33624 Long-term cutaneous manifestations in COVID-19 patients: A systematic review

Abstract

Introduction: Skin lesions have been reported as symptoms in several COVID-19 patients. Moreover, there is evidence describing persistence of pernio, papulosquamous lesions, and livedo reticularis in patients, several weeks after the peak of the disease. Materials and methods: A primary search for peer-reviewed literature published until May 1st, 2021 was conducted with PubMed and EMBASE. Studies documenting persistent skin lesions in confirmed COVID-19 cases after the initial diagnosis or resolution of symptoms were included. 22 studies (15 case reports, 5 case series, 1 cohort and 1 cross-sectional study) with a total of 236 COVID-19 patients were included. Results: Cutaneous lesions reported in the 236 long COVID patients (age range = 6-89 years, 164 females, 48 males, 24 no reported gender) were: 196 alopecia, 10 pernio, 4 maculopapular, 2 urticarial, 1 vesicular, 1 purpura, 1 papulosquamous, 1 Kawasaki like, 1 cheilitis, 1 sarcoid granuloma, 1 onychomadesis, and 1 orange nail lesion, while 16 patients did not have a specific lesion reported. The timing of onset of lesions ranged from 7 to 180 days after the initial diagnosis or symptom resolution. The duration of lesions ranged from 6 to 240 days. One patient was hospitalized and one required intubation. Conclusions: Our description of persistent cutaneous and pathological manifestations may help clinicians understand the spectrum of lesions in long COVID cases and suggests the mechanistic role of persistent inflammation and stress. However, further investigation is needed to determine the full clinical spectrum, mechanism and prognostic significance of such skin lesions.