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Table of Contents
EDITORIAL
Year : 2021  |  Volume : 39  |  Issue : 2  |  Page : 65-66

The cutaneous manifestations related to COVID-19 infection and vaccination: current aspects and future prospects


1 Department of Dermatology, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
2 Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
3 Department of Dermatology, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming Chiao Tung University; Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan

Date of Submission31-May-2021
Date of Acceptance31-May-2021
Date of Web Publication23-Jun-2021

Correspondence Address:
Dr. Chih-Chiang Chen
Department of Dermatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ds.ds_24_21

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How to cite this article:
Ma SH, Sytwu HP, Chen CC. The cutaneous manifestations related to COVID-19 infection and vaccination: current aspects and future prospects. Dermatol Sin 2021;39:65-6

How to cite this URL:
Ma SH, Sytwu HP, Chen CC. The cutaneous manifestations related to COVID-19 infection and vaccination: current aspects and future prospects. Dermatol Sin [serial online] 2021 [cited 2021 Aug 4];39:65-6. Available from: https://www.dermsinica.org/text.asp?2021/39/2/65/319147



Ever since the outbreak of the COVID-19 pandemic in 2019, the dermatology society worldwide has been faced with tremendous challenges.[1] To minimize the risk of COVID-19 transmission, nonurgent outpatient visits were discouraged and the patient volume decreased consequently.[2] Modification of the treatment for dermatological diseases was widely discussed, as some may concern the risk of infection under the usage of immunosuppressants and biologics. Moreover, a variety of cutaneous manifestations were linked to COVID-19 infection, which may even be the preceding signs in some patients.[3] Thus, dermatologists should be aware of these skin findings to enhance diagnostic accuracy in clinical practices.

Commonly reported COVID-19-associated cutaneous manifestations included morbilliform, urticarial, pernio-like, papulosquamous, and papulovesicular skin rash [Figure 1].[4],[5] Pernio-like skin rash, or the so-called “COVID toe,” was commonly reported in western countries, typically presented as violaceous papules and plaques on toes with occasional bullae formation or ulceration.[6] Comparing to other skin findings, pernio-like skin rash was more likely to be found in the younger population and those with mild COVID-19 infection.[4] Morbilliform skin rash and urticarial skin rash, on the other hand, were less specific and found more prevalently in COVID-19 patients with moderate severity. Retiform purpura (thrombotic vasculopathy) may also be observed in patients with COVID-19, especially in those with severe infection and respiratory failure.[4],[5] In children, a so-called “Kawasaki disease-like inflammatory syndrome,” characterized by gastrointestinal symptoms, myocarditis, and even shock, was documented in various countries.[7] Classic skin and mucosal presentations in Kawasaki disease, such as conjunctivitis, polymorphic rash, and erythema and induration over hand and feet, can also be seen in these COVID-19 affected children.[7] Several other mucocutaneous lesions, such as geographic tongue, erythema multiforme, pityriasis rosea, and dengue-like exanthem, had been documented in the literature.[7],[8],[9] Given the diverse skin manifestations of COVID-19, differentiation from other viral exanthems was difficult but crucial in clinical settings.[3],[10] Additional nasopharyngeal and serological viral testing may be helpful to achieve accurate diagnosis.
Figure 1: Commonly reported COVID-19-associated cutaneous manifestations.

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Although the number of researches on the skin manifestations related to COVID-19 infection was soaring, most of them were conducted in western countries. To determine the situation in Asian countries, Yildiray and colleagues reported the cutaneous manifestations of COVID-19 in Turkey recently.[11] They discovered five out of 266 patients (1.9%) developed skin lesions, which was much lower than previous reports.[12] Besides, only urticarial and vesicular skin rash were reported in this study. Ethnic differences, the severity of COVID-19 infection and variation of viral genome were possible explanations for the lower prevalence of skin manifestations in Turkey. Given the paucity of data in Asia, a registry-based database was warranted to shed light on the ethnic differences.

Aside from cutaneous manifestations related to COVID-19 infection, recent studies have focused on the skin findings related to the COVID-19 mRNA vaccine (Pfizer and Moderna). McMahon et al. recorded the cutaneous reactions after mRNA-based COVID-19 vaccines and demonstrated that local site reaction, urticarial skin rash, morbilliform skin rash, delayed local reaction, and erythromelalgia were most commonly presented.[13] Swelling of the cosmetic filler injection site was also reported in both vaccines, which was assumed to be caused by the delayed-type hypersensitivity reaction.

As a dermatologist, we should take notice of COVID-19-related skin manifestations and refer to COVID-19 testing if we encountered any suspected patients. Additionally, any skin manifestations in these patients should be recorded to help elucidate the full picture of COVID-19 infection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Lee CH. Role of dermatologists in the uprising of the novel corona virus (COVID-19): Perspectives and opportunities. Dermatol Sin 2020;38:1-2.  Back to cited text no. 1
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2.
Ma SH, Tai YH, Dai YX, Chen CC, Chen TJ, Chang YT. Impact of the COVID-19 pandemic on dermatology clinic visits: Experience from a tertiary medical center in Taiwan. Dermatol Sin 2020;38:180-1.  Back to cited text no. 2
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Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Desai SR, et al. The spectrum of COVID-19-associated dermatologic manifestations: An international registry of 716 patients from 31 countries. J Am Acad Dermatol 2020;83:1118-29.  Back to cited text no. 4
    
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Kanitakis J, Lesort C, Danset M, Jullien D. Chilblain-like acral lesions during the COVID-19 pandemic (“COVID toes”): Histologic, immunofluorescence, and immunohistochemical study of 17 cases. J Am Acad Dermatol 2020;83:870-5.  Back to cited text no. 6
    
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Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al. Skin manifestations of COVID-19 in children: Part 2. Clin Exp Dermatol 2021;46:451-61.  Back to cited text no. 7
    
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Nuno-Gonzalez A, Martin-Carrillo P, Magaletsky K, Martin Rios MD, Herranz Mañas C, Artigas Almazan J, et al. Prevalence of mucocutaneous manifestations in 666 patients with COVID-19 in a field hospital in Spain: oral and palmoplantar findings. Br J Dermatol 2021;184:184-5.  Back to cited text no. 8
    
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Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol 2020;82:e177.  Back to cited text no. 9
    
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Garcia-Gil MF, Monte-Serrano J, Pascual-Del-Riquelme AJ, Ara-Martin M. Parvovirus B19 infection simulating a vesicular exanthem associated with COVID-19. Dermatol Sin Ahead of print. Available from: https://www.dermsinica.org/preprintarticle.asp?id=314374. [Last accessed on 2021 May 23].  Back to cited text no. 10
    
11.
Yıldıray Y, Ayşe PS. Cutaneous manifestations of coronavirus disease in Turkey: A prospective stud. Dermatol Sin 2021;39:74-8.  Back to cited text no. 11
    
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Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020;34:e212-3.  Back to cited text no. 12
    
13.
McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol 2021;S0190-9622(21)00658-7.  Back to cited text no. 13
    


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