Unveiling the dermatological manifestations of nCOVID-19


  • Dheemant M. Department of Dermatology, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Sushmitha E. S. Department of Dermatology, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Madhan Jeyaraman Department of Orthopedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India http://orcid.org/0000-0002-9045-9493
  • Ajay S. S. Department of Orthopedics, JJM Medical College and Hospital, Davangere, Karnataka, India
  • Rashmi Jain Resident, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India




Coronavirus, nCOVID-19, Dermatotropic, Viral pneumonia


Coronaviruses are RNA viruses that have become a major public health concern since the severe acute respiratory syndrome CoV (SARS-CoV-2) outbreak in 2002. The continuous evolution of coronaviruses was further highlighted with the emergence of the middle east respiratory syndrome CoV (MERS-CoV) outbreak in 2012. The spike glycoprotein of SARS-CoV-2 plays a pivotal role in the entry of virus into the cell and it further interacts with ACE-II receptors which are widely distributed on the human cell surface especially on alveolar type II cells (AT-2) and endothelium. Currently, the world is concerned about the 2019 novel CoV (SARS-CoV-2) that was initially identified in the city of Wuhan, China in December 2019. Patients presented with severe viral pneumonia and respiratory illness. Despite the virus not being dermatotropic, several skin conditions have emerged mainly as a result of prolonged contact with personal protective equipment and excessive personal hygiene. In this review, we discuss structure, genome organisation, entry of CoVs into target cells, probable cutaneous manifestation that dermatologists may be aware of skin complications and the preventive measures, outcome of the disease and the management.


Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003;348:1953-66.

Peiris JSM, Lai ST, Poon LLM, Guan Y, Yam LYC. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003;361:1319-25.

Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus A, Fouchier RAM. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367:1814-20.

de Groot RJ, Baker SC, Baric RS, Brown CS, Drosten C. Middle East respiratory syndrome coronavirus (MERS-CoV): announcement of the Coronavirus Study Group. J Virol. 2013;87:7790-92.

Mole B. Deadly pig virus slips through US borders. Nature. 2013;499:388.

Stevenson GW, Hoang H, Schwartz KJ, Burrough ER, Sun D. Emergence of porcine epidmic diarrhea virus in the United States: clinical signs, lesions, and viral genomic sequences. J Vet Diagn Investig. 2013;25:649-54.

Chen Q, Li G, Stasko J, Thomas JT, Stensland WR. Isolation and characterization of porcine epidemic diarrhea viruses associated with the 2013 disease outbreak among swine in the United States. J Clin Microbiol. 2014;52:234-43.

Enjuanes L, Almazan F, Sola I, Zuniga S. Biochemical aspects of coronavirus replication and virus-host interaction. Annu Rev Microbiol. 2006;60:211-30.

Perlman S, Netland J. Coronaviruses post-SARS: update on replication and pathogenesis. Nat Rev Microbiol. 2009;7:439-50.

Graham RL, Baric RS. Recombination, reservoirs, and the modular spike: mechanisms of coron-avirus cross-species transmission. J Virol. 2010;84:3134-46.

Li F. Receptor recognition and cross-species infections of SARS coronavirus. Antivir Res. 2013;100:246-54.

Woo PC, Huang Y, Lau SK, Yuen KY. Coronavirus genomics and bioinformatics analysis. Viruses. 2010;2:1804-20.

Woo PC, Lau SK, Lam CS, Lau CC, Tsang AK, Lau JH, et al. Discovery of seven novel Mammalian and avian coronaviruses in the genus delta coronavirus supports bat coronaviruses as the gene source of alpha coronavirus and beta coronavirus and avian coronaviruses as the gene source of gamma coronavirus and delta coronavirus. J Virol. 2012;86:3995-4008.

Lin CM, Saif LJ, Marthaler D, Wang Q. Evolution, antigenicity and pathogenicity of global porcine epidemic diarrhea virus strains. Virus Res. 2016;226:20-39.

Zhou P, Fan H, Lan T, Yang XL, Shi WF, Zhang W, et al. Fatal swine acute diarrhoea syndrome caused by an HKU2‐related coronavirus of bat origin. Nature. 2018;556:255-8.

Li F. Structure, function, and evolution of coronavirus spike proteins. Annu Rev Virol. 2016;3:237-61.

