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Background: A variety of skin conditions are reported in association with COVID-19. Among these clinical patterns, urticarial lesions are described. We present a case of new-onset urticaria in an adult patient with mild COVID-19. In addition, we performed a comprehensive structured literature search to evaluate the temporal relationship between COVID-19 and urticarial manifestations and their duration. Method(s): This case report presents an adult patient with new-onset urticaria and confirmed diagnosis of COVID-19, assessed according to international guidelines. A systematic review was conducted for relevant studies published in Pubmed/Medline database, between January 2020 and January 2022, using specific keywords for clinical and temporal features of skin lesions. Result(s): A 28-year- old male with a 24-hour history of fever and headache presented new-onset urticarial lesions. In the context of COVID-19 pandemic, infection with SARS-CoV- 2 was suspected, and a PCR test detected viral RNA in a nasopharynx sample confirming the diagnosis in this patient. Other clinical manifestations and abnormal laboratory findings were not detected. A diagnosis of SARS-CoV- 2 infection-associated urticaria was established. The urticarial rash improved with oral new-generation H1 antihistamines and was remitted in 5 days. The outpatient treatment did not include systemic corticosteroid and antiviral therapy. Out of 3542 articles published in PubMed on cutaneous manifestations linked to COVID-19/ SARS-CoV- 2 infection, 53 met the criteria of assessing urticaria in these conditions. From these, 30 were case reports, 13 were case series and 10 were cohort studies. From 273 patients reported with urticaria, only 53 had a clear mention of a positive antigen or nucleic acid amplification viral test. Urticaria preceded the onset of respiratory/systemic COVID-19 symptoms in 12 patients, appeared at the same time in 81 patients, and as a late manifestation in 45 patients. For 135 patients, the timing was not specified. Urticarial lesions were remitted between several hours to 12 weeks, either spontaneously or with symptomatic treatment. Conclusion(s): Based on reported cases, urticaria may be associated with COVID-19. There is a need for more relevant studies regarding urticaria in these infectious conditions, with detailed data on clinical pattern, time of onset, duration, severity, need for specific treatment and prognosis.
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Background: Until January 2022, 8.975.458 cases of COVID-19 have been reported in Spain. In December of 2020, the European Union authorized the first mRNA vaccines against SARS-COV- 2, developed by Pfizer-BioNTech and Moderna, with two doses separated by 21 and 28 days, respectively. Reports of severe allergic reactions, including anaphylaxis, have prompted concern that the new mRNA vaccine platform has the potential to cause allergic reactions (including anaphylaxis) at a greater rate than other vaccines. Method(s): Immunization process started at Hospital Ramon y Cajal (Madrid, Spain) in January 2021. The hospital provided a form to report any adverse effect after the first or second dose of the vaccine. Until today, in our Allergy Department, we have received more than 500 patients with suspected adverse reaction to the vaccine, although the data in this publication are collected from January 2021 to September 2021. All of them were referred from different services (Occupational Risk Prevention Department, Preventive Medicine Department, General Practitioners and other specialties) by telephone, e-mail or personally at our service. Result(s): Out of the 139 vaccinated patients who reported adverse effects, 131 had a reaction with the first dose, of whom 65% were women. 51% were local reactions and 49% systemic, of which 62% were immediate reactions. We performed diagnostic tests in 55% of the patients: prick test (with macrogol, triamcinolone, dexketoprofen, methylprednisolone acetate, PEG), ID test (with triamcinolone, dexketoprofen, methylprednisolone acetate) with immediate reading and delayed reading in case of delayed reactions, epicutaneous tests (with PEG and polysorbate 80) and blood tests in systemic reactions. All diagnostic tests showed negative results. 82% of patients that reported adverse effects after the first dose tolerated the second dose of the vaccine without incidents. Only one patient had a reaction to the first and second dose despite a negative study, a 58-year- old woman who presented an urticarial rash 24 hours after administration. 8 patients, all of them women, were referred for reaction after the second dose, 87% of whom had tolerated the first dose. Conclusion(s): This single-center experience suggests that most patients who had mild reactions to the first dose of mRNA vaccines have received the second dose uneventfully or with only mild repeat reactions.
