Skin Manifestations In Patients Research Articles

Non-invasive SARS-CoV-2 RNA detection and human transcriptome analysis using skin surface lipids

There have been several reports of skin manifestations in patients with coronavirus disease 2019 (COVID-19). However, it is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA can be detected on the skin surface, including the sebum, of these patients. In this study, SARS-CoV-2 RNA was detected using real-time reverse-transcription polymerase chain reaction (RT-PCR) assay of skin surface lipids (SSLs) collected using an oil-blotting film from the faces of hospitalized patients with COVID-19. Human transcriptome analysis was also performed using the same samples. In facial SSLs of patients with COVID-19, the RT-PCR positivity rate was 84.6% (11/13 samples) within 5 days and 30.4% (7/23 samples) by 6–10 days of symptom onset. In the transcriptome analysis, the most characteristic SSL-RNA profile was the upregulation of interferon-stimulated gene (ISG)-related genes, such as ISG15, IFITM1, and MX1. This study presents an alternative technique using SSLs for non-invasive SARS-CoV-2 RNA detection and simultaneous analysis of human molecular pathogenesis in patients with COVID-19.

Skin Manifestations in Patients with COVID-19 Disease Admitted to the Corona Ward of Imam Khomeini Hospital in Ardabil City

Skin Manifestations in Patients with COVID-19 Disease Admitted to the Corona Ward of Imam Khomeini Hospital in Ardabil City

Cutaneous Manifestations of Diabetes Mellitus in a Tertiary Care Hospital in Eastern India: A Cross-sectional Study

Background: Diabetes mellitus is a chronic metabolic disorder and is a major public health problem worldwide. Skin diseases can appear as the first sign of diabetes or can develop at any time in the course of the illness. Purpose: This study aimed to determine the pattern and prevalence of skin manifestations in patients with diabetes mellitus. Methods: An observational cross-sectional study was done on 80 Type 1 and Type 2 diagnosed diabetes mellitus patients and with informed consent, they were thoroughly examined for their respective skin disorders. Results: Among 80 patients, 35% of patients had infectious skin lesions, whereas 20% had noninfectious dermatosis only. More than one type of dermatosis was seen in 45% of patients. Candidal balanoposthitis was the most common fungal infection. Limitation: Limited sample in a single center. Conclusion: Infections were more prevalent compared to noninfectious disease in a population with uncontrolled diabetes mellitus. Pruritus was the most common disorder among the other diabetic complications.

Prevalence of skin manifestations in patients with COVID-19: a systematic review and meta-analysis.

COVID-19 presents extrapulmonary manifestations that can aid in the diagnosis. Skin manifestations have been reported but their characteristics are not yet clear. Health professionals need information about its prevalence and main characteristics. This systematic review followed the PRISMA criteria. The protocol was registered in the PROSPERO (number CRD42020193173). Seven electronic databases and the gray literature were searched independently by two researchers. Observational analytical studies that presented data on the prevalence of skin manifestations in patients aged 19 or older with COVID-19 were included. Prevalence estimates were synthesized through a meta-analysis using random-effects models. Association meta-analysis and comparisons were performed for individual characteristics. We included 31 studies with 10,934 patients, of which 10,121 tested positive for COVID-19. The general prevalence of skin manifestations was 29% (95% CI: 17.0-43.0; I2: 99%), the most in Africa, with a mean duration between 7 and 9 days and the most frequently affecting feet+hands (75%) and the trunk (71%). Patients with mild/moderate COVID-19 had more of chilblain-like+pernio-like lesions (97%) and inflammatory lesions (86%) than patients with severe or critical COVID-19. Manifestations of vascular origin were only in elderly patients and were significant with the severity of COVID-19 (p = 0). The global prevalence of skin manifestations is similar to other signs and symptoms of COVID-19. Skin assessment should be considered when investigating and diagnosing COVID-19 in adult and elderly patients.Systematic review registration: PROSPERO, identifier CRD42020193173, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193173.