Lomniczi BJ. Biological properties of avian coronavirus RNA. Gen Virol. 1977;36:531-3.

Bond CW, Leibowitz JL, Robb JA. Pathogenic murine coronaviruses. II. Characterization of virus-specific proteins of murine coronaviruses JHMV and A59V. Virol. 1979;94:371-84.

Jeyaraman M, Somasundaram R, Anudeep TC, Ajay SS, Vinodh Kumar V, Rashmi Jain, et al. Mesenchymal stem cells (MSCs) as a novel therapeutic option for nCOVID-19 – A Review. Open J Regenerative Medicine. 2020;9:20-35.

Maeda J, Repass JF, Maeda A, Makino S. Membrane topology of coronavirus E protein. Virol. 2001;281:163-9.

Brian DA, Hogue BG, Kienzle TE. The coronavirus hemagglutinin esterase glycoprotein. In Siddell SG. The Coronaviridae. New York, NY: Plenum Press; 1995;165-179.

Arden KE, Nissen MD, Sloots TP, Mackay IM. New human coronavirus, HCoV- NL63, associated with severe lower respiratory tract disease in Australia. J Med Virol. 2005;75:455-62.

Brian DA and Baric RS. Coronavirus genome structure and replication. Curr Top Microbiol Immunol. 2005;287:1–30.

Brian DA and Baric RS. Coronavirus genome structure and replication. Curr Top Microbiol Immunol. 2005;287:1–30.

Lai MM. Coronavirus: Organization, replication and expression of genome. Annu. Rev. Microbiol. 1990;44:303–333.

Masters PS. The molecular biology of coronaviruses. Adv Virus Res. 2006;66:193–292.

Baric RS, Yount B. Subgenomic negative‐strand RNA function during mouse hepatitis virus infection. J Virol. 2000;74:4039–46.

Sawicki SG, Sawicki DL. Coronavirus transcription: Subgenomic mouse hepatitis virus replicative intermediates function in RNA synthesis. J Virol. 1990;64:1050-6.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.

Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130–7.

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;2012-7.

Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, Tan KS, Wang DY, Yan Y The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020;7(1):11.

Lee PI, Hsueh PR. Emerging threats from zoonotic coronaviruses-from SARS and MERS to 2019-nCoV. J Microbiol Immunol Infect. 2020.

Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020;9(1):386–9.

Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631–7.

Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019- nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4.

World Health Organisation. Q & A on coronaviruses (COVID-19). March 2020.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020.

Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, et al. Identification of severe acute respiratory syndrome in Canada. N Engl J Med. 2003;348(20):1995–2005.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506.

Darlenski R, Tsankov N. Covid-19 pandemic and the skin - What should dermatologists know?. Clinics in Dermatology. 2020.

Recalcati S. Cutaneous manifestations in COVID‐19: a first perspective. Journal of the European Academy of Dermatology and Venereology. 2020.

Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for Dengue. Journal of the American Academy of Dermatology. 2020.

Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol. 2020;92(4):401–2.

Gao HN, Lu HZ, Cao B, Du B, Shang H, Gan JH, et al. Clinical findings in 111 cases of influenza a (H7N9) virus infection. N Engl J Med. 2013;368(24):2277–85.

Wang J, Qi H, Bao L, Li F, Shi Y, National Clinical Research Center for Child H, et al. A contingency plan for the management of the 2019 novel coronavirus outbreak in neonatal intensive care units. Lancet Child Adolesc Health. 2020.

Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Napoli RD. Features, Evaluation and Treatment Coronavirus (COVID-19). Treasure Island, FL: StatPearls Publishing; 2020.

Anudeep TC, Madhan Jeyaraman, Dharma U. Shetty, Hemmanth Raj, Ajay SS, Rajeswari Somasundaram, Vinodh Kumar V, Rashmi Jain. Convalescent Plasma as a plausible therapeutic option in nCOVID-19 – A Review. J Clin Trials. 2020.

American Academy of Dermatology. Guidance on the use of biologic agents during COVID-19 outbreak. March 2020.

Rademaker M, Baker C, Foley P, Sullivan J, Wang, C. Advice regarding COVID-19 and use of immunomodulators, in patients with severe dermatological diseases. Australas J Dermatol. 2020.






Review Articles