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Background: As COVID-19 vaccines continue to be administered worldwide, there are an increasing number of studies documenting cutaneous reactions following vaccination. Systemic reactions, such as urticarial diseases, occur. Purpose(s): The main objective of this study was to investigate the association between urticaria and recent vaccination for COVID-19. Method(s): A retrospective chart review examining the association of urticaria and COVID vaccination was conducted. Result(s): We report 17 patients who developed an urticarial reaction following vaccination against COVID and one patient who developed an urticarial reaction following a COVID infection. The vast majority of the patients were women with a mean age of 42.8 years. Conclusion(s): Cutaneous manifestations often follow COVID vaccination and infection. It may be helpful to inquire about recent infections and vaccinations in patients presenting with urticarial diseases. Copyright © 2022 Journal of Dermatology and Dermatologic Surgery.
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Background: As COVID-19 vaccines continue to be administered worldwide, there are an increasing number of studies documenting cutaneous reactions following vaccination. Systemic reactions, such as urticarial diseases, occur. Purpose(s): The main objective of this study was to investigate the association between urticaria and recent vaccination for COVID-19. Method(s): A retrospective chart review examining the association of urticaria and COVID vaccination was conducted. Result(s): We report 17 patients who developed an urticarial reaction following vaccination against COVID and one patient who developed an urticarial reaction following a COVID infection. The vast majority of the patients were women with a mean age of 42.8 years. Conclusion(s): Cutaneous manifestations often follow COVID vaccination and infection. It may be helpful to inquire about recent infections and vaccinations in patients presenting with urticarial diseases. Copyright © 2022 Journal of Dermatology and Dermatologic Surgery.
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Cutaneous vasculitis (CV) is an inflammatory skin-limited vascular disease affecting the dermal and/or hypodermal vessel wall. From the pathogenetic point of view, idiopathic forms are described as well as the induction from various triggers, such as drugs, infections, and vaccines. Following SARS-CoV-2 pandemic outbreak, cases of CV induced by both COVID-19 and COVID-19 vaccinations have been reported in literature. The aim of our work was to collect multiple cases available in the literature and analyze the frequency of the different forms of induced vasculitis, as well as their histological and immunopathological features. Although rare, CV induced by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and vaccines may provide interesting insights into the pathogenesis of these inflammatory processes that may in the future be useful to understand the mechanisms underlying cutaneous and systemic vasculitis.
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BACKGROUND: The spreading of the SARS-CoV-2 Omicron variant is probably due to its increased transmissibility and ability to escape from neutralising antibodies. Cutaneous manifestations have been reported after infection with the Omicron strain, consisting mainly of generalised urticarial eruption and prickly heat rash, also known as miliaria, that can persist for several days. Here the impact of Omicron SARS-CoV-2 on skin was investigated. METHODS: The case series of 10 patients with SARS-CoV-2 Omicron variant-related cutaneous manifestations were described; moreover, skin derived cells were challenged in vitro with SARS-CoV-2 Omicron variant. RESULTS: The main clinical cutaneous features observed were urticarial lesions lasting more than 24 h, mainly involving the trunk and sometimes extending to the extremities, and miliaria presenting with clusters of small sweat-filled vesicles, sometimes surrounded by slight erythema. HaCaT keratinocytes, BJ fibroblast cell lines and outer root sheath (ORS) keratinocytes were not susceptible to SARS-CoV-2 Omicron variant infection; they also did not present any evident cytopathic effect or modification of cells viability. CONCLUSION: Our findings suggests that, despite the high number of nucleotide mutations in the spike protein of SARS-CoV-2 Omicron variant, responsible to the higher transmissibility of this virus, and the increased reports of cutaneous manifestation in COVID-19 affected patients, the virus is not able to directly infect and damage the keratinocytes and fibroblasts, thus suggesting an indirect virus-induced activation of the immune system as the major pathogenetic driver.
