Cutaneous Manifestations of COVID-19: A Preliminary Review
Reviewed by Dr Joyce Lee, National Skin Centre
This article was a systematic review of published and preprint articles describing cutaneous symptoms associated with COVID-19 infection. The authors searched all related published articles via PubMed/MEDLINE database and for pre-print manuscripts via medRxiv database published between December 31st, 2019 and May 3, 2020. Forty-six articles met inclusion criteria, with a total of 997 patients from 9 countries with skin manifestations related to COVID-19.
Symptoms of pain/burning and itch were present in at least 7% and 27% of reported cases respectively. Chillblain-like lesions were the most commonly reported skin manifestation of COVID-19, being present in 40.1% of the review cohort, followed by maculopapular (23.1%), vesicular, urticarial, and livedoid/necrotic lesions respectively.
The actual prevalence of cutaneous manifestation in COVID-19 infection is not known, although it varied from 0.20% to 20.45% in non-case report studies that contained COIVD-19 patients with and without skin findings. The authors suspect that the prevalence may be underestimated as people with COVID-19 who are asymptomatic or have only mild disease may still manifest COVID-19 related skin lesions.
The higher reporting of chilblain-like lesions may also be due in part to some studies focusing on this finding specifically. The data gleaned from this review is mainly from European countries, namely Spain, France and Italy, which account for more than 90% of the patients. This may not be fully representative of COVID-19 patients from different regions and ethnicities. More information from larger study populations around the world, including Asia, are needed.
[published online ahead of print, 2020 May 15]. J Am Acad Dermatol. 2020; S0190-9622(20)30924-5. doi:10.1016/j.jaad.2020.05.059