SAT646 Cutaneous Manifestations In Adults With Gender Dysphoria Under Treatment Hormonal In External Consultation Of The Hospital De San José , Bogotá Colombia

Abstract Disclosure: H. Tovar Cortes: None. I. Title Cutaneous manifestations in adults with gender dysphoria under treatment hormonal in external consultation of the Hospital de san José , Bogotá .Colombia II. Authors Dr. Manuel Fernando Ortiz Castañeda1, Dr. Henry Tovar Cortes2 , Dra. Nicolle Guiot Isaac3, Dra. Carolina Morales Cardenas3, Dr. Carlos Jimenez4 1. Dermatologist and Instructor or Professor (Assistant, Associate) of the Department of Dermatology Fundación Universitaria de Ciencias de Salud - Hospital de San José de Bogotá 2. Endocrinologist and Instructor or Professor (Assistant, Associate) from the Department of Endocrinology Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá 3. Third-year residents of Dermatology Fundación Universitaria de Ciencias de la Salud - Hospital de San José de Bogotá 4. Fellow of Endocrinology Foundation University of Health Sciences - Hospital de San José de Bogotá III. Introduction : Comprehensive health care for patients with gender dysphoria includes Access to gender affirmation hormone therapy. It can have skin and annex side effects, which often affect quality of life, are underdiagnosed and not treated promptly. Literature on the subject is scarce. Objective: To determine skin manifestations secondary to hormonal treatment in adults with gender dysphoria. IV. Methodology: Cross-sectional descriptive observational study. A search was carried out in the database of patients with gender dysphoria over 18 years of age, treated in dermatology and/or endocrinology clinic of the San José Hospital of Bogotá in the period 2015-2021. The clinical records of patients who were in hormonal therapy with skin manifestations were selected, patients who used other drugs as possible triggers were excluded. Sociodemographic data, skin manifestations, evaluation by specialists and treatment received were analyzed. V. Results : 85 patients were included, predominantly young transgender men in whom the main manifestation was acne (90%), followed by androgenetic alopecia and acanthosis nigricans. Transgender women presented more acne, androgenetic alopecia, seborrheic dermatitis and melasma. More than half of the patients were seen by endocrinology and dermatology, receiving mainly topical treatment. VI. Discussion and conclusion: Skin manifestations in patients with gender dysphoria in hormonal therapy are frequent, so they should be known and taken into account in the multidisciplinary approach of these patients, including the participation of a dermatologist. VII. KEYWORDS: Gender dysphoria, Gender identity, Gonadal steroid hormones, Testosterone, Estrogens, Estradiol, Antiandrogens, Androgens VIII. ADDRESS - CONTACT Dr. Henry Tovar Cortés Mail: htovar@fucsalud.edu.co Contact number: 3158849232 Correspondence address: Carrera 18 9-18 , office 103 Presentation: Saturday, June 17, 2023

Antibiotics hypersensitivity reactions during COVID-19 pandemic

During the COVID-19 pandemic, there have emerged publications about various skin manifestations mainly caused by the related coronavirus, also including some case reports on dermal drug-related adverse reactions. In Armenia, the doctors in COVID-19 hospitals periodically consulted with allergists-immunologists regarding allergic conditions that many patients already suffered on admission or manifested after it. We present the series of three most interesting drug-induced cases with various skin manifestations in patients with COVID-19 pneumonia who requited antibiotic therapy. The causative significance of antibiotics was assessed according to Naranjos algorithm. In the first case (a 58-year-old female patient), a diagnosis of maculopapular exanthem was made based on the clinical picture. Although the coronavirus per se can result in similar manifestations, previous history of allergic reaction to ampicillin led to the conclusion that ceftriaxone (both are beta-lactam antibiotics) was the most probable cause. The second case (a 53-year-old male patient), clinically manifested as vasculitis, caused some difficulties because this is quite often skin manifestations related to SARS-CoV-2, and is rarely induced by medications. Taking into account the history of reaction to beta-lactam antibiotic, as well as the fact that the patient took amoxicillin without a prescription before hospitalization and with overt skin lesions at that time, amoxicillin was assessed as a possible cause. In the third case (a 64-years-old female patient), diagnosed with a bullous drug-induced skin eruption, despite isolated cases of such lesions can be manifestations of SARS-CoV-2 infection, moxitec (fluoroquinolone antibiotic) was assessed as the most probable cause, especially taking into account herpes in history. According to current recommendations, an issue of drug tests was discussed with all three patients to confirm the causative significance of indicated drugs and/or to select an alternative drug, if necessary. In this regard, the subjects were included in the database of patients with severe drug hypersensitivity reactions by their informed consent.

