key: cord-0714132-omr30shm
authors: Albuquerque Brandão, Maria Girlane Sousa; Barros, Lívia Moreira; Mendonça, Jamilly de Aquino; Ramalho, Aline de Oliveira; de Araújo, Thiago Moura; Veras, Vivian Saraiva
title: Clinical and histopathological findings of cutaneous manifestations of COVID19 patients
date: 2020-07-07
journal: Dermatol Ther
DOI: 10.1111/dth.13926
sha: bb93ed9107b350c45a13bbf09515d6eb969265d9
doc_id: 714132
cord_uid: omr30shm

COVID19 became pandemic since this is a disease with a high infection rate. The study's object is to identify clinical and histopathological findings of cutaneous manifestations of COVID19 patients. The evidence was analyzed in PubMed, CINAHL, Cochrane, Web of Science and Scopus, with the search strategy (covid 19 OR covid‐19 OR corona OR coronavirus OR sars‐cov‐2) AND (cutaneous or cutaneous manifestations OR), and 17 studies were included, involving 351 cases with COVID19 and skin manifestations. The lesions were classified mainly as maculopapular, erythematous, vesicular and urticarial. Histopathological analyzes suggest a predominance of spongiosis, perivascular infiltrate of lymphocytes and thrombogenic vasculopathy. This article is protected by copyright. All rights reserved.

COVID19 became pandemic since this is a disease with a high infection rate. Studies indicate cutaneous manifestations as symptoms from COVID19 1-3 . However, they are still superficially reported and the consequences of identifying cutaneous lesions early on and its progression were not extensively studied. Therefore, the disease's cutaneous and histopathological manifestations must be an object of study among specialists to favour the resolution of the clinical picture 4 .

To comprehend how COVID19 causes dermatological alterations, affected areas, types of cutaneous manifestations, the period of appearance, cure and histological findings can provide subsidies for the disease's early recognition, to support a more effective clinical management of cutaneous lesions and give assistance in the screening and risk stratification 5 .

The study's object is to identify clinical and histopathological findings of cutaneous manifestations of COVID19 patients. The bibliographic research was made in June 2020, using the research strategy (covid 19 OR covid19 OR corona OR coronavírus OR sars-cov-2) AND (cutaneous OR cutaneous manifestations) in the following databases: Pubmed, CINAHL, Cochrane, Web of Science and Scopus. The publication period was limited to 2020. A total of 142 articles were identified in the search, two reviewers independently analysed abstract and complete texts.

Seventeen studies that involved 351 cases with COVID19 and skin manifestations were included, most were adults, female and their age varied between 12 to 89 years old (Chart 1).

The lesions were classified, mainly as maculopapular, erythematous, vesicular and urticarial 3, 6, 9, 14 . However, such lesions must be cautiously analysed, because they are common and may have divergent origins. Cutaneous polymorphism can be related to different reasons such as differences in the virus and the host 21 .

The predominant places were the torso and body's extremities and the latency period of the cutaneous symptoms varied from one to 30 days, in contrast, the lesions' progressive disappearance varied from four days to three weeks.

Histological analysis and biopsies of the skin suggest the prevalence of spongiosis, perivascular infiltration of lymphocytes and thrombogenic vasculopathy 8,11,20 . Spongiosis can ben related to the immune response to the infection, which leads to the activation of Langerhans' cells and vasodilation 22 . The thrombotic vasculopathy occurs due to the deposition of C5b-9 and C4d, in addition to their co-location with glycoprotein arising from COVID19 2 .

COVID19 can manifest several skin changes and mostly are maculopapular, erythematous, vesicular and urticarial. These lesions differ from their intensity, appearance period and duration. Histopathological findings suggest spongiosis, thrombogenic vasculopathy and perivascular infiltration of lymphocytes. 

Urticarial erup-tion in COVID19 infection

Complement associated microvascu-lar injury and thrombosis in the pathogenesis of severe COVID19 infec-tion: a report of five cases

Acral cutaneous lesions inthe time of COVID19

Cutaneous manifestations of the Coronavirus Disease 2019 (COVID19): a brief review

A late onset widespread skin rash in a previous Covid19 infected patient: viral or multidrug effect

Cutaneous small vessel vasculitis secondary to COVID19 infection: A case report

SARS-CoV-2 infection presenting as a febrile rash

Classificationof the cutaneous manifestations of COVID19: a rapid prospective nationwide consensus study in Spain with 375 cases

COVID19 and the skin-heuristicreview. Dermo Sprint. 2020

This article is protected by copyright. All rights reserved.Case report 19