|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 177-178
Cutaneous manifestations among COVID-19 patients
Mangla Sood1, Seema Sharma2
1 Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Pediatrics, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, India
|Date of Submission||08-Jul-2020|
|Date of Decision||10-Sep-2020|
|Date of Acceptance||25-Nov-2020|
|Date of Web Publication||31-Mar-2021|
Department of Pediatrics, Indira Gandhi Medical College, Shimla - 171 006, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sood M, Sharma S. Cutaneous manifestations among COVID-19 patients. Indian J Paediatr Dermatol 2021;22:177-8
COVID-19 caused severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) initially reported from Wuhan (China) by the end of 2019, has been declared a pandemic by the WHO on March 11, 2020. As more cases worldwide describe new systemic clinical manifestations, the case definition of COVID-19 is updated regularly.
We want to highlight potential cutaneous manifestations among patients (mostly children and adolescents) with confirmed or suspected SARS-CoV-2 infection. These were first reported from Italy among 20.4% of 148 COVID-19-positive patients, and from Spain among 18% of children with erythema-multiforme-like lesions, without a history of other viral infections (Herpes simplex, Epstein–Barr virus, etc.) or intake of drugs or recent immunization. Among 171 laboratory-confirmed COVID-19 patients from the American Academy of Dermatology's COVID-19 registry, the most commonly reported cutaneous manifestations were exanthematous morbilliform rash (22%) predominantly involving the trunk, pernio (chilblain)-like acral lesions (18%) in the absence of cold exposure, urticaria (16%), macular erythema (13%), vesicular eruption (11%), papulosquamous eruption (9.9%), and retiform purpura (6.4%). Fever and cough were reported in approximately 60% of cases. Fifty-five percent of patients were either asymptomatic or had mild disease. Ninety-eight percent of patients received only out patient department-based treatment. Skin rash is a manifestation of pediatric COVID-19 patients of the severe multisystem inflammatory syndrome also. Transient rash at birth was also noted among few neonates born to COVID-19 positive mothers.
The pathogenesis of these cutaneous lesions is still being unravelled. Primarily these appear to be hyperinflammatory responses to the SARS-CoV-2 virus. Histologic and immunohistochemistry studies of skin biopsies revealed a pattern of virus-induced altered coagulation and complement-mediated thrombotic vasculopathy with microvascular injury. In addition, there was colocalization of SARS-CoV-2 spike glycoproteins with C4d and C5b-9 in the cutaneous microvasculature. However, these findings need to be confirmed in larger studies. At present, there are no treatment guidelines for COVID-19-associated skin lesions; topical corticosteroids may be helpful if the lesions are causing discomfort.
The clustering of skin manifestations during the COVID-19 pandemic from multiple affected areas suggests an association with COVID-19. Several case reports and case series of patients with dermatological lesions who tested positive for SARS-CoV-2 serology (either immunoglobulin M [IgM]/immunoglobulin G [IgG]) and negative for polymerase chain reaction (PCR), possibly indicate a later stage in the disease process. Another contributing factor could be the cutaneous reactions to the numerous treatments used to treat COVID-19.
The challenge remains to find out the clinical value of these cutaneous manifestations; whether they are a clue pointing towards COVID-19 infection among the asymptomatic pediatric population. Whether these predict any specific course/outcome of COVID-19 and could lead to early intervention and development of specific treatment guidelines needs to be seen. In India, we need large-scale studies with tests to detect the presence of SARS-CoV-2 in the skin (e.g. immunohistochemistry, electron microscopy, PCR) to substantiate the finding. We also need to start COVID-19 registry similar to the American Academy of Dermatology to collate cases and better define the cutaneous manifestations of COVID-19. This will help form and test new hypotheses about the evolving spectrum of COVID-19. We also suggest, that among patients presenting with new-onset, pernio-like lesions that have no other clear Cause testing for SARS-CoV-2 by RT-PCR should be done. Those with lesions for >4 weeks, IgM and IgG antibody testing may be done following local guidelines.
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Conflicts of interest
There are no conflicts of interest.
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