Prepared by Sadia Salim, MD, Staff Dermatopathologist

To date, not much data has been available regarding skin manifestations of SARS-CoV-2, the virus that causes COVID-19. At present, the observed cutaneous manifestations associated with COVID-19 are limited to a few reports and press releases.

Some of the observed cutaneous lesions include sudden outbreak of erythematous rash, urticarial lesions, chickenpox-like vesicles and rashes similar to cutaneous involvement with other common viral infections.

A petechial rash (involving but not limited to the extremities, chest and neck), bruising around joints and purpuric cutaneous and oral lesions (involving gingiva and tongue) also have been reported. Another recently described cutaneous manifestation includes pseudo-chilblains like lesions (acro-ischemic lesions) on the extremities, fingers, and toes. Zhang Y. et al described such acro-ischemic lesions manifesting with cyanosis, blisters and gangrene of fingers and toes in severe cases of COVID-19. However, a subset of mildly affected and asymptomatic patients, including children and adolescents, appear to present with such acro-ischemic and purpuric lesions. The reports are limited, as several case studies have been collected via WhatsApp in groups and forums of dermatologists (particularly in Europe).

In some cases, it is possible that a skin rash may be the initial presenting sign of COVID-19.

There appears to be no correlation between the severity of the disease and cutaneous involvement. This is preliminary data that needs to be corroborated by further studies.

REFERENCES

1. Le Syndicat National des Dermatologues-Vénéréologues(SNDV) alerte sur les manifestations cutanées du COVID 19
2. Skin manifestations are emerging in the coronavirus pandemic
3. Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for Dengue. J Am Acad Dermatol. 2020 Mar 22. pii: S0190-9622(20)30454-0. doi: 10.1016/j.jaad.2020.03.036. [Epub ahead of print] PubMed PMID: 32213305.
4. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020 Mar 26. doi: 10.1111/jdv.16387. [Epub ahead of print] PubMed PMID: 32215952.
5. Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, Zhou X, Jiang W, Zhao YQ, Zhang SY, Li TS. [Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia]. [Article in Chinese; Abstract available in Chinese from the publisher] Zhonghua Xue Ye Xue Za Zhi. 2020 Mar 28; 41(0). [Epub ahead of print] PubMed PMID: 32220276
6. Qiu H., Wu J., Hong L. et Al. 2020. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: An observational cohort study. Lancet Infect. Dis. 2020 Mar 25 [Online ahead of print]