A case report of COVID-19-associated erythema nodosum: a classic presentation with a new trigger.

BACKGROUND: Over the course of the pandemic, cutaneous manifestations of SARS-CoV-2 infections have been increasingly characterized, yet only a few cases of erythema nodosum (EN) are reported in the literature and international registries. CASE PRESENTATION: In this report, we describe a case of tender, erythematous nodules that appeared acutely on the distal legs in a 48-year-old female with renal transplant following SARSs-CoV-2 infection complicated by prolonged fevers and pneumonia. The patient was diagnosed with a classic presentation of EN arising from a new and emerging trigger-COVID-19 infection. The cutaneous lesions resolved with conservative management. CONCLUSIONS: This report highlights the importance of clinician awareness of the potential association of COVID-19 with a classic clinical presentation of EN and underscores that these cases can be managed with the same therapeutic repertoire as EN due to other aetiologies. Of note, use of systemic agents was not employed in this case, as our patient improved with conservative therapy alone.

Characteristics of skin damage among healthcare workers during COVID-19 pandemic: an epidemiological survey.

Objective: To investigate epidemiological features of skin damage among front-line healthcare workers fighting against COVID-19 pandemic. Method(s): A self-designed questionnaire was released on an online survey website "wenjuan.com", and sent to the front-line medical staff caring for patients with confirmed COVID-19 in 6 infectious disease wards of the General Hospital of Central Theater Command of PLA via WeChat from March 10th to 20th, 2020. Then, the questionnaires were collected, a database was established, and statistical analysis was performed on the incidence, types and epidemiological characteristics of skin damage among the medical staff. Result(s): A total of about 550 medical staff were surveyed, 404 questionnaires were collected, of which 391 were valid, and 303 cases had skin damage. The survey showed that females, hand cleaning frequency > 10 times per day, wearing three-level protective equipment for more than 6 hours per week were risk factors for skin damage, and frequent use of a hand cream could reduce skin problems. Among the respondents, the incidence of skin damage was significantly higher in the females (79.81%, 249/312) than in the males (38.35%, 54/79;chi2 = 4.741, P = 0.029), and higher in the groups with hand cleaning frequency of 10-20 times per day (79.73%, 118/148) and > 20 times per day (85.71%, 84/98) than in the group with hand cleaning frequency of 1-10 times per day (69.66%, 101/145;chi2 = 9.330, P = 0.009). The incidence of skin damage was significantly lower in the group wearing protective equipment for 1-5 hours per week (64.04%, 73/114) than in the groups wearing protective equipment for 6-10 hours per week (81.48%, 66/81), 11-15 hours per week (95.24%, 20/21), 16-20 hours per week (81.82%, 36/44), 21-25 hours per week (86.49%, 32/37), and > 25 hours per week (80.85%, 76/94;chi2 = 19.164, P = 0.002). Among the 391 respondents, the skin damage related to disinfection and protective equipment mainly manifested as dry skin (72.89%), desquamation (56.78%), skin pressure injury (54.48%), skin maceration (45.01%), and sensitive skin (33.50%);acne (27.11%) was the related skin disease with the highest incidence, followed by facial dermatitis (23.27%), eczematous dermatitis (21.48%), folliculitis (18.92%), dermatomycosis (11.00%), urticaria (9.21%), etc. Conclusion(s): There was a high incidence of skin damage related to protective equipment among the front-line healthcare workers fighting against COVID-19, and strengthening skin protection could markedly reduce the incidence of skin damage.Copyright © 2020 by the Chinese Medical Association.