Non-infectious skin manifestations in patients with Chronic Granulomatous Disease: A report of 4 cases

BackgroundChronic granulomatous disease (CGD) is a monogenic inborn error of immunity caused by defects in the phagocytic NADPH oxidase complex. These defects lead to an increased risk of severe infection, autoimmunity, widespread granuloma formation and dysregulated inflammation. In individuals with CGD, immune dysregulation and autoimmune manifestations may impact almost every organ system with atypical dermatologic findings frequently reported. Case PresentationsHere we describe four cases of inflammatory skin lesions in patients with genetically confirmed CGD. Patient A is a 4-year-old male who presented with diffuse alopecia totalis preceded by a widespread skin eruption composed of polycyclic, annular, erythematous plaques and prominent facial erythema and edema. Whole exome sequencing was obtained due to concern for ectodermal dysplasia, which identified a variant in CYBB (CYBB c.901G>T; pVal301Phe). Patient B is a 4-year-old male with X-CGD (CYBB c.1016 C > A, p.Pro339His) who developed annular to polycyclic indurated red plaques on his face and arms. Patient C is a 19-year-old female with autosomal recessive CGD (NCF1 c.75_76delGT) and persistent hidradenitis suppurativa-like lesions in the axilla, inguinal areas, and popliteal fossa. Patient D is a 12-year-old female with autosomal recessive CGD (p47phox deficiency) and psoriasiform dermatitis of the scalp.Patient A had persistence of lesions that required chronic systemic corticosteroids and methotrexate. He underwent hematopoietic stem cell transplantation using a matched sibling donor with improvement in his dermatitis. Skin lesions in patient B resolved with the use of topical corticosteroids. Patient C improved with a combination of isotretinoin therapy and both intralesional and systemic corticosteroid treatment. Patient D had improvement in her psoriasiform dermatitis with topical corticosteroid solution and salicylic acid shampoo. ConclusionsThis case series expands our understanding of cutaneous non-infectious eruptions that can occur in patients with both X-linked and autosomal recessive forms of CGD. Each of these cases illustrates a unique clinical history, histologic findings and treatment plan in patients who developed cutaneous lesions secondary to immune dysregulation in the context of CGD. This series provides additional insights that may assist providers in identifying and managing non-infectious dermatologic manifestations of CGD.

