Abstract

Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19.Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: “SARS-CoV-2” or “COVID-19” or “new coronavirus” or “Wuhan Coronavirus” or “coronavirus disease 2019” and “skin disease” or “skin manifestation” or “cutaneous manifestation.”Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1,847 patients with confirmed COVID-19 were examined. The overall frequency of cutaneous manifestations in COVID-19 patients was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. Forty-eight percentage of the patients had a mild, 32% a moderate, and 20% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. Seventy-two percentage of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%).Conclusion: The mere occurrence of skin manifestations in COVID-19 patients is not an indicator for the disease severity, and it highly depends on the type of skin lesions. Chilblain-like and vascular lesions are the ends of a spectrum in which from chilblain-like to vascular lesions, the severity of the disease increases, and the patient's prognosis worsens. Those with vascular lesions should also be considered as high-priority patients for further medical care.

Highlights

  • Until now, there are several reports on cutaneous manifestations in COVID-19 patients

  • The current study found that 10.5% of the COVID-19 patients reported skin lesions before the initiation of other symptoms or as their chief complaint

  • It may suggest that urticaria-like lesions may be a diagnostic sign for COVID-19

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Summary

Introduction

There are several reports on cutaneous manifestations in COVID-19 patients. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19. The cutaneous changes reported to date include maculopapular rash, vesicular lesions, urticaria-like lesions, and chilblain-like lesions (4–8) Some of these skin manifestations arise before the signs and symptoms more commonly associated with COVID-19, suggesting that they could be presenting signs of COVID-19 (9). Due to the great variety of reported dermatologic presentations as well as the inconsistency of data on the association between skin presentations of COVID-19 with poor outcome, we aimed to conduct a comprehensive systematic review on the clinical and histopathological characteristics of skin manifestations in relation to other features of confirmed COVID-19 patients and to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19

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