The trend of cutaneous lesions during COVID-19 pandemic: lessons from a meta-analysis and systematic review.

Bandhala Rajan, M; Kumar-M, Praveen; Bhardwaj, Abhishek

BACKGROUND Besides predominant respiratory and gastrointestinal manifestations, reports on cutaneous manifestations in COVID-19 patients are being noted increasingly. OBJECTIVES To estimate the prevalence of cutaneous manifestations in COVID-19 patients. METHODS This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A detailed literature search was done in PubMed and Embase from December 1, 2019, till May 1, 2020. Studies reporting cutaneous manifestations in COVID-19 patients were included. Irrespective of the heterogeneity of data, a random effects model with inverse-variance approach was used for pooling the prevalence using meta package in R version 3.6.2. RESULTS Out of 15,143 articles, 2086 articles were selected for full-text read. Forty-three articles were selected for qualitative analysis, of which 10 articles (N = 1682) were included for meta-analysis. The pooled prevalence of overall cutaneous lesions was 5.69 (95% confidence interval [CI]: 1.87-15.98; I2 88%). The pooled prevalence of other outcome parameters were as follows: viral exanthem-like presentation 4.15 (95% CI: 1.33-12.23; I2 88%), maculopapular rash 3.81 (95% CI: 1.02-13.18; I2 87%), vesiculobullous lesions 1.67 (95% CI: 0.70-3.96; I2 0%). CONCLUSION The estimated prevalence of cutaneous manifestations in COVID-19 was 5.69%. Other manifestations were urticaria, chilblain-like lesions, livedo reticularis, and finger/toe gangrene. Although it is premature to conclude the prevalence of the cutaneous manifestations during this ongoing pandemic, our report may be a stimulating factor for the physicians to perform further vigilant streamlined reporting of cutaneous manifestations in COVID-19 patients to estimate the final prevalence.