|Year : 2021 | Volume
| Issue : 2 | Page : 65-66
The cutaneous manifestations related to COVID-19 infection and vaccination: current aspects and future prospects
Sheng-Hsiang Ma1, Hou-Ping Sytwu2, Chih-Chiang Chen3
1 Department of Dermatology, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
2 Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
3 Department of Dermatology, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming Chiao Tung University; Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
|Date of Submission||31-May-2021|
|Date of Acceptance||31-May-2021|
|Date of Web Publication||23-Jun-2021|
Dr. Chih-Chiang Chen
Department of Dermatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ma SH, Sytwu HP, Chen CC. The cutaneous manifestations related to COVID-19 infection and vaccination: current aspects and future prospects. Dermatol Sin 2021;39:65-6
|How to cite this URL:|
Ma SH, Sytwu HP, Chen CC. The cutaneous manifestations related to COVID-19 infection and vaccination: current aspects and future prospects. Dermatol Sin [serial online] 2021 [cited 2022 Dec 3];39:65-6. Available from: https://www.dermsinica.org/text.asp?2021/39/2/65/319147
Ever since the outbreak of the COVID-19 pandemic in 2019, the dermatology society worldwide has been faced with tremendous challenges. To minimize the risk of COVID-19 transmission, nonurgent outpatient visits were discouraged and the patient volume decreased consequently. Modification of the treatment for dermatological diseases was widely discussed, as some may concern the risk of infection under the usage of immunosuppressants and biologics. Moreover, a variety of cutaneous manifestations were linked to COVID-19 infection, which may even be the preceding signs in some patients. Thus, dermatologists should be aware of these skin findings to enhance diagnostic accuracy in clinical practices.
Commonly reported COVID-19-associated cutaneous manifestations included morbilliform, urticarial, pernio-like, papulosquamous, and papulovesicular skin rash [Figure 1]., Pernio-like skin rash, or the so-called “COVID toe,” was commonly reported in western countries, typically presented as violaceous papules and plaques on toes with occasional bullae formation or ulceration. Comparing to other skin findings, pernio-like skin rash was more likely to be found in the younger population and those with mild COVID-19 infection. Morbilliform skin rash and urticarial skin rash, on the other hand, were less specific and found more prevalently in COVID-19 patients with moderate severity. Retiform purpura (thrombotic vasculopathy) may also be observed in patients with COVID-19, especially in those with severe infection and respiratory failure., In children, a so-called “Kawasaki disease-like inflammatory syndrome,” characterized by gastrointestinal symptoms, myocarditis, and even shock, was documented in various countries. Classic skin and mucosal presentations in Kawasaki disease, such as conjunctivitis, polymorphic rash, and erythema and induration over hand and feet, can also be seen in these COVID-19 affected children. Several other mucocutaneous lesions, such as geographic tongue, erythema multiforme, pityriasis rosea, and dengue-like exanthem, had been documented in the literature.,, Given the diverse skin manifestations of COVID-19, differentiation from other viral exanthems was difficult but crucial in clinical settings., Additional nasopharyngeal and serological viral testing may be helpful to achieve accurate diagnosis.
|Figure 1: Commonly reported COVID-19-associated cutaneous manifestations.|
Click here to view
Although the number of researches on the skin manifestations related to COVID-19 infection was soaring, most of them were conducted in western countries. To determine the situation in Asian countries, Yildiray and colleagues reported the cutaneous manifestations of COVID-19 in Turkey recently. They discovered five out of 266 patients (1.9%) developed skin lesions, which was much lower than previous reports. Besides, only urticarial and vesicular skin rash were reported in this study. Ethnic differences, the severity of COVID-19 infection and variation of viral genome were possible explanations for the lower prevalence of skin manifestations in Turkey. Given the paucity of data in Asia, a registry-based database was warranted to shed light on the ethnic differences.
Aside from cutaneous manifestations related to COVID-19 infection, recent studies have focused on the skin findings related to the COVID-19 mRNA vaccine (Pfizer and Moderna). McMahon et al. recorded the cutaneous reactions after mRNA-based COVID-19 vaccines and demonstrated that local site reaction, urticarial skin rash, morbilliform skin rash, delayed local reaction, and erythromelalgia were most commonly presented. Swelling of the cosmetic filler injection site was also reported in both vaccines, which was assumed to be caused by the delayed-type hypersensitivity reaction.
As a dermatologist, we should take notice of COVID-19-related skin manifestations and refer to COVID-19 testing if we encountered any suspected patients. Additionally, any skin manifestations in these patients should be recorded to help elucidate the full picture of COVID-19 infection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lee CH. Role of dermatologists in the uprising of the novel corona virus (COVID-19): Perspectives and opportunities. Dermatol Sin 2020;38:1-2. [Full text]
Ma SH, Tai YH, Dai YX, Chen CC, Chen TJ, Chang YT. Impact of the COVID-19 pandemic on dermatology clinic visits: Experience from a tertiary medical center in Taiwan. Dermatol Sin 2020;38:180-1. [Full text]
Huang YW, Tsai TF. Skin manifestation and diagnosis of febrile diseases by COVID-19 and other ribonucleic acid viruses: The diagnostic clues. Dermatol Sin 2020;38:131-41. [Full text]
Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Desai SR, 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.
Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID-19: Current knowledge and future perspectives. Dermatology 2021;237:1-12.
Kanitakis J, Lesort C, Danset M, Jullien D. Chilblain-like acral lesions during the COVID-19 pandemic (“COVID toes”): Histologic, immunofluorescence, and immunohistochemical study of 17 cases. J Am Acad Dermatol 2020;83:870-5.
Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al.
Skin manifestations of COVID-19 in children: Part 2. Clin Exp Dermatol 2021;46:451-61.
Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Martin Rios MD, Herranz Mañas C, Artigas Almazan J, et al.
Prevalence of mucocutaneous manifestations in 666 patients with COVID-19 in a field hospital in Spain: oral and palmoplantar findings. Br J Dermatol 2021;184:184-5.
Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol 2020;82:e177.
Garcia-Gil MF, Monte-Serrano J, Pascual-Del-Riquelme AJ, Ara-Martin M. Parvovirus B19 infection simulating a vesicular exanthem associated with COVID-19. Dermatol Sin Ahead of print. Available from: https://www.dermsinica.org/preprintarticle.asp?id=314374
. [Last accessed on 2021 May 23].
Yıldıray Y, Ayşe PS. Cutaneous manifestations of coronavirus disease in Turkey: A prospective stud. Dermatol Sin 2021;39:74-8.
Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020;34:e212-3.
McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, et al.
Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol 2021;S0190-9622(21)00658-7.