance maculo-papular eruptions in association with the coronavirus disease 2019. A case series of seven patients. J Eur Acad Dermatol Venereol 2020;34:e755-7. DOI: https://doi.org/10.1111/jdv.16707
Marzano AV, Genovese G, Fabbrocini G, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol 2020;83:280-5. DOI: https://doi.org/10.1016/j.jaad.2020.04.044
Genovese G, Colonna C, Marzano AV. Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: A diagnostic clue? Pediatr Dermatol 2020;37:435-6. DOI: https://doi.org/10.1111/pde.14201
Magro C, Mulvey JJ, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res 2020;220:1-13. DOI: https://doi.org/10.1016/j.trsl.2020.04.007
Askin O, Altunkalem RN, Altinisik DD, et al. Cutaneous manifestations in hospitalized patients diagnosed as COVID-19. Dermatol Ther 2020;24:e13896.
Trellu LT, Kaya G, Alberto C, et al. Clinicopathologic aspects of a papulovesicular eruption in a patient with COVID-19. JAMA Dermatol 2020;156:922-4. DOI: https://doi.org/10.1001/jamadermatol.2020.1966
Mahé A, Birckel E, Merklen C, et al. Histology of skin lesions establishes that the vesicular rash associated with COVID-19 is not ‘varicella-like’. J Eur Acad Dermatol Venereol 2020;34:e559–61. DOI: https://doi.org/10.1111/jdv.16706
Elsaie ML, Nada HA. Herpes zoster (shingles) complicating the course of COVID19 infection. J Dermatolog Treat 2020;12:1-3. DOI: https://doi.org/10.1080/09546634.2020.1782823
Marzano AV, Genovese G. Response to: "Reply to 'Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients': To consider varicella-like exanthem associated with COVID-19, virus varicella zoster and virus herpes simplex must be ruled out". J Am Acad Dermatol 2020;83:e255-6. DOI: https://doi.org/10.1016/j.jaad.2020.05.072
Freeman EE, McMahon DE, Lipoff JB, et al. American Academy of Dermatology Ad Hoc Task Force on COVID-19. Pernio-like skin lesions associated with COVID-19: A case series of 318 patients from 8 countries. J Am Acad Dermatol 2020;83:486-92. DOI: https://doi.org/10.1016/j.jaad.2020.05.109
Deutsch A, Blasiak R, Keyes A, et al. COVID toes: Phenomenon or epiphenomenon? J Am Acad Dermatol 2020;83:e347-8. DOI: https://doi.org/10.1016/j.jaad.2020.07.037
Colonna C, Genovese G, Monzani NA, et al. Outbreak of chilblain-like acral lesions in children in the metropolitan area of Milan, Italy, during the COVID-19 pandemic. J Am Acad Dermatol 2020;83:965-9. DOI: https://doi.org/10.1016/j.jaad.2020.06.019
Piccolo V, Neri I, Filippeschi C, et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol 2020;34:e291-3. DOI: https://doi.org/10.1111/jdv.16526
Proietti I, Tolino E, Bernardini N, et al. Auricle perniosis as a manifestation of Covid-19 infection. Dermatol Ther 2020;33:e14089. DOI: https://doi.org/10.1111/dth.14089
Navarro L, Andina D, Noguera-Morel L, et al. Demoscopy features of COVID-19-related chilblains in children and adolescents. J Eur Acad Dermatol Venereol 2020;34:e762-4. DOI: https://doi.org/10.1111/jdv.16800
Fernandez-Nieto D, Jimenez-Cauhe J, Suarez-Valle A, et al. Comment on "Characterization of acute acro-ischemic lesions in non-hospitalized patients: A case series of 132 patients during the COVID-19 outbreak". J Am Acad Dermatol 2020;83:e241. DOI: https://doi.org/10.1016/j.jaad.2020.05.120
Kaya G, Kaya A, Saurat JH. Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature. Dermatopathology (Basel) 2020;7:3-16. DOI: https://doi.org/10.3390/dermatopathology7010002
Colmenero I, Santonja C, Alonso-Riano M, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven pediatric cases. Br J Dermatol 2020;183:729-37. DOI: https://doi.org/10.1111/bjd.19327