Skin Manifestations Following COVID-19 Vaccination: A Multicenter Case Series Study in Korea

Background: During the coronavirus disease 2019 (COVID-19) pandemic, large-scale vaccinations have been performed worldwide without sufficient verification of safety profiles. So far, little is known about skin manifestations following COVID-19 vaccination in Korean patients. Objective: We investigated the epidemiological and clinical characteristics of patients who had skin manifestations following COVID-19 vaccination in Korea. Methods: We retrospectively reviewed me data of 123 patients that presented with skin manifestations within 1 month after COVID-19 vaccination from two tertiary referral hospitals in Korea. The types of COVID-19 vaccinations administered to the patients, demographics, comorbidities, and clinical course of the patients were obtained from the data. Statistical analyses of the extracted data were performed using Microsoft Excel. Results: Skin manifestations following COVID-19 vaccination were mostly observed in patients in their 40s (23.6%), according to our data. Urticarial eruption was the most common manifestation, followed by macular rash (17.1%) and papulosquamous eruption (17.1%). Notably, 70% of the patients showed delayed reactions. More than half of the patients showed a good prognosis, and their symptoms were relieved with conservative treatment, including corti-costeroids and antihistamines, even after additional vaccination. Conclusion: We statistically analyzed the prevalence and characteristics of skin manifestations after COVID-19 vaccination. Urticarial eruptions are the most common skin manifestations associated with the COVID-19 vacci¬nation. We believe that this real-world retrospective study will provide valuable information for doctors who treat patients with skin manifestations after COVID-19 vaccination by providing real-world experience in Korea. (Korean J Dermatol 2022;60(9):576~584). © 2022 Korean Dermatological Association. All rights reserved.

Cutaneous manifestations of COVID-19.

COVID - 19 can be accompanied by a variety of cutaneous abnormalities, which mainly include vascular lesions chilblain - like lesions, livedo reticularis, purpura, ecchymosis, acral cyanosis, gangrene, etcand inflammatory lesionsdiffuse erythema, morbilliform exanthem, acute urticaria, varicella- like exanthem, etc. Some types of skin lesions may be the first symptom or the only clinical manifestation of COVID-19.Copyright © 2022 Chinese Journal of Dermatology. All rights reserved.

Skin, mucosa and nail findings in hospitalized pediatric patients with Coronavirus disease-2019 (COVID-19).

BACKGROUND: Cutaneous manifestations of Coronavirus Disease-2019 (COVID-19) disease have not yet been fully described in hospitalized pediatric patients. OBJECTIVES: This prospective study aims to demonstrate the skin, mucosal, and nail findings of hospitalized children with COVID-19. METHODS: The authors included hospitalized pediatric patients. Two dermatologists examined skin, hair, nails, and mucosa. Patients with drug eruptions were excluded with an anamnesis, clinical and laboratory test results. RESULTS: Out of 46 enlisted patients, 19 (41,3%) patients displayed skin, mucosal or nail findings. Skin findings were seen on 14 (30.4%) patients. Ten (22%) patients presented skin findings matching described patterns. Half of the patients with patterned rashes had confluent erythematous/maculopapular/morbilliform rashes. Eleven out of 46 (23.9%) patients developed periorbital erythema and edema. Ten (22%) patients had at least one oral mucosal finding. One telogen effluvium, one blue nail, and one flag sign on nails were noticed. Nine (19.5%) patients out of 46 had developed MIS-C. MIS-C patients had mucocutaneous manifestations except one (88.8%). STUDY LIMITATIONS: The authors have detected a higher rate of mucocutaneous manifestations compared to out-patients with mild COVID-19 because the study is based on hospitalized patients only. CONCLUSIONS: Pediatric COVID-19 patients are more susceptible to developing mucocutaneous manifestations compared to adults. The authors propose COVID-19 should be acknowledged as one of the viral exanthem rashes of childhood. The authors noticed that the most common findings were periorbital erythema and edema. The confluent erythematous/maculopapular/morbilliform rashes appear to be the most common patterns associated with severe COVID-19.

