AUTHOR=Jamshidi Parnian , Hajikhani Bahareh , Mirsaeidi Mehdi , Vahidnezhad Hassan , Dadashi Masoud , Nasiri Mohammad Javad 

TITLE=Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.634208

DOI=10.3389/fmed.2021.634208

ISSN=2296-858X

ABSTRACT=Introduction: Until now, there are several reports on cutaneous manifestations in COVID-19 patients. However, the link between skin manifestations and the severity of the disease remains debatable. We conducted a systematic review to evaluate the temporal relationship between different types of skin lesions and the severity of COVID-19.

Methods: A systematic search was conducted for relevant studies published between January and July 2020 using Pubmed/Medline, Embase, and Web of knowledge. The following keywords were used: “SARS-CoV-2” or “COVID-19” or “new coronavirus” or “Wuhan Coronavirus” or “coronavirus disease 2019” and “skin disease” or “skin manifestation” or “cutaneous manifestation”.

Results: Out of 381 articles, 47 meet the inclusion criteria and a total of 1847 patients with confirmed COVID-19 were examined. The prevalence rate of cutaneous manifestations was 5.95%. The maculopapular rash was the main reported skin involvement (37.3%) commonly occurred in middle-aged females with intermediate severity of the disease. 45% of the patients had a mild, 30% a moderate, and 19% a severe COVID-19 disease. The mild disease was mainly correlated with chilblain-like and urticaria-like lesions and patients with vascular lesions experienced a more severe disease. 72% of patients with chilblain-like lesions improved without any medication. The overall mortality rate was 4.5%. Patients with vascular lesions had the highest mortality rate (18.2%) and patients with urticaria-like lesions had the lowest mortality rate (2.2%).
Conclusion: Occurrence of skin manifestations in COVID-19 patients is associated with mild to moderate severity, good prognosis, and lower mortality rate (except for vascular lesions). Patients with vascular lesions should be considered high risk and have a priority for further medical care.