FREQUENCY OF SKIN MANIFESTATIONS IN PATIENTS ON CHEMOTHERAPY

The study's objective was to determine the frequency of skin manifestations in patients on chemotherapy. This cross-sectional study was conducted on 170 patients on chemotherapy with post-acne scarring and hyperpigmentation not responsive to other treatments were included at the Department of Dermatology, Unit-1, Jinnah Hospital Lahore from April 2016 to September 2016. Patients of both genders and any age and on chemotherapy, at least after their first dosage, were included. Patients having skin manifestation before chemotherapy, patients with a history of HCV, those having diabetes mellitus (Fasting BSR > 100 mg/dl), andpatients having other connective tissue diseases, SLE, DLE, etc., were excluded. A dermatologic examination was performed, and biopsy, mycological and bacteriological tests were conducted if necessary. Skin manifestations were labelled. A total of 170 chemotherapy patients participated in this trial. There were 58 (34.1 percent) females and 112 (65.9%) males. Fifty-three people (31.2%) had no skin manifestations, 61 people (34.9%) had one, 40 people(23.5%) had two, and 16 people (9.4%) had three skin manifestations. A total of 75 patients (44.1%) are under the age of 30, 40 patients (23.5%) are between the ages of 31 and 45, and 55 patients (32.4%) are over the age of 45. In 2 cases, acral erythema was seen (1.2 percent ). In 21 cases, dry skin was seen (12.4 percent ). There was alopecia in 93 individuals (54.7 percent ). Sixteen patients still had the eruption (9.4 percent ). Three of the patients had acne(1.8 percent ). In 7 cases, purpura was present (4.1 percent ). In 47 cases, mucositis was found (27.6 percent ). Age and gender had no impact on the number of cutaneous manifestations. People receiving chemotherapy frequently get cutaneous symptoms. Alopecia, mucositis, and xerosis were among the most typical cutaneous signs.

Skin Manifestations associated with COVID-19

Introduction: the recognition of skin manifestations in patients with COVID-19 is very useful since its identification could help to diagnose SARS-COV-2 infection early and contribute to delaying the transmission of the virus.Objective: determine the skin manifestations associated with Covid 19.Methods: a narrative bibliographical review was carried out; For the search for information, Scopus and PubMed databases were used with MESH/DECS descriptors using keywords, taking into account the last five years, in English and Spanish, and with inclusion and exclusion criteria for the articles to be analyzed.Results: in Spain, 58 patients admitted to hospital for suspected COVID-19 infection presented skin lesions such as generalized maculopapular rash (20,7 %), Livedo reticularis (6,9 %), Urticaria (6,9 %) and others non-specific eruptions in 22,4 %.Conclusion: the most frequent lesions are urticarial rash, erythematous/maculopapular/morbilliform confluent rash, papulovesicular rash, chilblain-like acral pattern, livedo reticularis/racemose pattern, vasculitic purpuric pattern, cataloging the most frequent skin lesions to maculopapular rash that affect the trunk. and acral regions, especially toes and plantar region

Mendelian randomization study of the genetic interaction between psoriasis and celiac disease

Epidemiological studies have observed some relationship between psoriasis and celiac disease (CD), while the causal link between these 2 autoimmune diseases was unclear. In the current study, we aimed to explore the causal link between psoriasis and celiac disease with bidirectional 2-sample Mendelian Randomization (MR) study. Eligible instrument variables (IVs) with genome-wide significance (p < 5E−08) were extracted from the summary-level datasets from the published genome-wide association studies (GWAS), which were conducted in the European population. The inverse variance weighted (IVW) method was performed as the main analysis, sensitivity analyses and post-MR analyses were also performed. Our MR analyses found that genetically doubling the odds of CD would increase the risk for psoriasis (p = 1.58e−03, OR [95% CI] 1.232 [1.061–1.432]). And the results were supported by sensitivity analyses. While we found that genetically determined psoriasis was not associated with the risk for CD (IVW: p = 0.985, OR [95% CI] 1.000 [0.965–1.037]). Our study provided novel genetic evidence that patients with CD were at an increased risk of developing psoriasis, while psoriasis was not associated with the risk for CD. Clinicians should be aware of the associations and pay attention to skin manifestations in patients with CD.

Skin Manifestations in Patients with Selective Immunoglobulin E Deficiency.

