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(searched for: Chilblain-Like Lesions in COVID-19: A Detailed Review)
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Harjas Singh, Harleen Kaur, Kanhaiya Singh,
Advances in Wound Care, Volume 10, pp 51-80; doi:10.1089/wound.2020.1309

Abstract:
Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a pandemic. Although pulmonary health has been the primary focus of studies during the early days of COVID-19, development of a comprehensive understanding of this emergent disease requires knowledge of all possible disease manifestations in affected patients. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant review focuses on cutaneous manifestations reported in COVID-19 patients.Approach: Literature review was conducted using the PubMed database to examine various cutaneous manifestations related to the SARS-CoV-2 infection. Published articles (n = 56) related to search criteria from the onset of the COVID-19 pandemic to June 30, 2020, were included. The primary literature articles included in this study were mainly from France, Spain, Italy, and the United Kingdom.Results: Unique to many other symptoms of COVID-19, its cutaneous manifestations have been found in people of all age groups, including children. The cutaneous manifestations of COVID-19 are varied and include maculopapular, chilblain-like, urticarial, vesicular, livedoid, and petechial lesions. In addition, rashes are common in multisystem inflammatory syndrome in children, a new and serious health condition that shares symptoms with Kawasaki disease and is likely related to COVID-19. In addition, personal protective equipment-related skin wounds are of serious concern since broken cutaneous barriers can create an opening for potential COVID-19 infections.Innovation and Conclusion: As this virus continues to spread silently, mainly through asymptomatic carriers, an accurate and rapid identification of these cutaneous manifestations may be vital to early diagnosis and lead to possible better prognosis in COVID-19 patients. This systematic review and photo atlas provide a detailed analysis of the skin pathologies related to COVID-19. Study of these cutaneous manifestations and their pathogenesis, as well their significance in human health will help define COVID-19 in its entirety, which is a prerequisite to its effective management.
Muhammad Arslan Aslam, Asma Nasir, Ekpo Chidera Philippa, Antonia Lisseth Valle Villatoro, Unaiza Ali, Nduka Tagbo Charles, Ghulam Muhammad Humayun, Belonwu Valentine Okafor, Oluwasegun Shoewu, Sakshi Mishra, et al.
Archives of Internal Medicine Research, Volume 04, pp 142-148; doi:10.26502/aimr.0065

Abstract:
Coronavirus disease (COVID-19) was declared a pandemic in early 2020. Since then, it has continued to spread havoc in the lives of millions of people. The Covid-19 infection can have a spectrum of symptoms, ranging from asymptomatic infection to a fatal multi-organ failure. A number of unusual manifestations have also been reported. Among them are pernio-like lesions, also referred to as Chilblain-like lesions. Previously, these skin lesions were associated with damp conditions and autoimmune diseases. But, their presentation in this pandemic has confused the clinicians. It is very important to understand the clinical picture, pathophysiology, histology, and treatment of these lesions, especially in the COVID era. Hence, in this review, we have made an effort to understand these lesions further. The main aim of our article is to provide physicians with a detailed analysis of chilblains like lesions so that this can help them with diagnosis and treatment.
Harjas Singh, Harleen Kaur, Kanhaiya Singh, Chandan Sen
Published: 15 December 2020
Proceedings of IMPRS, Volume 3; doi:10.18060/24767

