Skin manifestations associated with COVID-19

This article will address the main aspects of skin manifestations associated with COVID-19, based on a review of the literature published to date. Since the beginning of the pandemic, more than 1,500 articles have been published on the subject. Regarding the patho-physiology, it is believed that the same mechanisms responsible for the disease in the main target organs also act in the skin, although they are not yet fully elucidated. The actual frequency of dermatological manifestations remains uncertain - it can range from 0.2% to 45%, being close to 6% in systematic reviews. Pioneering studies of large case series conducted in European countries and the USA provide the first information on the main skin manifestations associated with COVID-19 and propose classifications regarding their clinical presentation, pathophysiology, as well as their frequencies. Although there is yet no consensus, maculopaputar eruptions are considered the most frequent presentations, followed by erythema pemio-like (EPL) lesions. Manifestations such as urticaria, vesicular conditions and livedo/purpura/necrosis are rare. The time of onset, severity, need for specific treatment and prognosis vary according to the clinical presentation pattern. The increasing histopathological description of skin conditions can contribute to the diagnosis, as well as to the understanding of the pathophysiology. Also, in the dermatological field, the relationship between COVID-19 and androgens has been increasingly studied. Despite all the generated knowledge, the actual biological meaning of skin manifestations remains uncertain. Therefore, the exclusion of the main differential diagnoses is essential for the correlation between skin manifestation and COVID-19. (C) 2021 Sociedade Brasileira de Dermatologia. Published by Elsevier Espana, S.L.U.

Automated summary

This article addresses the main aspects of skin manifestations associated with COVID-19 based on a literature review. The actual frequency of dermatological manifestations remains uncertain, but maculopapular eruptions and erythema pemio-like lesions are considered the most frequent presentations. The time of onset, severity, and prognosis vary according to the clinical presentation pattern. Histopathological descriptions and the relationship between COVID-19 and androgens have also been studied.