Erythema Multiforme and COVID-19: A Case Report and Deep Insight

There are several differences in illness presentation in clinical practice. Because diseases are ever-evolving, a single negative test cannot totally exclude the presence of a disease. The most frequent etiologies of erythema multiforme (EM), a prevalent mucocutaneous condition, are herpes infection and the use of numerous medicines. As a novel virus, SARS-CoV-2 is not often the primary differential for EM eruptions. This case represents a young female patient who presented solely with EM symptoms involving the distal parts of her upper and lower extremities after a positive swab for SARS-CoV-2. The condition improved with symptomatic treatment, and there were no major complications.

Concomitant Severe Psoriasis and Bullous Pemphigoid Induced by COVID-19.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first isolated in Wuhan, China, is currently a pandemic. At the beginning of the pandemic, pulmonary issues were the most discussed and studied. However, now 3 years later, the role of the dermatologist has become increasingly central. Often the diversity in the presentation of these manifestations has made it difficult for the dermatologist to recognize them. In addition to the common symptoms involving fever, cough, dyspnea, and hypogeusia/hyposmia that have been widely discussed in the literature, much attention has been paid to dermatologic manifestations in the past year. The vaccination campaign has been the most important strategy to combat the COVID-19 pandemic. Specifically, two viral vector-based vaccines [Vaxzervria® (AstraZeneca; AZD1222) and COVID-19 Janssen® vaccine (Johnson & Johnson; Ad26.COV2. S)] and two mRNA-based vaccines [Comirnaty® (Pfizer/BioNTech; BNT162b2) and Spikevax® (Moderna; mRNA-1273)]. However, several cutaneous adverse reactions have been reported following vaccination, making the dermatologist's role critical. It is possible to group these adverse reactions according to a classification with six main clinical pictures: urticarial rash, erythematous/maculopapular/morbid rash, papulovesicular rash, chilblain-like acral pattern, livedo reticularis/racemose-like, and purpuric "vasculitic" pattern. Beyond this classification, there are several reports of other dermatologic manifestations associated with the infection, such as pityriasis rosea, herpes zoster, or, particularly, the worsening of pre-existing chronic inflammatory dermatologic diseases. Here we report the case of a 61-year-old patient who presented at our clinic with a diffuse psoriasiform eruption mixed with a concomitant blistering rash induced by COVID-19. The uniqueness of our case has two features: the first is the concomitance of the two events after infection that seems to be unprecedented; the second is the management of the patient that could help dermatology colleagues in the management of these conditions during infection.

Cutaneous manifestations of COVID⁃19

COVID ⁃ 19 can be accompanied by a variety of cutaneous abnormalities, which mainly include vascular lesions （chilblain ⁃ like lesions, livedo reticularis, purpura, ecchymosis, acral cyanosis, gangrene, etc）and inflammatory lesions（diffuse erythema, morbilliform exanthem, acute urticaria, varicella⁃ like exanthem, etc）. Some types of skin lesions may be the first symptom or the only clinical manifestation of COVID⁃19. © 2022 Chinese Journal of Dermatology. All rights reserved.

Pathobiology of Cutaneous Manifestations Associated with COVID-19 and Their Management.

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.

COVID-19 and cutaneous manifestations: Two cases and a review of the literature

COVID-19 can affect multiple organs, including skin. A wide range of skin manifestations have been reported in literature. Six main phenotypes have been identified: i) urticarial rash, ii) confluent erythematous/maculopapular/morbilliform rash, iii) papulovesicular exanthem, iv) a chilblain-like acral pattern, v) a livedo reticularis/racemosa-like pattern, and vi) a purpuric vasculitic pattern. The pathogenetic mechanism is still not completely clear, but a role of hyperactive immune response, complement activation and microvascular injury have been postulated. The only correlation between the cutaneous phenotype and the severity of COVID-19 has been observed in the case of chilblain-like acral lesions, that is generally associated with the benign/subclinical course of COVID-19. Herein, we report two cases of SARS-CoV-2 infection in patients who developed cutaneous manifestations that completely solved with systemic steroids and antihistamines. The first case is a female patient not vaccinated for SARS-CoV-2 with COVID-19 associated pneumonia, while the second case is a vaccinated female patient with only skin manifestations.