Selective immunoglobulin E deficiency (SIgED) is still an unrecognised primary immunodeficiency despite several observations supporting its existence. This study aimed to describe the skin manifestations associated with SIgED. We retrospectively assessed medical records of patients with SIgED, the diagnosis being based on serum IgE levels ≤2 Uk/L associated with normal serum levels of immunoglobulins G, M, and A. A total of 25 patients (24 female) with SIgED were included in the study. Eleven patients (44%) presented chronic spontaneous urticaria (CSU), five (20%) angioedema always associated with CSU, five erythema (20%), and six eczema (24%). Other, less frequent manifestations were lichen planus, anaphylactoid purpura, thrombocytopenic purpura, bullous pemphigoid, bullous pyoderma gangrenosum, and atypical skin lymphoproliferative infiltrate associated with reactive lymphadenopathy, chronic cholestasis, arthritis, and fibrosing mediastinitis. Fifteen patients (60%) had different types of associated autoimmune diseases, Hashimoto's thyroiditis being the most frequent (n = 5, 20%), followed by arthritis (n = 4, 16%), autoimmune hepatitis, neutropenia, vitiligo, and Sjögren's syndrome (n = 2, 8% each). Five malignancies were diagnosed in four patients (16%). An ultralow IgE serum level may be the only biomarker that reveals the presence of a dysregulated immune system in patients with a broad spectrum of skin manifestations.

Skin manifestations in patients with covid-19: A literature review

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. In December 2019, cases of pneumonia with unknown cause were first reported in Wuhan, Hubei Province, China. Confirmed cases and death rates due to COVID-19 in the world are still increasing. One part of the body that is affected and causes clinical symptoms in COVID-19 is the skin. This review aims to describe and analyze cutaneous manifestation in COVID-19. This study method is a review of the literature sourced from Google Scholar and PubMed. The literature was selected using English language criteria, using the clinical study method in the form of case reports. Meanwhile, literature review, systematic literature, and meta-analysis were excluded. Journal searches were carried out using the keywords "skin" OR "cutaneous" AND "manifestation" AND "COVID-19" OR "coronavirus". The skin manifestations of COVID-19 have been observed. The most common clinical symptoms of COVID-19 were fever (47%), dry or productive cough (25%), sore throat (16%), generalized sore throat (6%), and pain (5%). However, currently there has been a shift in the approach to diagnosing COVID-19 because it can cause symptoms in other organ systems, one of which is skin manifestations. There are early reports of skin involvement (erythematous rash, extensive urticaria, and chickenpox-like vesicles) occurring in 20% of patients in the course of the COVID-19 disease. In addition, several case reports provide descriptions of petechiae and chilblains. Based on the cases that have been reported, patients with COVID-19 who have manifestations on the skin can give a picture of maculopapular eruptions, vesicular eruptions, petechiae, and also childblains.

Dermatologic manifestations in patients with the Hermansky–Pudlak syndrome types 1 and 3

BackgroundThe Hermansky–Pudlak syndrome (HPS) is a genetically heterogeneous group of diseases characterized by oculocutaneous albinism, bleeding diathesis, and systemic complications. It is the most common genetic disorder in Puerto Rico. These patients are at a significant risk of developing a variety of skin complications and little is known about the prevalence of dermatologic diagnoses in this population.ObjectivesTo report dermatologic manifestations in patients with Hermansky–Pudlak syndrome (HPS). Secondary aims include skin concerns, sun protection habits, barriers to dermatologic care, and skin cancer knowledge.MethodsCross-sectional study with twenty-nine Puerto Rican patients who carried a clinical diagnosis of HPS type 1 or type 3 through a telephonic questionnaire.ResultsTwenty-nine patients participated with a mean (SD) age of 37.3 (16.8) years and the majority were female (69%). The most common diagnoses were skin cancer (34.5%), acne (34.5%), bacterial skin infections (34.5%), warts (24%), urticaria (17.2%), and psoriasis (17.2%). The most common skin concerns were dry skin (62.1%), hair loss (58.9%), redness (34.5%), moles (31%), and rash (31%). The most common sun protection behavior was wearing a shirt that covers the shoulders (93.1%, often or always) and the least common was wearing a hat (24.1%, often or always). Higher income was significantly associated with being more likely to use sunscreen often or always (OR = 3.38, 95% CI 1.02–11.18, p = 0.04). Those in northern urban areas were significantly less likely to report barriers to dermatologic care (OR = 0.13, 95% CI 0.02–0.76, p = 0.02).ConclusionsThis study provides an important overview of the most common self-reported skin manifestations in patients with HPS. Unfortunately, a high prevalence of cutaneous malignancy was reported. The results stress the need for adequate care and potential interventions to promote sun protection behaviors and skin cancer prevention.

