Presentation and Management of Cutaneous Manifestations of COVID-19.

Almeida, Guilerme; Arruda, Suleima; Marques, Elaine; Michalany, Nichola; Sadick, Neil

INTRODUCTION The spread of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has instigated a fervent race of the medical community to identify its manifestations, the patients at risk, and optimal disease management. While the COVID-19 illness is largely associated with respiratory consequences, there is increased reporting of other organ-specific disease sequelae that include the skin. OBJECTIVE To identify, describe, and classify the main skin manifestations of COVID-19 and associated protocols for management. METHODS Forty-five patients from three clinical centers in North and South America with positive COVID-19 PCR and/or serology presenting cutaneous manifestations were included in this retrospective chart review. Medical history, biopsies, dermoscopy, laboratory findings, clinical photography, and disease management were documented. RESULTS Seven main types of cutaneous manifestations were identified: exanthema/molbilliform, urticaria, papular/pustular/vesicular, petechiae/purpura, livedo reticularis, chilblains, and alopecia. Histopathogical analysis from skin biopsies and/or dermoscopy highlighted an inflammatory or vascular pathophysiology depending on the type of manifestation. While the first three types of COVID-19 skin manifestations preceded or coincided with other symptoms such as anosmia, fever, chills, chilblains, and livedo were found in later disease stages. All cases had a positive resolution with appropriate treatment. CONCLUSIONS Cutaneous symptoms are part of the COVID-19 disease spectrum. Early identification, diagnosis, and management through a multidisciplinary approach can facilitate safe disease resolution for patients. J Drugs Dermatol. 2021;20(1):76-83. doi:10.36849/JDD.2021.5676.