Griffiths C, Barker J, Bleiker T, et al. Rook’s textbook of dermatology. 9th ed, rev. Hoboken: Wiley-Blackwell; 2016. DOI: https://doi.org/10.1002/9781118441213
Khalil S, Hinds BR, Manalo IF, et al. Livedo reticularis as a presenting sign of severe acute respiratory syndrome coronavirus 2 infection. JAAD Case Rep 2020;6:871-4. DOI: https://doi.org/10.1016/j.jdcr.2020.07.014
Magro CM, Mulvey JJ, Laurence J, et al. The differing pathophysiologies that underlie COVID-19-associated perniosis and thrombotic retiform purpura: a case series. Br J Dermatol 2021;184:141-50. DOI: https://doi.org/10.1111/bjd.19415
Cordoro KM, Reynolds SD, Wattier R, Mc-Calmont TH. Clustered cases of acral perniosis: clinical features, histopathology, and relationship to COVID-19. Pediatr Dermatol 2020;37:419-23. DOI: https://doi.org/10.1111/pde.14227
Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic manifestation of COVID-19: Transient livedo reticularis. J Am Acad Dermatol 2020;83:700. DOI: https://doi.org/10.1016/j.jaad.2020.04.018
Verheyden M, Grosber M, Gutermuth J, Velkeniers B. Relapsing symmetric livedo reticularis in a patient with COVID-19 infection. J Eur Acad Dermatol Venereol 2020;34:e684-6. DOI: https://doi.org/10.1111/jdv.16773
Chibane S, Gibeau G, Poulin F, et al. Hyperacute multi-organ thromboembolic storm in COVID-19: a case report. J Thromb Thrombolysis 2021;51:25-8. DOI: https://doi.org/10.1007/s11239-020-02173-w
Droesch C, Do MH, DeSancho M, et al. Livedoid and purpuric skin eruptions associated with coagulopathy in severe COVID-19. JAMA Dermato 2020;156:1-3. Erratum in: JAMA Dermatol 2020;156:1272. DOI: https://doi.org/10.1001/jamadermatol.2020.2800
Caputo V, Schroeder J, Rongioletti F. A generalized purpuric eruption with histopathologic features of leucocytoclastic vasculitis in a patient severely ill with COVID-19. J Eur Acad Dermatol Venereol 2020;34:e579-81. DOI: https://doi.org/10.1111/jdv.16737
Karaca Z, Yayli S, Çalışkan O. A unilateral purpuric rash in a patient with COVID-19 infection. Dermatol Ther 2020;33:e13798. DOI: https://doi.org/10.1111/dth.13798
García-Gil MF, Monte Serrano J, García García M, et al. Acral purpuric lesions associated with coagulation disorders during the COVID-19 pandemic. Int J Dermatol 2020;59:1151-2. DOI: https://doi.org/10.1111/ijd.15041
Del Giudice P, Boudoumi D, Le Guen B, et al. Catastrophic acute bilateral lower limbs necrosis associated with COVID-19 as a likely consequence of both vasculitis and coagulopathy. J Eur Acad Dermatol Venereol 2020;34:e679-80. DOI: https://doi.org/10.1111/jdv.16763
Larrondo J, Cabrera R, Gosch M, et al. Papular-purpuric exanthem in a COVID-19 patient: clinical and dermoscopic description. J Eur Acad Dermatol Venereol 2020;34:e570-2. DOI: https://doi.org/10.1111/jdv.16732
Jimenez-Cauhe J, Ortega-Quijano D, Carretero-Barrio I, et al. Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. Clin Exp Dermatol 2020;45:892–5. DOI: https://doi.org/10.1111/ced.14281
Gupta A, Gill A, Sharma M, Garg M. Multi-system inflammatory syndrome in a child mimicking Kawasaki Disease. J Trop Pediatr 2021;67:fmaa060. DOI: https://doi.org/10.1093/tropej/fmaa060
Shanshal M. COVID-19 related anagen effluvium. J Dermatolog Treat 2020;16:1–2. DOI: https://doi.org/10.1080/09546634.2020.1792400

How to Cite

Bastoni, D., Borio, G., Rienzo, P., Magnacavallo, A., Vercelli, A., & Poggiali, E. (2022). COVID-19 and cutaneous manifestations: Two cases and a review of the literature. Emergency Care Journal, 18(2). https://doi.org/10.4081/ecj.2022.10468