Mucocutaneous Manifestations of COVID-19 among Iraqi Patients in Al Diwaniyah Province, Iraq: Case Series Study

Background:The relatively wide distribution of ACE2 receptors all over body tissues suggests the possibility of clinical manifestations other than that of the respiratory tract. The usual incubation period is about 14 days which is often followed by the usual respiratory symptoms and constitutional signs. Globally, additional novel manifestations, including dermatological ones have been reported. Aim:To characterise the skin manifestations in patients with COVID-19 in Al Diwaniyah Province, mid-Euphrates region of Iraq.Method: The present case series study included 54 patients with COVID-19 and a variety of skin manifestations. Those patients visited the dermatology unit at Al Diwaniyah teaching hospital, Al Diwaniyah province, Iraq during the period of the study. The study started in July 2020 and ended in June 2021.Results: The most common features were those of morbilliform eruptions accounting for 18.5% of cases followed by urticarial lesions accounting for 13.0% of cases for followed by ecchymotic pruritic lesion (11.1%). Other features such as oral ulceration and vesicular lesions were also seen in 9.3% of cases. All the body was involved in 29.6% followed by tongue and lip involvement. Morbilliform eruption was the most common diagnosis followed by acute urticaria, herpes simplex, leukocytoclastic vasculitis and then by a variety of other skin manifestations. Conclusion: Skin manifestations in association with COVID-19 were highly variable with onset and duration which could be due to infection, drug reaction or immune mechanisms.

Skin manifestations in patients with coronavirus disease 2019.

Purpose of reviewCoronavirus disease 2019 (COVID-19) is a well established respiratory tract illness. Recent studies in adults and children have shown an increasing number of patients reporting polymorphic cutaneous manifestations during COVID-19, including different types of rashes, from maculopapular, vascular, vesicular to atypical forms.Recent findingsAlthough pathogenesis of skin manifestations is still not fully understood, it has been proposed that cutaneous involvement during COVID-19 may be the results of the activation of the immune response against severe acute respiratory syndrome coronavirus-2, the reactivation or co-infection of herpesviruses or drug hypersensitivity.SummaryAccording to available literature, skin manifestations in patients with COVID-19 may be categorized on the basis of their clinical presentations as follows: erythematous rashes, lesions of vascular origin, vesicular rash, urticarial rash and acute generalized exanthematous pustulosis (AGEP), erythema multiforme and other polymorphic erythema/atypical reactions. Prompt recognition of these cutaneous manifestations represents a crucial point to facilitate diagnosis and management of COVID-19 patients.

Skin manifestations in patients with COVID-19: a prospective observational study during the first wave of the pandemic in the UK and review of the recent literature.

BackgroundCOVID-19 (SARS-CoV-2) is a viral infection that presents in heterogeneous forms with effects on multiple organ systems including the skin.ObjectivesThe objectives of this prospective observational study were to identify cutaneous lesions in confirmed COVID-19-positive patients admitted to a district general hospital in the eastern region of England, to determine the prevalence of these lesions and compare the findings with the current literature.Materials & MethodsThe study was conducted at the Luton and Dunstable University Hospital during the first peak of the pandemic in the United Kingdom to identify skin manifestations in patients infected with COVID-19. Several variables were taken into consideration and photographs of skin lesions were taken. Unlike previous similar studies, all patients included in this study had a positive nasopharyngeal PCR swab for SARS-CoV-2. All photographs were analysed by a dermatology consultant.ResultsA total of 93 patients were included in the study; 40% (n = 37) had cutaneous lesions but only 5.5% of the total patients (n = 6) presented with likely coronavirus-related skin changes. Lesions identified were pseudochilblain and purpuric/livedoid type. We also noted several coagulation abnormalities in these patients.ConclusionCOVID-19 can present with a variety of skin manifestations. Pseudochilblain lesions and purpuric livedoid lesions have been described in the literature and although the underlying mechanism is not fully understood, it is possible that these lesions represent thromboinflammatory processes as a result of the hypercoagulability state associated with COVID-19. More research is required to better understand the pathophysiology and epidemiology of these manifestations.Supplementary dataSupplementary data associated with this article can be found, in the online version, at doi: 10.1684/ejd.2022.4202.

