Nonspecific rash, with perifollicular distribution in a patient with COVID-19.

Nonspecific rash, with perifollicular distribution in a patient with COVID-19.

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The coronavirus 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had enormous health, economic, and social consequences. The clinical spectrum of cutaneous manifestations observed in patients with COVID-19 is both heterogeneous and complex. To date, reports have identified 5 main categories: acra...

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... together, and given the difficulty of further subclassification, account for 47% of the skin manifestations in patients with COVID-19. 11 At times, these rashes may be accompanied by a petechial component or with macules or more extensive areas with a purpuric appearance. In other cases, the lesions have a markedly perifollicular distribution (Fig. 4) with variable degrees of scaling, some of which have been reported as similar to pityriasis rosea. 25 Infiltrated papules have also been observed; these are pseudovesicular lesions or similar to erythema elevatum diutinum or multiform erythema, and they may occasionally be pruritic (Fig. 5). 26 A markedly craniocaudal development has ...

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... More severe cases may require oral antihistamines and oral corticosteroids (93,100). Despite being largely self-limited and mild, the Zika virus is emerging as a public health crisis in tropical and subtropical countries for inhabitants and visitors alike. ...
Article
In this paper, we discuss pertinent cutaneous findings that patients may present following travel to tropical destinations. We address arthropod-borne infectious diseases such as Cutaneous Leishmaniasis, Chagas Disease, Cutaneous Larvae Migrans, Myiasis, and others. We discuss other relevant diseases with cutaneous signs such as Monkey Pox and SARS-CoV-2. We provide clinicians with information regarding the background, diagnosis, treatment, and prevention of these tropical rashes. Additionally, we address the impact that climate change will have on the temporal and geographic incidence of these rashes. Viral, fungal, and vector-borne diseases have seen a geographic expansion into more northern latitudes. Among these are tick-borne Lyme disease, aquatic-snail-related Sea bather's eruption, and atopic dermatitis. As these diseases spread, we believe the updated information within this article is significant to the practicing physician in today's warming world.
... This difference may be attributed to the geographical differences between the two studies. Vesicular (Chickenpoxlike) rashes appear as small monomorphic vesicles mainly on the trunk, mostly in middleaged COVID19 patients in up to 4% of cases which is less than what is reported in many studies (9%) [22][23][24]. Patients with papulovesicular exanthem were 34 (9%), while they were 3 out of 52 (5.8%), 1 out of 18 (5.5%), and 2 out of 53 (4%) in the cohorts published by Askin et al. [9], Recalcati [10] and De Giorgi et al. [8]. ...
... However, Recalcati was the first to report skin manifestations associated with SARS-CoV-2 [2]. The estimated incidence of cutaneous manifestations secondary to COVID-19 is between 4 and 20.4% [3]. In an independent survey of 11,544 respondents, Visconti et al. reported 17% of patients infected with SARS-CoV-2 had skin manifestations as their first symptom and 21% as their only clinical sign of illness [4]. ...
... The prevalence of livedo reticularis and racemosa in SARS-CoV-2 patients is between 0.6 and 6% and they occur more frequently in adults than children [3]. In a case series study of 719 patients, Freeman et al. reported that livedoid reticularis represented 3.5% and livedoid racemosa represented 0.6% of all SARS-CoV-2-related cutaneous manifestations [28]. ...
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... Acral ischemic lesions occur as a result of increased inflammation and cutaneous thrombosis. 17 Pernio, one of the acral ischemic lesions, occurs due to increased inflammation. However, livedoid lesions occur due to cutaneous thrombosis and may also develop as precursor lesions of COVID-19. ...
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COVID 19 is a systemic disease characterized by vascular damage, increased inflammation and hypercoagulability. Acral ischemic lesions occur as a result of increased inflammation and cutaneous thrombosis. Skin lesions can sometimes be the only symptom of COVID‐19. In this respect, recognizing acroischemic lesions, which are skin lesions, may help in the early diagnosis of the disease and in predicting the prognosis. In patients with skin lesions without typical symptoms, the diagnosis of COVID‐19 should be kept in mind. Herein we describe 5 patients affected by COVID‐19 which developed acro‐ischemic lesions.