Cutaneous Manifestations of COVID-19 in the Lower Limbs: A Narrative Review.

In 2020, the World Health Organization declared the COVID-19 pandemic. This infectious pathology can be associated with different manifestations in different body systems, among which are dermatological lesions. The purpose of this work is to determine the most frequent dermatological signs, in the lower limbs, produced by SARS-CoV-2. To carry this out, a bibliographic search was performed in the following databases: PubMed, SciELO, ScienceDirect, Cochrane Database of Systematic Reviews, and the Google Scholar literature. The inclusion criteria were articles that included confirmed subjects or those with a clinical suspicion of COVID-19, written in the Spanish or English languages, and the results presented clinical manifestations in the lower extremities. Initially, 128 scientific documents were identified and, after reading the title and abstract, 18 articles were selected. The most frequent skin lesions on the lower limbs are acral lesions such as pernio erythema or ischemic lesions, maculopapular rash, petechiae, and erythematous plaques.

Dermatologic Manifestation of Acro-Ischemia Associated With COVID-19.

Background: The common dermatologic manifestations seen in patients with coronavirus disease 2019 (COVID-19) include morbilliform, pernio-like, urticarial, macular erythematous, vesicular, and papulosquamous disorders, as well as retiform purpura. Although cases of acro-ischemia have been demonstrated, they are not well studied or reported. Case Report: A 73-year-old male was admitted for acute hypoxic respiratory failure secondary to COVID-19 infection. During the patient's hospital course, his oxygen requirement progressively increased, and he developed painful, violaceous purpura on his right lower extremity digits. The patient was treated with therapeutic doses of enoxaparin and nitroglycerin ointment in the hospital and apixaban on discharge. The patient was lost to follow-up. Conclusion: The multiorgan dysfunction associated with COVID-19 includes dermatologic manifestations. This case illustrates that acro-ischemia can resolve with guideline-based medical treatment.

Cutaneous Manifestations in COVID-19-Positive African American Patients.

Background: The United States of America is the leading country in confirmed cases of and deaths from severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). In April and May 2020, respectively, 0.2% of patients in a Chinese COVID-19-positive cohort and 20.4% of patients in an Italian COVID-19-positive cohort developed cutaneous abnormalities. Cutaneous abnormalities associated with COVID-19 are not well documented or discussed, and investigation of cutaneous manifestations is necessary to determine if they have any clinical value. Methods: We conducted a retrospective study of COVID-19-positive patients who were admitted to Ochsner-Louisiana State University-Shreveport and Ochsner-Louisiana State University-Monroe facilities in Louisiana. Cutaneous manifestations were determined from clinical notes, descriptions in medical records, and a billing code for skin rashes. Results: Of 1,086 COVID-19-positive patients investigated, 871 were African American and 130 were Caucasian. Only 10 patents exhibited probable COVID-19-induced cutaneous abnormalities: 6 (0.7%) of the 871 African American patients and 4 (3.1%) of the 130 Caucasian patients. Dermatologic abnormalities included pruritic or erythematous rash and hypopigmentation of the face, upper chest, abdomen, and trunk areas. Our data are consistent with the smaller percentage of patients in the Chinese cohort study vs the larger percentage in the Italian cohort study. Conclusion: Our data provide evidence that cutaneous manifestations of COVID-19, especially in African American patients, are rare, but documentation of more cases is necessary to establish a cause and effect for COVID-19-induced skin manifestations.

