TY - JOUR
T1 - Skin Manifestations in COVID-19 Patients
T2 - Are They Indicators for Disease Severity? A Systematic Review
AU - Jamshidi, Parnian
AU - Hajikhani, Bahareh
AU - Mirsaeidi, Mehdi
AU - Vahidnezhad, Hassan
AU - Dadashi, Masoud
AU - Nasiri, Mohammad Javad
N1 - Funding Information:
This study was related to the project No. 25240 From Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran. We also appreciate Student Research Committee and Research and Technology Chancellor in Shahid Beheshti University of Medical Sciences for their financial support of this study.
Publisher Copyright:
© Copyright © 2021 Jamshidi, Hajikhani, Mirsaeidi, Vahidnezhad, Dadashi and Nasiri.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2/16
Y1 - 2021/2/16
N2 - Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19. Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: “SARS-CoV-2” or “COVID-19” or “new coronavirus” or “Wuhan Coronavirus” or “coronavirus disease 2019” and “skin disease” or “skin manifestation” or “cutaneous manifestation.” Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1,847 patients with confirmed COVID-19 were examined. The overall frequency of cutaneous manifestations in COVID-19 patients was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. Forty-eight percentage of the patients had a mild, 32% a moderate, and 20% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. Seventy-two percentage of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%). Conclusion: The mere occurrence of skin manifestations in COVID-19 patients is not an indicator for the disease severity, and it highly depends on the type of skin lesions. Chilblain-like and vascular lesions are the ends of a spectrum in which from chilblain-like to vascular lesions, the severity of the disease increases, and the patient's prognosis worsens. Those with vascular lesions should also be considered as high-priority patients for further medical care.
AB - Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19. Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: “SARS-CoV-2” or “COVID-19” or “new coronavirus” or “Wuhan Coronavirus” or “coronavirus disease 2019” and “skin disease” or “skin manifestation” or “cutaneous manifestation.” Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1,847 patients with confirmed COVID-19 were examined. The overall frequency of cutaneous manifestations in COVID-19 patients was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. Forty-eight percentage of the patients had a mild, 32% a moderate, and 20% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. Seventy-two percentage of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%). Conclusion: The mere occurrence of skin manifestations in COVID-19 patients is not an indicator for the disease severity, and it highly depends on the type of skin lesions. Chilblain-like and vascular lesions are the ends of a spectrum in which from chilblain-like to vascular lesions, the severity of the disease increases, and the patient's prognosis worsens. Those with vascular lesions should also be considered as high-priority patients for further medical care.
KW - COVID-19
KW - coronavirus – COVID-19
KW - disease severity
KW - mortality
KW - prognosis
KW - skin - pathology
KW - skin manifestations
KW - systematic literature search
UR - http://www.scopus.com/inward/record.url?scp=85101974572&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101974572&partnerID=8YFLogxK
U2 - 10.3389/fmed.2021.634208
DO - 10.3389/fmed.2021.634208
M3 - Review article
AN - SCOPUS:85101974572
VL - 8
JO - Frontiers in Medicine
JF - Frontiers in Medicine
SN - 2296-858X
M1 - 634208
ER -