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COVID-19 , Miliaria , Humans , SARS-CoV-2 , COVID-19/complications , SkinABSTRACT
Purpose of Review: Contact urticaria syndrome includes contact urticaria and protein contact dermatitis. Underreport, underdiagnosis, or misdiagnosis of entities within the contact urticaria syndrome is believed to be common, especially in the occupational setting. This review provides a structured overview of the entities comprised in this syndrome as well as the diagnostic work-up and management strategies. Recent Findings: Contact urticaria syndrome has been increasingly described due to personal protective equipment and hand sanitizers in the context of the COVID-19 pandemic. The use of legal cannabis products has led to a rise in occupational cases of contact urticaria to cannabis. A declining trend in the evolution of contact urticaria has been described for natural rubber latex allergy due to the use of synthetic gloves. Prick test has been proposed as a screening method, particularly if multiple products are to be tested, instead of the classical sequential scheme. Summary: Physicians should be aware of the growing number of culprit agents leading to contact urticaria syndrome. Clinical presentation may be challenging since it includes immediate urticaria and/or eczema and even more generalized reactions. Diagnosis requires a high degree of suspicion, detailed occupational history, and complementary tests, including skin testing. The best treatment is to avoid contact with the culprit agent and to implement preventive measures.
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BACKGROUND: Urticarial vasculitis (UV) is a rare and difficult-to-treat chronic skin disease defined by long-lasting urticarial lesions and the histopathologic finding of leukocytoclastic vasculitis. As of yet, little is known about UV patients' perspective on the disease. OBJECTIVE: To assess UV patients' perspective on the clinical course, treatment response, greatest challenges, and quality-of-life (QOL) impairment. METHODS: A web-based questionnaire was disseminated in a Facebook group of patients with UV. Patients with UV confirmed by skin biopsy were included. RESULTS: Patients with UV had a mean age of 47.3 ± 12.3 years and were mostly female (94.3%; n = 82 of 87). The median delay in diagnosis was 8.1 months (interquartile range, 2.0-46.3). Normocomplementemia and hypocomplementemia were present in 54.0% (n = 27) and 46.0% (n = 23) of 50 patients, respectively. Most patients with UV (51.8%; n = 43 of 83) reported severely decreased QOL due to their disease. Low QOL was also the most frequently reported greatest challenge for patients with UV (40.7%), followed by the long-standing course of UV with frequent relapses (14.8%). Low QOL correlated with long disease duration (r = 0.298; P = .02) and high numbers of clinical symptoms (r = 0.294; P = .007). Patients with UV with allergies, lung diseases, and chronic infections reported lower QOL. Patients with UV with low QOL were treated with analgesics, dapsone, montelukast, omalizumab, and colchicine more often than patients with UV with higher QOL (P < .05 for all). CONCLUSIONS: Our results show a considerable impairment in QOL in patients with UV associated with long disease duration, high symptom burden, and a high need for therapy. Improvement of the management of UV by further research is necessary.
Subject(s)
Urticaria , Vasculitis, Leukocytoclastic, Cutaneous , Adult , Colchicine , Dapsone/therapeutic use , Female , Humans , Male , Middle Aged , Omalizumab/therapeutic use , Patient Reported Outcome Measures , Quality of Life , Urticaria/diagnosis , Urticaria/drug therapy , Vasculitis, Leukocytoclastic, Cutaneous/diagnosisABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has been a rising concern since its declaration as a pandemic by the World Health Organization on 11 March 2020. Recently, its association with multiple underlying organs has been identified that includes cardiac, renal, gastrointestinal, nervous systems, and cutaneous manifestations. Cutaneous COVID-19 findings have been supposedly classified into the following categories: vesicular (varicella-like), papulo-vesiculsar, chilblains-like ("COVID toes") maculopapular, and urticarial morphologies. In this review, we aim to focus on the proposed pathophysiology behind the various dermatological manifestations associated with COVID-19 and their associated management. We also included prevalence and clinical features of the different COVID-19-related skin lesions in our review. A comprehensive narrative review of the literature was performed in PubMed databases. Data from case reports, observational studies, case series, and reviews till June 2022 were all screened and included in the review.