... These eruptions are frequent in middle-aged and elderly adults and without significant differences between sexes [39]. The location of petechial eruptions can be diffuse or on the extremities, while purpura lesions are located on the legs and buttocks [35] or in a generalized manner, localized in intertriginous regions or with an acral distribution [40]. Petechiae and generalized purpura usually appear in the most severe cases of SARS-CoV-2 infection. ...
... These lesions have a high mortality rate [23]. Rashes with petechiae/purpura secondary to small subdermal hemorrhages could be considered as a cutaneous manifestation related to COVID-19 and appear at any time during the course of the disease [35,40]. ...
... The pathophysiological mechanism of purpura lesions could be due to severe microvascular injury mediated by complement activation [40] or by cytokine storm [28]. The petechial exanthema associated with COVID-19 may be causing thrombocytopenia, mimicking dengue disease in endemic areas. ...
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Coronavirus disease 2019 (COVID-19) is a multisystem disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), that primarily causes respiratory symptoms. However, an increasing number of cutaneous manifestations associated with this disease have been reported. The aim of this study is to analyze the scientific literature on cutaneous manifestations associated with SARS-CoV-2 by means of a narrative literature review until June 2021. The search was conducted in the following electronic databases: Medline (PubMed), SciELO, and Cochrane Library Plus. The most common cutaneous manifestations in patients with COVID-19 are vesicular eruptions, petechial/purpuric rashes, acral lesions, liveoid lesions, urticarial rash, and maculopapular-erythematous rash. These manifestations may be the first presenting symptoms of SARS-CoV-2 infection, as is the case with acral lesions, vesicular eruptions, and urticaria. In relation to severity, the presence of liveoid lesions may be associated with a more severe course of the disease. Treatment used for dermatological lesions includes therapy with anticoagulants, cortico-steroids, and antihistamines. Knowledge of the dermatologic manifestations associated with SARS-CoV-2 contributes to the diagnosis of COVID-19 in patients with skin lesions associated with respiratory symptoms or in asymptomatic patients. In addition, understanding the dermatologic lesions associated with COVID-19 could be useful to establish a personalized care plan.
... En cuanto a la duración de las lesiones, esta suele ser en promedio ocho días sin dejar cicatrices. [6][7][8] En los casos en que se obtuvo una biopsia, los hallazgos se describen como compatibles con infección vírica, mostrando alteraciones vacuolares, alteración de la maduración de los queratinocitos, así como queratinocitos de mayor tamaño, multinucleados y disqueratosis. 8 Un punto relevante y controversial es si las lesiones dérmicas guardan relación con la gravedad de la enfermedad o es un factor pronóstico, así se informó que el sabañón se asoció con una enfermedad menos grave y livedo reticularis se asoció con las formas más graves de la enfermedad; sin embargo, otro estudio no informó correlación alguna entre las presentaciones cutáneas y la gravedad de la enfermedad. ...
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Se presenta el caso de un paciente de 45 años que inicio con tos no productiva, malestar general y disnea progresiva, confirmándose el diagnostico COVID-19 severo con respuesta favorable al tratamiento. En la evolución clínica presentó lesiones tipo papulovesicular pruriginosas que se resolvieron de forma espontánea en el transcurso de las semanas.
... 15 In the case series published by Recalcati,16.7% of the 18 patients had these lesions, slightly itchy and mainly distributed over the trunk. 1 12 It is important to note that these skin changes did not correlate with the severity of the disease 12 and were described in patients with a milder clinical course and limited symptoms. 13 In the literature cases, this rash has improved with the introduction of oral antihistamines. 12 15 In our two patients with urticarial rashes, the COVID-19 had a ...
