key: cord-0995706-fa6kbjif authors: Rongioletti, Franco title: SARS‐CoV, Mers‐CoV and Covid‐19:what differences from a dermatological viewpoint? date: 2020-06-11 journal: J Eur Acad Dermatol Venereol DOI: 10.1111/jdv.16738 sha: acea316f4470abac89e4543841c655ce36ca8d6c doc_id: 995706 cord_uid: fa6kbjif Over the past two decades, 3 zoonotic global coronavirus outbreaks have occurred: 1. SARS starting in 2002 in China due to SARS‐CoV; 2. MERS starting in 2012 in Saudi Arabia due to MERS‐CoV; 3. Covid‐19 due to SARS‐CoV‐2 starting in 2019 in Wuhan, China (1). Both beta‐coronaviruses, SARS‐CoV and MERS‐CoV caused a severe disease in most infected people. Over the past two decades, 3 However, it is clear now that the epidemic of COVID-19 is different from SARS and MERS. Although presenting symptoms are similar-fever and cough, progressing to pneumonia in severe cases, with poorer outcomes associated with men gender, older age and comorbidities-SARS and MERS were/are much less transmissible but more likely to be severe or fatal than COVID-19. In fact, COVID-19 has a general fatality rate of 3.4% lower than that of SARS (9.6%) and much lower than that of MERS (34.4%) (5) but SARS-CoV-2 caused many more deaths. As for dermatology, the most relevant difference between Covid-19 and SARS/MERS is the absolute lack of reports of skin manifestations in the latter. Actually, many cutaneous manifestations have been described in association with SARS-COv-2 infection, although their prevalence is controversial ranging from 0.2% in a cohort of 1099 Chinese patients to 20.4% in an Italian study of 88 patients (8, 9) . They include: pseudo-chilblain lesions, livedoid or necrotic lesions and vesicular eruptions which appear as the most characteristic ones and urticarial, purpuric and maculopapular eruptions which are the most frequent rashes, albeit less specific (6, 7) . The reasons why there is a robust evidence in the literature of cutaneous manifestations in Covid-19 due to SARS-CoV-2 and not even one report of skin rashes both in SARS-CoV and MERS-CoV infections is unclear. One possible explanation is that the international response to COVID-19 has been more transparent and efficient when compared to the SARS /MERS outbreaks. The rapidly progressing of COVID-19 pandemic has become a global concern stimulating a lot of dermatological researches with many more cases than its predecessors. Another explanation is that a part of these skin manifestations of Covid-19 is not directly related to the virus but to the multi drugs which have been used in a relatively large amount in Covid-19 compared to the therapies used for the previous epidemic of SARS and MERS (10) . In this setting, we cannot rule out that, in view of the greater severity of lung and multiorgan involvement in SARS and MERS, the skin has received less attention or that SARS-CoV and MERS-CoV may have less tropism for the skin than Sars-Cov-2. There is still much more to know about skin manifestations associated with COVID-19 but unfortunately, we cannot learn from the experience of previous coronavirus epidemics. It is only with this new pandemic that dermatologists are exploring a new chapter whose aim is not only to identify patients or asymptomatic carriers in the risk population throughout skin signs but also to understand whether skin rashes could be a part of a potential transmission route for SARS-CoV-2. This article is protected by copyright. All rights reserved here is an increasing concern whether skin rashes could be a part of a potential transmission route for SAR The novel zoonotic COVID-19 pandemic: An expected global health concern Coronavirus infections: Epidemiological, clinical and immunological features and hypotheses Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan Pathological findings of COVID-19 associated with acute respiratory distress syndrome A novel coronavirus emerging in China -key questions for impact assessment Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases Accepted Article This article is protected by copyright. All rights reserved Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients Clinical Characteristics of Coronavirus Disease 2019 in China Cutaneous manifestations in COVID-19: a first perspective Cutaneous Sıde-Effects of the Potentıal Covıd-19 Clinical characteristics of coronavirus disease 19 in China Cutaneous manifestations in COVID-19: a first perspective Clinical characteristics of coronavirus disease 19 in China This article is protected by copyright. All rights reserved