Subject(s)
COVID-19 , Skin Diseases , Humans , Pandemics , SARS-CoV-2 , Skin/pathology , Skin Diseases/epidemiology , Skin Diseases/etiology , Skin Diseases/therapyABSTRACT
During the COVID-19 pandemic, various skin manifestations have been described. These include an urticarial rash, morbilliform rash, maculopapular rash, vascular lesions, and varicella-like eruptions. A 30-year-old woman presented with a mild cough, then hives and pruritic rash for 3 days, followed by fever, dyspepsia, and throat pain for one day.
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BACKGROUND: Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily responsible for respiratory symptoms, an increasing number of cutaneous manifestations have been reported. Cutaneous manifestations are reported by patients following disease recovery. OBJECTIVE: We sought to document various skin lesions relating to COVID-19 symptoms either before, during, or after infection with severe acute respiratory syndrome coronavirus 2. METHODS: This was a descriptive study with 273 patients who had cutaneous manifestations after recovering from COVID-19. Each patient provided a thorough medical history and underwent a general physical examination. Following polymerase chain reaction analysis, all participants were confirmed to be COVID-19 patients. RESULTS: Acral lesions were the most common, accounting for 39% of all cases. An erythematous maculopapular rash was found in 21% of cases and was the second most common after urticaria, with fewer cases of erythema multiform, vesicular rash (9%), vascular livedo reticularis, figurate erythema, and flexural rash documented. CONCLUSION: The most common cutaneous changes seen in patients with COVID-19 were pseudo-chilblain acral lesions, which had a good prognosis. Vascular rashes within the spectrum of livedo/purpura/necrosis were seen with severe forms of COVID-19.
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Chlorpheniramine Maleate (CPM), also known as chlorphenamine, is a potent alkylamine first-generation H1 antihistamine that has been around since the 1950s. CPM is a widely popular drug commonly used to treat allergic conditions, given its antihistamine properties. Although mainly used in over-the-counter treatment for cough and colds, various studies discuss a wide range of CPM's clinical uses, such as treating asthma, plasma cell gingivitis, chronic urticaria, depression, among others. This antihistamine is usually taken orally; however, intravenous, intramuscular, and subcutaneous routes have been documented. Intranasal routes have recently been explored, especially due to its antiviral properties against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Accordingly, given CPM's extensive medical and safety profile, the present review explores this versatile drug's current and potential clinical applications. Although it is widely used mainly for treating common colds and aforementioned allergic conditions, it can be concluded that CPM can be considered to be used for other clinical indications. The repurposing of CPM for other clinical indications such as COVID-19 needs to be further explored through more extensive studies.
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Background/Aims There is a growing number of reports of new-onset autoimmune disease or complications of underlying autoimmune disorders following COVID-19 infection and vaccination. Methods We describe two cases of systemic lupus erythematosus (SLE) that developed De novo in two female patients shortly after receiving their COVID-19 vaccinations. Results The first case is a 29-year-old female with no prior medical history. One week following her COVID-19 Pfizer/BioNTech vaccination, she developed widespread pruritus, fatigue, myalgia, arthralgia, fever and night sweats. Blood tests showed pancytopenia and she was referred for an urgent haematology opinion due to lymphoma. Positron Emission Tomography/computed tomography (PET/CT) demonstrated widespread lymphadenopathy. Bone and lymph node biopsy showed reactive changes only. Her symptoms progressed with polyarticular inflammatory arthritis, oral ulceration, Raynaud's, pleuritic chest pain, palmar purpuric rash, and a widespread tender urticarial rash. Further investigations showed low complement C3/C4, anti-double stranded DNA antibody titre (dsDNA) >200 IU/mL, positive Anti-Ro antibody, positive Anti-La antibody, weakly positive anti-RNP antibody and an Anti-C1q antibody >400 units/ml with a urine protein/creatinine ratio (PCR) of 39 mg/mmol. A diagnosis of SLE with urticarial vasculitis was made and she commenced