key: cord-0981312-dc0uwymd authors: Galli, Elena; Cipriani, Francesca; Ricci, Giampaolo; Maiello, Nunzia title: Cutaneous manifestation during COVID‐19 pandemic date: 2020-11-24 journal: Pediatr Allergy Immunol DOI: 10.1111/pai.13384 sha: c2cba21d6fad30be6fb7a0a376a9d2736721bbe2 doc_id: 981312 cord_uid: dc0uwymd BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic, causing COVID‐19, is rapidly spread across the world, by posing novel challenges for all physicians. Cutaneous manifestations of COVID‐19 may be present in 20% of patients, but they are still now poorly characterized. METHODS: We search literature to describe all the various cutaneous manifestation observed during COVID‐19 pandemic. RESULTS: Different cutaneous clinical patterns were described, showing a wide polymorphism. CONCLUSION: We provided an overview of all the various cutaneous manifestations of COVID‐19 described in the literature today, to improve our knowledge and lead a more prompt and accurate diagnosis, especially in asymptomatic or paucisymptomatic cases. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, causing COVID-19, poses novel challenges for all physicians since the novel coronavirus can often be responsible for unusual and unsuspected pictures. There have been increasing reports of various cutaneous manifestations for COVID-19, until recent reports of Kawasaki disease, even if the virus does not seem dermatotropic. In the beginning, cutaneous manifestations appeared as an infrequent presentation of COVID-19: A Chinese study of 1099 cases provided the first evidence of skin manifestations in 2 patients with severe respiratory disease. 1 A review article analyzed 6 case series and 12 case reports identified in the maculopapular exanthem (morbilliform) as the most common cutaneous manifestation of COVID-19 since it was found to be present in 36.1% (26/72) patients. 3 • Urticaria and urticaria-like rush Several case reports described urticaria or urticariform rush in COVID-19 patients, mostly distributed in the trunk and often before the onset of fever or respiratory symptoms. 3 Among patients with confirmed COVID-19 and skin manifestations, the prevalence of urticaria varies from 9.7% to 16.7%. 2, 3 • Chickenpox-like vesicles Case reports described varicella-like papulovesicular exanthem. 4 In Italy, Recalcati et al described vesicles formation in 1/18 patients (5.6%) with confirmed COVID-19 with skin manifestations. 2 Data from current reports show a higher prevalence of this manifestation, raising to 34.7%. 3 As reported by Zhang et al, COVID-19 could be responsible for coagulation disorders, increasing the D-dimer and fibrinogen degradation products, and leading to acro-ischemia with finger and toe cyanosis. 5 Other case reports described acro-ischemia in children and critical patients, or acral ischemic lesions presenting as red-purple papules. 5 Painful acral red-purple papules were reported in 15.3% of patients with COVID-19 and skin lesions. 3 Other less frequent cutaneous manifestations were described, in adults and the pediatric population, such as livedo reticularis lesions, a rash mistaken for dengue, rash with petechiae, and confluent erythematous yellowish plaques in the heels. 3 The early recognition of KD and KDSS and the prompt referral to a hospital setting is essential to prevent complications and to improve the outcome of these patients. However, even if data suggest an association between SARS-CoV-2 infection and KD, some caution is needed in concluding that the novel coronavirus is a trigger for KD. Additional clinical studies regarding skin manifestations in COVID-19 are needed to understand the exact cutaneous features and to lead to more prompt and accurate diagnosis, especially in asymptomatic or paucisymptomatic cases. The authors have no conflict of interest to declare. The peer review history for this article is available at https://publo ns.com/publo n/10.1111/pai.13384. https://orcid.org/0000-0001-6692-9101 Francesca Cipriani https://orcid.org/0000-0002-2229-5263 Giampaolo Ricci https://orcid.org/0000-0002-3660-8750 Clinical characteristics of Coronavirus Disease 2019 in China Cutaneous manifestations in COVID-19: a first perspective Cutaneous manifestations of COVID-19: report of three cases and a review of literature Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia Kawasaki disease shock syndrome: clinical characteristics and possible use of IL-6, IL-10 and IFN-γ as biomarkers for early recognition COVID-19 and Kawasaki disease: novel virus and novel case Hyperinflammatory shock in children during COVID-19 pandemic An outbreak of severe Kawasakilike disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study Cutaneous manifestations in COVID-19: Lessons learned from current evidence