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Coronaviruses have been known to the mankind for decades. In the past, they were thought to cause mild infections of the upper respiratory tract. The emergence at the beginning of the 21st century of two highly transmissible and pathogenic viruses β-coronaviruses, i.e. Severe Acute Respiratory Syndrome Coronavirus (SARS- CoV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV), causing respiratory failure leading to the death of a large number of patients, highlighted a significant threat to the entire world. The 21st century has brought events at a catastrophic scale - the COVID-19 pandemic. SARS-CoV-2 virus from the Coronaviridae family responsible for the disease, appeared at the end of 2019 in Wuhan, China, and in a short time has lead to the devastation of lives of millions of people around the world. A comparison of the SARS-CoV-2 genome sequence and other available β-coronavirus genomes indicates the closest association of SARS-CoV-2 with the BatCov RaTG13 bat coronavirus strain (96% similarity). Therefore, it is suggested that SARS-CoV-2 virus may have evolved naturally from the RaTG13 virus strain transmitted by bats. The consequences of the COVID-19 pandemic include, among others, a significant number of illnesses and fatalities, inefficiency of health care systems, mental disorders and unprecedented methods of fighting the pandemic requiring closure of large sectors of the economy and a drastic reduction of interpersonal contacts. This survey presents basic information about β-coronaviruses. It also describes the course of COVID-19, taking into account a wide range of clinical symptoms from the respiratory, cardiovascular, digestive, reproductive and nervous systems, kidneys and skin. In addition, problems of mental disorders related to the current situation, both in patients and medical personnel as well as in general population, are discussed. The most common symptoms of COVID-19 in children are presented. The article also describes methods used for a diagnosis of the SARS-CoV-2 infection, and disturbances in hematological, biochemical, hemostatic and inflammatory parameters found in COVID-19 patients, emphasizing their role as prognostic factors for the severity of the disease.
... Although SARS-CoV-2 is associated with milder health effects than SARS-CoV-1 and MERS-CoV, SARS-CoV-2 is more efficiently transmitted within the community, while SARS-CoV-1 and MERS-CoV are associated with nosocomial spread (Pergolizzi et al., 2020;Petrosillo et al., 2020). The most common symptoms caused by SARS-CoV-2 include fever, dry cough, fatigue, shortness of breath, and loss of taste and smell, while the less common include skin lesions, gastrointestinal outcomes, neurological manifestations and respiratory failure (Carrascosa et al., 2020;Gisondi et al., 2020;Matar et al., 2020;Romoli et al., 2020;Zheng et al., 2020). ...
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Respiratory viruses are the main agents causing respiratory tract diseases. Nowadays, coronaviruses – and specifically, SARS-CoV-1, MERS-CoV and SARS-CoV-2 – are the principal responsible for the major epidemic outbreaks of the 21st century. The major routes of transmission for respiratory viruses – including coronaviruses – are via direct and indirect contacts. However, transmission through contaminated foods has not been extensively assessed. The present paper was aimed at reviewing scientific data on the transmission of respiratory viruses through potentially contaminated foods. While the current data seem to suggest that this route of transmission is not likely to occur, in order to increase the knowledge on this issue further investigations are still clearly necessary for a more complete prevention of the risks. Studies should include fresh produce and cooked foods. Anyway, prevention measures and good hygienic practices for both consumers and workers are mandatory when handling and cooking foods.
... Finalmente, se presenta trombosis de la microcirculación causando severa isquemia de los tejidos, incluyendo la piel (Figura 1). 10,11 El coronavirus SARS-CoV-2 vino a retar la habilidad diagnóstica de los médicos. Hasta el momento ha mostrado su capacidad para provocar cualquier cuadro clínico de los antes mencionados. ...
... Su semiología es diversa y heterogénea, lo cual complica su diagnóstico diferencial. 11 La presencia del virus en las lesiones de la piel aún es una controversia. [12][13][14][15][16][17] Cuando inició la pandemia en Wuhan, las primeras descripciones del proceso no incluyeron las manifestaciones cutáneas, se les consideró un problema secundario. ...
... En la literatura corresponde al segundo lugar entre las lesiones causadas por SARS-CoV-2, aparentemente precedida por los seudosabañones. 4,11,[20][21][22][32][33][34]41,42 El exantema maculopapular puede aparecer previo a los síntomas respiratorios, durante la primera o segunda semanas de la enfermedad y también se ha visto hasta 45 días después del diagnóstico. Esto hace pensar que la fisiopatología puede cambiar durante la historia natural de la virosis en donde la carga viral y los elementos de inmunidad juegan un papel importante siendo primordial descartar las reacciones medicamentosas. ...