Cutaneous manifestations in SARS-CoV-2 (COVID-19) infection: A review of clinical, histopathologic features, and management

Background@#Numerous studies have demonstrated various information about COVID-19 infection. With this, the authors intend to abridge, present, and synthesize current available information, focusing on the cutaneous manifestations of COVID-19 infection, to help guide dermatologists in understanding the dermatologic aspect of this disease.@*Objective@#This study aims to review the different cutaneous manifestations of COVID-19 by morphology and to evaluate the lesions seen in the different age groups. Furthermore, this study aims to discuss cutaneous findings together with histologic evidence and hypothesized pathophysiology, and to review the management used in treating COVID-19-related cutaneous manifestations.@*Methods@#OVID® and PubMed databases were used to search in detail for COVID-19-induced skin lesions across all ages and their management.@*Discussion@#COVID-19 affects the skin, hair and nails of patients. These may be attributed to the different virologic phases as well as the immune response of the body. Histopathologic findings of these lesions vary depending on the clinical presentation. Use of corticosteroid therapy and antihistamines as treatment for some cutaneous manifestations of COVID-19 showed good response.@*Conclusion@#COVID-19 infection-associated cutaneous manifestations present with different morphologies. It is important for dermatologists to gain better understanding of this disease in order to promptly identify and suspect the possibility of this illness, as well as provide appropriate actions.

A descriptive study on the clinical, dermoscopic and histopathologic features of pigmented skin lesions among Filipino adults

Background@#Dermoscopy increases the diagnostic accuracy of clinical visual inspection by 5% to 30%. This has led to a reduction of unnecessary excision of benign skin lesions and the earlier diagnosis of malignant skin lesions.@*Objectives@#To compare the concordance agreement of the clinical versus histopathologic diagnosis to the concordance agreement of the dermoscopic versus histopathologic diagnosis of pigmented lesions.@*Research Design@#This is a prospective, cross-sectional study of the clinical, dermoscopic and histopathological features of pigmented skin lesions on patients seen at the Out-Patient Departments of Quirino Memorial Medical Center and Ospital ng Makati from March 2013 to June 2014.@*Methods@#Sixty-eight subjects fulfilled the criteria and were all included in the final analysis. Classification and definitive diagnosis of the lesion as benign or malignant were determined thru clinical, dermoscopic and histopathologic features by one dermatopathologist. Kappa and concordance analyses were performed to determine the statistical and concordance agreement among the results of the three diagnostic procedures, respectively.@*Results@#The statistical agreement between clinical versus histopathologic classification as benign or malignant was good (kappa=0.872), while the statistical agreement was high (kappa=0.872) between dermoscopic versus histopathologic classification. Concordance agreement between clinical versus histopathologic diagnosis showed fair agreement (concordance coefficient=0.2397) as compared to a high agreement (concordance coefficient=0.98) in dermoscopic versus histopathologic diagnosis.@*Conclusion@#The use of dermoscopy in pigmented lesions aids the dermatologist in giving an accurate diagnosis without invasive procedures. Knowledge of the dermoscopic features will help in the early clinical detection and management of benign and malignant pigmented skin lesions.

Primary cutaneous anaplastic large-cell lymphoma with metastases in an 81-year-old Filipino female

Introduction@#Primary Cutaneous Anaplastic Large Cell Lymphoma (PC-ALCL) is a rare Non-Hodgkin lymphoma (NHL) representing approximately 9% of all cutaneous lymphomas.3 It usually manifests as a slow-growing, solitary tumor which has a tendency to regress spontaneously. However, metastasis is reported in 5-10% of cases.2@*Case Summary@#Our case is an 81-year-old female with a four-month history of an enlarging nodule on the left upper back. The initial impression was a malignant cutaneous tumor. Histopathology revealed epidermotropic large atypical lymphocytes and diffuse infiltrates of hyperchromatic, pleomorphic mononuclear cells and lymphocytes. Immunohistochemistry showed CD3+, CD20-, CD30+, epithelial membrane antigen (EMA)- and anaplastic lymphoma kinase (ALK)- consistent with PC-ALCL. Metastatic work-up revealed pulmonary involvement. The patient underwent two cycles of multi-agent chemotherapy with marked improvement. However, patient declined further treatment and expired five months after the diagnosis.@*Conclusion@#This case emphasizes that although PC-ALCL commonly presents with an indolent course, extracutaneous spread can occur. Prompt treatment with chemotherapy increases survival significantly with a cure rate of 92%.2