Classification and pathophysiology of cutaneous manifestations of COVID-19
Keywords:Cutaneous manifestations, COVID-19, Classification, Pathophysiology
Cutaneous manifestation of in COVID-19 patients are varied and needs proper categorization and classification. Various morphological manifestation on skin are seen. The pathophysiology of this virus is not well understood because of it being a novel virus. This disease involves all organs of the body, primarily the respiratory system, heart, kidneys, liver, spleen and the skin as well. In addition to pneumonia which is a hall mark feature of this virus, multiorgan failure occurs as a result of its cascading pathological pathways. Another fatal feature of this virus is hyperimmune response (because of IL-6), known as, ‘cytokine storm’. The pathophysiological changes in skin leading to different kinds of rashes range from vasculitis changes to formation of microthrombi obliterating the dermal vessels. After reviewing current literature, we have proposed a simplified classification of cutaneous manifestations of COVID-19 is proposed based on morphological features, relation with severity of disease and histopathological changes. Pathophysiology of cutaneous changes is also being described.
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;382:727-33.
Cascella M, Rajnik M, Cuomo A. Features, Evaluation and Treatment Coronavirus (COVID-19). Stat Pearls; 2020.
Li XW, Geng MM, Peng YH, Meng LS, Lu SM. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;10(2):102-8.
Sterling JC. Viral Infections. In: Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rooks’s Textbook of Dermatolgy. 9th ed. Oxford: Wiley Blackwell; 2016: 25.2-25.4.
Hoffmann M, Weber KH, Schroeder S. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271‐88.
Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad. 2020;63(4):119-24.
Casas C, Catala A, Hernandez G, Jimenez RP, Nieto D, Lario A. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. British J Dermatology; 2020.
Sachdeva M, Gianotti R, Shah M. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020.
Gianotti R, Zerbi P, Gad DR. Histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy. J Dermatol Sci; 2020.
Zhang Y, Cao W, Xiao M. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi. 2020;41:6.
Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic manifestation of COVID-19: transient livedo reticularis. J Am Acad Dermatol. 2020.
Cauhe JJ, Quijano OD, Barrios PM, Arrones MO, Nieto FD. Reply to COVID-19 can present with a rash and be mistaken for Dengue: petechial rash in a patient with COVID-19 infection. J Am Acad Dermatol. 2020.
Hunt M, Koziatek C. A case of COVID-19 pneumonia in a young male with full body rash as a presenting symptom. Clin Pract Cases Emerg Med. 2020.
Nieto FD, Quijano OD, Miravalles SG, Ortega PC, Barrios PM, Cauhe JJ. Comment on: cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies. J Eur Acad Dermatol Venereol. 2020.
Henry D, Ackerman M, Sancelme E, Finon A, Esteve E. Urticarial eruption in COVID-19 infection. J Eur Acad Dermatol Venereol. 2020.
Alramthan A, Aldaraji W. Clin Exp Dermatol. 2020. A case of COVID‐19 presenting in clinical picture resembling chilblains disease. First report from the Middle East. 2020.
Kolivras A, Dehavay F, Delplace D, Feoli F, Meiers I, Milone L. Coronavirus (COVID-19) infection- induced chilblains: a case report with histopathological findings. JAAD Case Rep. 2020.
Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM. Varicella- like exanthem as a specific COVID-19 associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol. 2020.
Tay MZ, Poh CM, Renia L. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020: 1-12.
Sterling JC. Viral Infections. In: Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rooks’s Textbook of Dermatolgy. 9th ed. Oxford: Wiley Blackwell; 2016: 25.4.
Jose RJ, Williams AE, Chambers RC. Proteinase- activated receptors in fibroproliferative lung disease. Thorax. 2014;69:190-2.
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844-7.
Zhou F, Yu T, Du R. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62.