Abstract:
Background: Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), is currently a pandemic. Although pulmonary health has been the primary focus of studies during the early days of COVID-19, development of a comprehensive understanding of this emergent disease requires knowledge of all possible disease manifestations in affected patients. Methods: This PRISMA-compliant review focuses on cutaneous manifestations reported in COVID-19 patients. Literature review was conducted using the PubMed database to examine various cutaneous manifestations related to the SARS-CoV-2 infection. Published articles related to search criteria from the onset of the COVID-19 pandemic to June 30, 2020 were included. In total 56 articles were used for data collection. Results: Unique to many other symptoms of COVID-19, its cutaneous manifestations have been found in people of all age groups including children. The cutaneous manifestations of COVID-19 are varied and include maculopapular, chilblain-like, urticarial, vesicular, livedoid, and petechial lesions. In addition, rashes are common in multisystem inflammatory syndrome in children (MIS-C), a new and serious health condition that shares symptoms with Kawasaki disease and is likely related to COVID-19. Lastly, personal protective equipment (PPE)-related skin complications are of serious concern since broken cutaneous barriers can create an opening for potential COVID-19 infections and by inadvertently spreading the virus. Conclusion and Potential Impact: As this virus continues to spread silently, mainly through asymptomatic carriers, an accurate and rapid identification of these cutaneous manifestations may be vital to early diagnosis and lead to possible better prognosis in COVID-19 patients. This systematic review provides a detailed analysis on the changes in skin morphology related to COVID-19 and discusses plausible underlying molecular mechanisms. Study of these cutaneous manifestations, their pathogenesis as well their significance in human health will help define COVID-19 in its entirety which is a prerequisite to its effective management.
A O Enitan, O A Olasode
Published: 1 October 2020
The publisher has not yet granted permission to display this abstract.
Bandhala Rajan M., ,
International Journal of Dermatology, Volume 59, pp 1358-1370; doi:10.1111/ijd.15154

Abstract:
Background Besides predominant respiratory and gastrointestinal manifestations, reports on cutaneous manifestations in COVID‐19 patients are being noted increasingly. Objectives To estimate the prevalence of cutaneous manifestations in COVID‐19 patients. Methods This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines. A detailed literature search was done in PubMed and Embase from December 1, 2019, till May 1, 2020. Studies reporting cutaneous manifestations in COVID‐19 patients were included. Irrespective of the heterogeneity of data, a random effects model with inverse‐variance approach was used for pooling the prevalence using meta package in R version 3.6.2. Results Out of 15,143 articles, 2086 articles were selected for full‐text read. Forty‐three articles were selected for qualitative analysis, of which 10 articles (N = 1682) were included for meta‐analysis. The pooled prevalence of overall cutaneous lesions was 5.69 (95% confidence interval [CI]: 1.87–15.98; I2 88%). The pooled prevalence of other outcome parameters were as follows: viral exanthem‐like presentation 4.15 (95% CI: 1.33–12.23; I2 88%), maculopapular rash 3.81 (95% CI: 1.02–13.18; I2 87%), vesiculobullous lesions 1.67 (95% CI: 0.70–3.96; I2 0%). Conclusion The estimated prevalence of cutaneous manifestations in COVID‐19 was 5.69%. Other manifestations were urticaria, chilblain‐like lesions, livedo reticularis, and finger/toe gangrene. Although it is premature to conclude the prevalence of the cutaneous manifestations during this ongoing pandemic, our report may be a stimulating factor for the physicians to perform further vigilant streamlined reporting of cutaneous manifestations in COVID‐19 patients to estimate the final prevalence.
Published: 2 September 2020
British Journal of Dermatology, Volume 183; doi:10.1111/bjd.19361

Abstract:
COronaVIrus Disease‐19 (COVID‐19) is an infection due to a virus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2). This virus was first identified in Wuhan (China) in December 2019 and, subsequently, it has rapidly spread throughout the world. Although the most common symptoms of COVID‐19 are fever, cough, shortness of breath, headache and muscle pain, skin manifestations (symptoms) associated with this disease have been reported more and more frequently in recent times. In this review article, we have gathered clinical data on COVID‐19‐associated skin manifestations by analysing the articles published up to the 30th of April 2020 and available on the electronic databases PubMed, Scopus and Web of Science. Based on the clinical appearance of the skin manifestations, six main patterns have been recognized: i) urticarial rash, ii) confluent erythematous/maculopapular/morbilliform rash, iii) papulovesicular exanthem, iv) chilblain‐like acral pattern, v) livedo reticularis/racemosa‐like pattern, and vi) purpuric “vasculitic” pattern. The clinical (how they look) and histopathological (from skin samples) features of these manifestations are discussed in detail in the manuscript. In view of the low number of experimental studies on this absolutely new topic, the exact mechanisms explaining the occurrence of such different skin lesions in COVID‐19 patients need to be further explored. Likewise, the possible correlation between skin manifestations and disease severity will be the subject of future studies. However, at the present time, clinicians, and particularly dermatologists, should be aware that the presence of certain cutaneous (skin) findings could indicate COVID‐19 and help to identify potentially contagious cases. Linked Article: Marzano et al. Br J Dermatol 2020; 183:431–442.
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