Hydroxychloroquine in addition to weaning prednisolone (60mg). A skin biopsy confirmed lupus vasculitis. Despite high dose prednisolone, urine PCR increased over 2 weeks from 39 to 84 mg/mmol. Renal biopsy demonstrated class 3 lupus nephritis. She was pulsed with 500mg IV methyl prednisolone over 3 days and commenced mycophenolate 1g BD. Within weeks she was in clinical remission. The second case is a 70-year-old female with a past medical history of diverticulosis, uterine fibroids and small hand joint osteoarthritis. She presented with a sudden onset, 6-week history of bilateral symmetrical small and large joint synovitis that developed 8 days following the first dose of the COVID-19 Oxford-AstraZeneca vaccine. Her investigations showed reduced lymphocyte counts (0.9 109/L), raised CRP 26 mg/L and ESR 32 mm/hr. Antinuclear antibodies were weakly positive with a homogenous pattern. DsDNA titre was raised at 175 IU/mL and C4 reduced at 0.14 g/L. There was no proteinuria or any evidence of major internal organ involvement. She was started on a short reducing course of oral prednisolone given the severity of her presenting clinical features. Her symptoms improved, with no recurrence on stopping steroids but she has continued elevation in DsDNA;a conservative management approach is being adopted. Conclusion Both cases met the EULAR/ACR and SLICC classification criteria for SLE. There was a clear temporal association between the onset of SLE symptoms and COVID-19 vaccination. Our cases raise the possible association/causation of SLE following COVID-19 vaccination. Potential mechanisms include immune responses elicited by the COVID-19 vaccination, triggering autoimmunity in genetically predisposed individuals. Further research and data from registries are required.
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Background: The relatively wide distribution of ACE2 receptors all over body tissues suggests the possibility of clinical manifestations other than that of the respiratory tract. The usual incubation period is about 14 days which is often followed by the usual respiratory symptoms and constitutional signs. Globally, additional novel manifestations, including dermatological ones have been reported. Aim: To characterise the skin manifestations in patients with COVID-19 in Al Diwaniyah Province, mid-Euphrates region of Iraq. Method: The present case series study included 54 patients with COVID-19 and a variety of skin manifestations. Those patients visited the dermatology unit at Al Diwaniyah teaching hospital, Al Diwaniyah province, Iraq during the period of the study. The study started in July 2020 and ended in June 2021. Results: The most common features were those of morbilliform eruptions accounting for 18.5% of cases followed by urticarial lesions accounting for 13.0% of cases for followed by ecchymotic pruritic lesion (11.1%). Other features such as oral ulceration and vesicular lesions were also seen in 9.3% of cases. All the body was involved in 29.6% followed by tongue and lip involvement. Morbilliform eruption was the most common diagnosis followed by acute urticaria, herpes simplex, leukocytoclastic vasculitis and then by a variety of other skin manifestations. Conclusion: Skin manifestations in association with COVID-19 were highly variable with onset and duration which could be due to infection, drug reaction or immune mechanisms. Copyright (c) 2022: Author(s).
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The emergence of the novel SARS-CoV-2 coronavirus and rapid spread of the COVID-19 disease it causes in late 2019 and early 2020 has since led to a global pandemic announced by the World Health Organization (WHO). The pandemic is a steadily growing social, economic, psychological, and health burden. The infection rates worldwide are climbing. COVID-19 is considered a systemic disease, potentially resulting in acute respiratory distress and cardiovascular failure leading to death. Yet, SARS-CoV-2, a novel and still under-studied virus, has been documented to cause a large variety of symptoms, in many cases including cutaneous manifestations. This paper is a review of medical literature available to date regarding the cutaneous manifestations in the course of SARS-CoV-2 infection. It is also aimed at discussing the significance of dermatological findings for improved diagnosis and treatment of COVID-19 patients. Considering the gravity of the novel coronavirus pandemic, an improved dermatological approach would aid timely diagnosis and effective management of COVID-19, and would facilitate classification of the cutaneous abnormalities observed.