Skin manifestations of COVID-19

The infection caused by the recently identified SARS-CoV-2, dubbed coronavirus disease-19 (COVID-19), has become a pandemic. With exponential growth of morbidity among the people around the world, the clinical characteristics of COVID-19 are becoming clearer and description of new disease symptoms descriptions is emerging. The sufficient amount of descriptions of various skin manifestations in patients with COVID-19 has appeared, however they are characterized by great heterogeneity. The pathogenetic mechanisms of the development of skin rashes in patients with COVID-19 are currently unknown, however, hypotheses have been put forward that they have an overactive immune response, activation of the complement system and microvascular damage. Based on the published literature data and our own experience, the following characteristic types of skin rashes can be distinguished among the skin manifestations of this viral disease: urticaria, confluent, papulovesicular exanthema, acral rashes similar to frostbite, livedo reticularis and purpura. Possible development of skin lesions against the background of the development of COVID-19 provides the need to inform dermatologists about the features of the skin manifestations of this disease, as well as to study further these symptoms of COVID-19 to determine their diagnostic and prognostic value.

Skin Manifestations in Psoriatic and HS Patients in Treatment with Biologicals during the COVID-19 Pandemic.

The Coronavirus Disease 2019 (COVID-19) pandemic, a global public health emergency, has changed dermatology practice and daily routine in just under two years. Much has been written in the literature about COVID-19-associated skin manifestations. Nevertheless, much less has been written regarding skin manifestations in patients affected by severe immune-mediated skin diseases, e.g., psoriasis and hidradenitis suppurativa, undergoing biological treatment during the COVID-19 outbreak. Thus, the aim of this article is to provide the reader with an overview of the cutaneous manifestations during the COVID-19 pandemic in this subset of patients.

COVID-19 Skin Manifestations in Skin of Colour.

Coronavirus disease (COVID-19) skin manifestations have been increasingly reported in medical literature. Recent discussions have identified a lack of images of skin of color (SOC) patients with COVID-19 related skin findings despite people with skin of color being disproportionately affected with the disease. There have been calls to prioritize the identification of COVID-19 skin manifestations in patients with SOC and disseminate these findings. The objective of this article is to review the existing literature on COVID-19 skin manifestations and, where possible, discuss how they may present differently in patients with SOC. Further research is needed to allow primary care physicians and dermatologists to be aware of and easily identify patients with cutaneous findings that may be secondary to COVID-19. Patients presenting with idiopathic dermatologic manifestations should be considered for COVID-19 testing and follow public health guidelines for self-isolation.

Skin Tissue: A Place for SARS-CoV-2 to Multiply and Transmit?

