Seven coronaviruses are known to infect humans.
Four common cold viruses: OC43, HKU1, 229E, NL63, have been infecting humans for hundreds of thousands of years.
Three new 'emerging' viruses cause severe disease: SARS-CoV (2003), MERS-CoV (2012), SARS-CoV-2 (2019)
COVID-19 is the disease, SARS-CoV-2 is the virus.
Early studies have shown that the median incubation period for COVID-19 of approximately five days, and a quarantine period of 14 days is likely sufficient for 99% of potential transmission.
Currently, no vaccines and no antiviral medications are available; however, vaccine trials and clinical pharmacologic studies are proceeding globally at a frantic pace.
The COVID-19 pandemic is a highly contagious respiratory viral infection that has changed the way we approach our daily lives beginning in Q1 2020.
While respiratory symptoms predominate the clinical presentation of this viral infection, several dermatologic conditions are reported.
The reported incidence of dermatologic manifestations has varied from 0.2% to 20%. As our knowledge of COVID-19 grows, we will likely see the rate be closer to double digits.
COVID-19, a disease caused by the SARS-CoV2, has afflicted millions of people around the world over the past several months. Although there are multiple reports of systemic findings observed in patients with COVID-19, cutaneous manifestations of this disease have not been as widely described.
Anectodal and incidental cutaneous findings associated with COVID-19 have appeared in the literature.
Some of the cutaneous manifestations of COVID-19 that have been in the literature range from:
- Erythematous eruptions involving the trunk and flexural areas
- Morbilliform rash
- Urticarial eruption
- Transient livedoid reticularis
- Widespread erythema and chickenpox-like vesicles
- Skin rash with petechia
- Confluent erythematous-yellowish papules on heels bilaterally, which progressed to hard, erythematous papules
Figure 1: Covid-19 Urticarial Eruption
Furthermore, COVID-19 patients seem to be prone to coagulation dysfunction with signs of small blood vessel occlusion, as is evident by systemic, as well as cutaneous findings of ischemia in the limbs.
These cutaneous manifestations of microcirculation disorder that patients with COVID-19 may be developing can clinically present as findings ranging from petechiae or tiny bruises to nonpruritic blanching livedoid vascular eruptions on extremities to plantar plaques, plantar vesicles, dry gangrene, or just bruising in the fingers and toes (i.e., Covid Toes).
Figure 2: Covid Toes
Figure 3: Covid Toes
Skin manifestations in health care workers
Health care workers are developing skin problems related to their frequent hand washing and as a result of wearing Personal Protective Equipment (PPE).
- Eczema, especially on their hands from frequent and repetitive use of antibacterial soap and alcohol-based cleaners
- Pressure injuries on their face, especially the nasal bridge, cheeks, and forehead when protective masks (N-95) are word for six (6) hours or longer.
- These pressure injuries range from erythema to maceration and ulceration.
- These changes cause itching and discomfort, which impact their quality of life while attempting to help their patients.
No doubt, as additional investigation proceeds into COVID-19, a better understanding of the overall pathophysiology of the infection, as well as systemic and cutaneous manifestations, will emerge.
References
- Nat Microbiol. 2020;5(4):536-544.
- Recalcati, S. J Eur Acad Dermatol Venereol. 2020 Mar 26. doi: 10.1111/jdv.16387. [Epub ahead of print].
- Guan W: N Engl J Med. 2020 Feb 28. doi: 10.1056/NEJMoa2002032. [Epub ahead of print].
- Ortega-Quijano D: J AM Acad Dermatol 2020, doi: https://doi.org/10.1016/j.jaad.2020.05.034.
- Joob B: J Am Acad Dermatol. 2020 May;82(5):e177. doi: 10.1016/j.jaad.2020.03.036. Epub 2020 Mar 22.
- Estébanez A: J Eur Acad Dermatol Venereol. 2020 Apr 15. doi: 10.1111/jdv.16474. [Epub ahead of print].
- Zhang, Y: N Engl J Med. 2020 Apr 8. doi: 10.1056/NEJMc2007575. [Epub ahead of print].
- Wu P: JAMA Ophthalmol. 2020 Mar 31. doi: 10.1001/jamaophthalmol.2020.1291. [Epub ahead of print].
- Tang N: J Thromb Haemost. 2020 Apr;18(4):844-847. doi: 10.1111/jth.14768.
- Oranges T: J Am Acad Dermatol 2020, doi: https://doi.org/10.1016/j.jaad.2020.04.003
Image Credit: Cover Image