Isolated skin rash in patient with Coronavirus Disease 2019: A case report of skin manifestation in COVID-19 Virus Disease Isolated skin rash in patient with Coronavirus Disease 2019

BACKGROUND: Coronavirus Disease 2019 was initially identified as an infection of the lower respiratory tract, but has so far manifested itself with very different symptoms. One of these symptoms is skin lesions associated with active viral infection that can occur from the onset of infection until treatment. Therefore, observing these skin manifestations can be helpful to diagnose and manage the disease. CASE REPORT: Our case is a 56-year-old man who came to the infectious clinic with chief complain of skin rashes. The patient was in good general condition on arrival and had no evidence of systemic symptoms of infection, such as fever, body aches, and cough. However, the PCR test for COVID-19 was positive. CONCLUTION: Although many dermatological findings have been reported with Coronavirus Disease, but this case has reported with no symptoms other than skin manifestations that describe a viral infection. It seems that this disease can cause unexpected symptoms even in mild cases. Therefore, it is better to have the COVID-19 in the corner of your mind when examining people with these symptoms.

Cutaneous manifestations of coronavirus disease 2019 - review of literature and case reports.

Primary clinical manifestations of coronavirus disease are respiratory tract infections, ranging from an asymptomatic carrier state to severe interstitial pneumonia. The most common symptoms are fever, dry cough, fatigue, nausea, diarrhea, and loss of smell or taste. Recent reports indicate the possibility of several nonspecific dermatological symptoms. These include urticaria, maculopapular lesions, vascular lesions involving petechiae, purpura and livedo reticularis. The onset of cutaneous lesions may precede full-blown COVID-19 or remain the only manifestation of the disease (especially in young patients). Focusing on dermatological symptoms may be crucial for preventing the spread of SARS-CoV-2. However, unambiguous assessment of cutaneous manifestations of COVID-19 requires more research and case studies conducted by dermatologists.

COVID-19 in a Dermatologist's Clinic: A Case From Pakistan.

SARS-CoV-2 is a novel virus that is the causative agent of COVID-19. It can affect a variety of human organ systems, including the skin. Five clinical patterns of this infection have been described. These patterns not only help in diagnosing the disease but are also helpful in predicting the severity of infection. The percentage of dermatological manifestations of COVID-19 is highly variable in different regions of the world, with some western countries reporting the percentage as high as 20%. However, the data from Asia, especially Pakistan, in this regard is sparse. We report a case of COVID-19 infection (PCR proven) with maculopapular eruption. To our knowledge, this is the first case report of its kind being reported from Pakistan. We would encourage our fellow physicians to report more such cases so that the dermatological pattern of COVID-19 in Pakistan can be appropriately categorized in the literature.

Skin Manifestations in Psoriatic and HS Patients in Treatment with Biologicals during the COVID-19 Pandemic.

The Coronavirus Disease 2019 (COVID-19) pandemic, a global public health emergency, has changed dermatology practice and daily routine in just under two years. Much has been written in the literature about COVID-19-associated skin manifestations. Nevertheless, much less has been written regarding skin manifestations in patients affected by severe immune-mediated skin diseases, e.g., psoriasis and hidradenitis suppurativa, undergoing biological treatment during the COVID-19 outbreak. Thus, the aim of this article is to provide the reader with an overview of the cutaneous manifestations during the COVID-19 pandemic in this subset of patients.

COVID-19 Skin Manifestations in Skin of Colour.

Coronavirus disease (COVID-19) skin manifestations have been increasingly reported in medical literature. Recent discussions have identified a lack of images of skin of color (SOC) patients with COVID-19 related skin findings despite people with skin of color being disproportionately affected with the disease. There have been calls to prioritize the identification of COVID-19 skin manifestations in patients with SOC and disseminate these findings. The objective of this article is to review the existing literature on COVID-19 skin manifestations and, where possible, discuss how they may present differently in patients with SOC. Further research is needed to allow primary care physicians and dermatologists to be aware of and easily identify patients with cutaneous findings that may be secondary to COVID-19. Patients presenting with idiopathic dermatologic manifestations should be considered for COVID-19 testing and follow public health guidelines for self-isolation.