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The unknown pneumonia was first found in Wuhan, China in December 2019. A novel corona virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was isolated from lower respiratory tract swab in infected patient. The disease caused by this novel virus was then named as COVID-19 (Coronavirus Disease 2019). We report a male patient with urticarial lesions, varies on size and shape on the both arms and both legs and diagnosed with COVID-19 confirmed case. He was treated with powdered oral medicine containing combination of lopinavir and ritonavir. He developed urticarial lesions in three hours after administration of the drug. The lesions then dissapeared and resolved after 4 days of treatment using cetirizine. The conclusion of this case is still needed to be proven whether the urticarial lesion is related to COVID-19 or drugs used for COVID-19 therapy. © 2021 Pakistan Association of Dermatologists. All rights reserved.
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The ongoing COVID-19 pandemic, declared by the World Health Organisation in March 2020, with the emergence of new, possibly more contagious and more virulent strains, remains a research subject, with the complex systemic involvement better described and understood, but also with a variety of skin and mucosal lesions described in the literature. Mucocutaneous lesions associated with SARS-CoV-2 infection are still under investigation, due to their polymorphic clinical aspect and incompletely understood pathogenic mechanism. The cutaneous inflammatory, exanthematous and purpuric rashes, erythemato-purpuric enanthems, oral ulcers, lichenoid oral lesions, conjunctivitis, conjunctival pseudomembranes, or corneal lesions have been described in patients with COVID-19. Several classifications have been proposed based on the clinical pattern, histological findings, and possible pathogenic mechanisms. The pathogenic mechanism, the diagnostic criteria, the prognostic importance of these lesions are still being debated. The diverse clinical aspects of dermatological manifestations render the diagnosis difficult. However, several clinical patterns strongly associated with COVID-19, such as chilblains, papulovesicular exanthems, and febrile rash require increased awareness and changes to the investigation protocols for these conditions, to include testing for SARS-CoV-2. In the present review, the mucocutaneous findings associated with the novel coronavirus infection, reported thus far in the literature, was provided.
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Background: Coronavirus disease-2019 (COVID-19) has been shown to involve multiple-organ systems during disease process. Dermatologists have also reported various findings in patients of COVID-19 and have pointed out few cutaneous manifestations that are novel and are probably related to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, currently very limited data are available regarding various aspects of cutaneous involvement. Aims: This study aimed to investigate various aspects of cutaneous involvement in COVID-19. Methods: Institutional ethics committee approval was secured before conducting a study. Patients with at least one positive nasopharyngeal swab result for SARS-CoV-2 carried out by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. After informed consent subjects were interviewed and monitored for appearance of any cutaneous signs and symptoms. Those with relevant findings were evaluated for characteristics of cutaneous findings. Data of all patients were collected and analyzed. Results: A total of 303 patients were enrolled for the study. Approximately 1.98% of patients developed cutaneous manifestations. Four types of skin lesions were observed in study subjects: urticarial lesions, maculopapular rash, acro-ischemia, and glossitis. Limitations: Relatively less number of patients, collection of data from single center, and absence of histopathological confirmation were limitations of the study. Conclusion: COVID-19 disease process has a cutaneous component;however, incidence of cutaneous findings remains low. Urticaria was the most common type of cutaneous finding, whereas acro-ischemia was the most characteristic one.
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BASCULE syndrome, characterized by Bier anemic spots, cyanosis, and an urticaria-like eruption, has been described as a benign vasomotor dermatosis that occurs in the setting of transient tissue hypoxia. It has been postulated that dermal ischemia triggers an exaggerated vasoconstrictive arteriolar reaction, which then causes a paradoxical urticarial rash by an unknown mechanism. In patients with COVID-19, there is evidence of angiocentric inflammation leading to vasoconstriction, endothelial damage, and thrombosis. We present a case of acute-onset BASCULE syndrome appearing after asymptomatic infection with COVID-19. BASCULE syndrome should be considered in the expanding spectrum of dermatologic manifestations associated with COVID-19.