The virus that causes COVID-19, SARS-CoV-2, is a highly transmissible member of the Coronavirinae subfamily, and the related spread of infection has been declared a pandemic by the World Health Organization.1 Because this virus causes potentially devastating health consequences, in addition to identifying effective treatments, determining the different routes of viral entry into the body will be useful in prevention efforts. Although aerosolized transmission of the virus has attracted the most attention,2 transmission through other routes such as the skin merits further investigation. Many recent studies have reported skin manifestations in patients with COVID-19 and suggested possible mechanisms for these signs and symptoms. The group of dermatologic complications seen in these patients includes generalized or localized morbilliform, urticarial eruptions; vesicular eruptions; and chilblain-like lesions.3 In addition, hair loss has been seen in patients with COVID-19.4 With a better understanding of the possible pathophysiologic mechanisms of these manifestations, the presence of the virus in the skin and the infection of skin cells or consequences of infection such as the cytokine storm may be delayed. To examine this issue more closely, it is possible to use studies investigating other members of this virus family, such as SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). According to Ding et al,5 SARS-CoV can infect sweat glands; accordingly, this virus may be present in sweat. Similarly, the infection of a healthcare worker with MERS-CoV during CPR may have resulted from transmission through sweat.6 Unsurprisingly, given these previous studies, the expression of angiotensin-converting enzyme 2 (ACE2) as a receptor for SARS-CoV-2 also has been noted in sweat glands.7 In another interesting study, Liu and colleagues8 found that SARS-CoV-2 can infect keratin (Krt) 7+ secretory luminal cells (major target cells), and Krt5−/Krt7− epithelial cells were found in sweat ducts in skin autopsy samples from patients with COVID-19. Because severe sweating has been observed in a significant number of patients with COVID-19, the presence of the virus in the sweat of these patients is a salient detail.9 In addition to the possibility of infection spread through sweat, it is necessary to examine the possibility of infection via the skin. To do so, the expression of SARS-CoV-2 receptors should be discussed. The expression of ACE2 has been noted in sebaceous gland cells, basal epidermal layers, and hair follicle cells in normal skin.10 In addition, the high expression of ACE2 in keratinocytes and their apoptosis in patients with COVID-19 has been demonstrated.11 Interestingly, a higher expression of ACE2 in visceral and subcutaneous adipose tissues (versus lung tissue) is associated with COVID-19-related mortality in patients with obesity.12 Transmembrane serine protease 2 is required for SARS-CoV-2 entry in to cells through ACE2 and is expressed in skin tissue.13 Another SARS-CoV-2 receptor, cluster of differentiation 147, is expressed in skin and associated with several immune system disorders such as psoriatic dermatitis.14 In addition, SARS-CoV has been shown to infect Langerhans cells, although no data are available yet on the relationship of these cells to SARS-CoV-2.15 In patients with COVID-19 and chilblains-like lesions, infected endothelial cells have been detected in immunohistochemistry studies. Further, SARS-CoV-2 particles have been found in endothelial cell’ cytoplasm using electron microscopy.16 Finally, small blood vessels in the skin are important targets for SARS-CoV-2, and lymphocyte skin infiltration in patients with COVID-19 provides evidence that the virus enters the skin through blood vessels after systemic infection.8 In addition to the direct infection of endothelial cells by SARS-CoV-2, indirect infection is possible following viral entry into skin. Previously, these authors reviewed the effect of elevated levels of angiotensin II (Ang II) followed by ACE2 downregulation in patients with COVID-19.17 Increased Ang II levels were associated with increased endothelial cell permeability, which induced lymphocyte infiltration; that said, the effect of Ang II on the entry of SARS-CoV-2 into different tissues such as skin should be examined.18 However, it is likely that the entry of the virus into subcutaneous layers paves the way for viral proliferation on a large scale. Although the superficial layers of skin prevent viral entry under normal conditions, given skin disruptions such as wounds and the long viability of the virus on the surface of skin, there exists a possibility of contamination of underlying tissues. The Figure represents the probable mechanism of SARS-CoV-2-induced skin lesions and possible cell routes for the virus to multiply in the skin. These authors eagerly anticipate the publication of future studies on this topic to help illuminate the transmission of SARS-CoV-2 via skin.Figure.: THE PROBABLE MECHANISM OF SARS-COV-2-INDUCED SKIN LESIONS AND CELL TYPES THAT MAY BE INVOLVED IN VIRAL REPLICATION IN SKIN