Literature review: manifestation of skin lesion on COVID-19


  • Yohanes Firmansyah Faculty of Medicine, Tarumanagara University, Banten, Indonesia
  • Sukmawati Tansil Tan Department of Dermatology and Venereology, Faculty of Medicine, Tarumanagara University, Banten, Indonesia
  • Jessica Elizabeth Faculty of Medicine, Tarumanagara University, Banten, Indonesia
  • Christopher Lauren Faculty of Medicine, Tarumanagara University, Banten, Indonesia



Skin manifestation, COVID-19, SARS-CoV-2


New cases of pneumonia, which spread rapidly and are deadly, have spread throughout the world. This disease is known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or corona virus disease 2019 (COVID-19) with a viral etiology in the form of novel coronavirus 2019 (2019-nCoV). This disease has extensive clinical manifestations starting from the lungs, hematology system, heart, nerves, reproduction, and the skin. The thing to be aware of is that the skin manifestations in the form of atypical lesions are often found in COVID-19. Common skin manifestations on COVID-19 are erythema-edema with vesicles or pustules (pseudo-chilblain), vesicular eruption, maculopapular rash, urticaria, and livedo lesion. This literature review discusses comprehensively what kind of skin lesions can be suspected of being part of a COVID-19 infection. This literature review is useful for increasing the awareness of doctors about COVID-19 infection and may help in early diagnose of COVID-19 infection and prevent further transmission.


Author Biographies

Yohanes Firmansyah, Faculty of Medicine, Tarumanagara University, Banten, Indonesia

General Practitioner

Department of Pediatric Surgery, Tarakan Regional Hospital, Jakarta, Indonesia


Sukmawati Tansil Tan, Department of Dermatology and Venereology, Faculty of Medicine, Tarumanagara University, Banten, Indonesia

Department of Dermatovenereology

Jessica Elizabeth, Faculty of Medicine, Tarumanagara University, Banten, Indonesia

General Practitioner

Christopher Lauren, Faculty of Medicine, Tarumanagara University, Banten, Indonesia

General Practitioner


AHC Media. Beating the Pandemic: What Emergency Providers Should Know About COVID-19. Pediatr Emerg Med Reports. 2020.

Du B, Qiu HB, Zhan X, Wang YS, Kang HYJ, Li XY et al. Pharmacotherapeutics for the new coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(3):173-6.

Gorbalenya AE, Baker SC, Baric RS, Groot RJ De, Gulyaeva AA, Haagmans BL et al. The species and its viruses-a statement of the Coronavirus Study Group. Biorxiv (Cold Spring Harb Lab. 2020.

World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. World Health Organization. 2020.

Kemenkes RI. Situasi COVID-19. Kementrian Kesehatan Republik Indonesia. 2020.

Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: A systematic review. J Neurol Sci. 2020;413:116832.

Zhou Y, Li W, Wang D, Mao L, Jin H, Li Y et al. Clinical time course of COVID-19, its neurological manifestation and some thoughts on its management. Stroke Vasc Neurol. 2020;svn-2020-000398.

Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Crit Care. 2020;24(1):176.

Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020;51(9):843-51.

Cheong J, Bartell N, Peeraphatdit T, Mosli M, Al-Judaibi B. Gastrointestinal and liver manifestations of COVID-19. Saudi J Gastroenterol. 2020;26(5):226-32.

Sinonquel P, Roelandt P, Demedts I, Van Gerven L, Vandenbriele C, Wilmer A et al. COVID-19 and gastrointestinal endoscopy: what should be taken into account? Dig Endosc. 2020;32(5):723-31.

Agarwal A, Chen A, Ravindran N, To C, Thuluvath PJ. Gastrointestinal and Liver Manifestations of COVID-19. J Clin Exp Hepatol. 2020;10(3):263-5.

Musa S. Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now? Arab J Gastroenterol. 2020;21(1):3-8.

Wong SH, Lui RN, Sung JJ. Covid‐19 and the digestive system. J Gastroenterol Hepatol. 2020;35(5):744-8.

Puliatti S, Eissa A, Eissa R, Amato M, Mazzone E, Dell’Oglio P et al. COVID-19 and urology: a comprehensive review of the literature. BJU Int. 2020;125(6):E7-14.

Kang Y, Chen T, Mui D, Ferrari V, Jagasia D, Scherrer-Crosbie M et al. Cardiovascular manifestations and treatment considerations in covid-19. Heart. 2020;heartjnl-317056.

Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531-8.

Bansal M. Cardiovascular disease and COVID-19. Diabetes Metab Syndr Clin Res Rev. 2020;14(3):247-50.

Yang Z, Wang M, Zhu Z, Liu Y. Coronavirus disease 2019 (COVID-19) and pregnancy: a systematic review. J Matern Neonatal Med. 2020;1-4.

Sachdeva M, Gianotti R, Shah M, Lucia B, Tosi D, Veraldi S et al. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020;98(2):75-81.

Wollina U, Karadağ AS, Rowland‐Payne C, Chiriac A, Lotti T. Cutaneous Signs in COVID‐19 Patients: A Review. Dermatol Ther. 2020;dth.13549.

Ortega-Quijano D, Jimenez-Cauhe J, Burgos-Blasco P, Jimenez-Gomez N, Fernandez-Nieto D. Reply to “Varicella-like exanthem as a specific COVID-19–associated skin manifestation: multicenter case series of 22 patients”: Discussing specificity. J Am Acad Dermatol. 2020;83(1):e87.

Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM et al. Varicella-like exanthem as a specific COVID-19–associated skin manifestation: Multicenter case series of 22 patients. J Am Acad Dermatol. 2020;83(1):280-5.

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):P497-506.

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.

Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infectious Diseases of Poverty. 2020;9(1):29.

Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatology Venereol. 2020;26.

Zhao Q, Fang X, Pang Z, Zhang B, Liu H, Zhang F. COVID‐19 and cutaneous manifestations: A systematic review. J Eur Acad Dermatology Venereol. 2020;34(11):2505-10.

Firmansyah Y, Elizabeth J, Tan ST. Skin manifestation in COVID-19 infection: a thousand appearances (immune response perspective). Int J Res Dermatology. 2020;6(6):776.

Bourgonje AR, Abdulle AE, Timens W, Hillebrands J, Navis GJ, Gordijn SJ et al. Angiotensin‐converting enzyme 2 , SARS‐CoV‐2 and the pathophysiology of coronavirus disease 2019 (COVID‐19). J Pathol. 2020;251(3):228-48.

Liao X, Xiao J, Li SH, Xiao LL, Cheng B, Fu XB, et al. Critical role of the endogenous renin-angiotensin system in maintaining self-renewal and regeneration potential of epidermal stem cells. Biochim Biophys Acta - Mol Basis Dis. 2019;1865(10):2647-56.

Harmer D, Gilbert M, Borman R, Clark KL. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett. 2002;532(1-2):107-10.

Grzegrzolka J, Swiatko K, Pula B, Zamirska A, Olbromski M, Bieniek A, et al. ACE and ACE2 expression in normal and malignant skin lesions. Folia Histochem Cytobiol. 2013;51(3):232-8.

Xue X, Mi Z, Wang Z, Pang Z, Liu H, Zhang F. High Expression of ACE2 on Keratinocytes Reveals Skin as a Potential Target for SARS-CoV-2. J Invest Dermatol. 2020;141(1):206-9.

Li MY, Li L, Zhang Y, Wang XS. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020;9(1):45.

Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020;82(5):e177.

Fernandez-Nieto D, Ortega-Quijano D, Segurado-Miravalles G, Pindado-Ortega C, Prieto-Barrios M, Jimenez-Cauhe J. Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies. J Eur Acad Dermatology Venereol. 2020;9(9):4563-9.

Zhang J jin, Dong X, Cao Y yuan, Yuan Y dong, Yang Y bin, Yan Y qin, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur J Allergy Clin Immunol. 2020;75(7):1730-41.

Estébanez A, Pérez-Santiago L, Silva E, Guillen-Climent S, García-Vázquez A, Ramón MD. Cutaneous manifestations in COVID-19: a new contribution. J Eur Acad Dermatology Venereol. 2020.

Mazzotta F, Troccili T. Acute Acro-Ischemia in the Child At the Time of Covid-19. Dermatología Pediatr. 2020;30(2):71-4.

Alramthan A, Aldaraji W. Two cases of COVID‐19 presenting with a clinical picture resembling chilblains: first report from the Middle East. Clin Exp Dermatol. 2020;45(6):746-8.

Gianotti R, Recalcati S, Fantini F, Riva C, Milani M, Dainese E et al. Histopathological Study of a Broad Spectrum of Skin Dermatoses in Patients Affected or Highly Suspected of Infection by COVID-19 in the Northern Part of Italy: Analysis of the Many Faces of the Viral-Induced Skin Diseases in Previous and New Reported Case. Am J Dermatopathol. 2020;42(8):564-70.

Henry D, Ackerman M, Sancelme E, Finon A, Esteve E. Urticarial eruption in COVID‐19 infection. J Eur Acad Dermatology Venereol. 2020;34(6).

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;4(2):219-21.

Jimenez-Cauhe J, Ortega-Quijano D, Prieto-Barrios M, Moreno-Arrones OM, Fernandez-Nieto D. 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 Academy Dermatol. 2020;45(6):746-8.

Kolivras A, Dehavay F, Delplace D, Feoli F, Meiers I, Milone L, et al. Coronavirus (COVID-19) infection–induced chilblains: A case report with histopathologic findings. JAAD Case Reports. 2020;7:573188.

Mahé A, Birckel E, Krieger S, Merklen C, Bottlaender L. A distinctive skin rash associated with coronavirus disease 2019? J Eur Academy Dermatol Venereol. 2020;36(6).

Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic manifestation of COVID-19: Transient livedo reticularis. J Am Acad Dermatol. 2020;83(2):700.

Najarian DJ. Morbilliform exanthem associated with COVID-19. JAAD Case Reports. 2020;6(6):493-4.

Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi. 2020;41(0):E006.

Zhang J, Dong X, Cao Y, Yuan Y, Yang Y, Yan Y, et al. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy. 2020;75(7):1730-41.

Casas GC, Català A, Carretero Hernández G, Rodríguez‐Jiménez P, Fernández‐Nieto D, Rodríguez‐Villa Lario A, et al. Classification of the cutaneous manifestations of COVI ‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71-7.

Fernandez-Nieto D, Jimenez-Cauhe J, Suarez-Valle A, Moreno-Arrones OM, Saceda-Corralo D, Arana-Raja A, et al. Characterization of acute acral skin lesions in nonhospitalized patients: A case series of 132 patients during the COVID-19 outbreak. J Am Acad Dermatol. 2020;83(1):e61-3.






Review Articles