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LETTER TO EDITOR
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 177-178

Cutaneous manifestations among COVID-19 patients


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 Submission08-Jul-2020
Date of Decision10-Sep-2020
Date of Acceptance25-Nov-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Mangla Sood
Department of Pediatrics, Indira Gandhi Medical College, Shimla - 171 006, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_116_20

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How to cite this article:
Sood M, Sharma S. Cutaneous manifestations among COVID-19 patients. Indian J Paediatr Dermatol 2021;22:177-8

How to cite this URL:
Sood M, Sharma S. Cutaneous manifestations among COVID-19 patients. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 Apr 18];22:177-8. Available from: https://www.ijpd.in/text.asp?2021/22/2/177/312826



Sir,

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,[1] 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.[2] 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.[3] Skin rash is a manifestation of pediatric COVID-19 patients of the severe multisystem inflammatory syndrome also.[4] Transient rash at birth was also noted among few neonates born to COVID-19 positive mothers.[5]

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.[6] 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.[7]

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.[3] Another contributing factor could be the cutaneous reactions to the numerous treatments used to treat COVID-19.[6]

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.[7] We also need to start COVID-19 registry similar to the American Academy of Dermatology[3] 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Recalcati S. Cutaneous manifestations in COVID-19: A first perspective. J Eur Acad Dermatol Venereol 2020;34:e212-3.  Back to cited text no. 1
    
2.
Torrelo A, Andina D, Santonja C, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, et al. Erythema multiforme-like lesions in children and COVID-19. Pediatr Dermatol 2020;37:442-6.  Back to cited text no. 2
    
3.
Freeman EE, McMahon DE, Fitzgerald ME, Fox LP, Rosenbach M, Takeshita J, et al. The AAD COVID-19 registry: Crowdsourcing dermatology in the age of COVID-19. J Am Acad Dermatol 2020;83:509-10.  Back to cited text no. 3
    
4.
CDC. Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children; 2020. Available form: https://www.cdc.gov/mis-c/hcp/ [Last accessed on 2020 Jul 09].  Back to cited text no. 4
    
5.
Zimmermann P, Curtis N. COVID-19 in children, pregnancy and neonates: A review of epidemiologic and clinical features. Pediatr Infect Dis J 2020;39:469-77.  Back to cited text no. 5
    
6.
Manchanda Y, Das S, De A. Coronavirus disease of 2019 (COVID-19) facts and figures: What every dermatologist should know at this hour of need. Indian J Dermatol 2020;65:251-8.  Back to cited text no. 6
  [Full text]  
7.
Jamiolkowski D, Mühleisen B, Müller S, Navarini AA, Tzankov A, Roider E. SARSCoV-2 PCR testing of skin for COVID-19 diagnostics: A case report. Lancet 2020;396(10251):598-9.  Back to cited text no. 7
    




 

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