Skip to main content Skip to main navigation menu Skip to site footer


To date, skin manifestations in Coronavirus Disease 2019 (COVID-19) patients cannot be certainly described and predicted, as immunologic factors, viral load, hypercoagulable state, and treatment response varied among each case. Skin lesions in COVID-19 are similar to other viral infections, including dengue fever, morbilli, or varicella. The skin has Angiotensin-Converting Enzyme-2 (ACE-2) receptors that bind to spike proteins on SARS-CoV-2. Damaged skin surface can be the port d'entrée for the virus to reach ACE-2 receptors in keratinocytes. Skin manifestations in COVID-19 include maculopapular eruption, pseudo-chilblain, urticarial lesions, vesicular eruption, and vasculopathy-related lesions such as petechiae, purpura, livedo, acrocyanosis, thrombosis/ischemia, and dry gangrene/necrosis. Pseudo-chilblain and urticarial lesions are associated with younger age and milder disease, while vasculopathy-related lesions are often seen in severe infections. Treatment depends on the severity, morphology of the lesion, and the symptoms that the patient complains of. The treatment may consist of systemic/topical corticosteroids, antihistamines, and emollients. More research regarding the correlation between the etiopathogenesis of skin lesions in COVID-19 and the prognosis are needed. By identifying skin manifestations in COVID-19, clinicians can differentiate COVID-19 from other similar-looking lesions; therefore, early diagnosis, transmission prevention, treatments, and complication prevention can be conducted accordingly. This literature review aims to discuss the skin manifestations in COVID-19, understand the underlying etiopathogenesis, and explore the proper treatment for each case.


  1. World Health Organization. WHO coronavirus disease (COVID-19) dashboard [Internet]. 2021 [cited 2021 Aug 12]; Available from:
  2. Galván Casas C, Català A, Carretero Hernández G, Rodríguez?Jiménez P, Fernández?Nieto D, Rodríguez?Villa Lario A, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71–7.
  3. Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID-19: Current knowledge and future perspectives. Dermatology. 2021;237(1):1–12.
  4. Farinazzo E, Dianzani C, Zalaudek I, Conforti C, Grabbe S, Goldust M. Synthesis of the data on COVID-19 skin manifestations: Underlying mechanisms and potential outcomes. Clin Cosmet Investig Dermatol. 2021;14:991–7.
  5. Giavedoni P, Podlipnik S, Pericàs JM, Fuertes de Vega I, García-Herrera A, Alós L, , et al.. Skin manifestations in COVID-19: Prevalence and relationship with disease severity. J Clin Med. 2020;9(10):3261.
  6. Gugus Tugas Percepatan Penanganan COVID-19. Data sebaran COVID-19 [Internet]. 2021 [cited 2021 Aug 12]. Available from:
  7. Recalcati S. Cutaneous manifestations in COVID?19: A first perspective. J Eur Acad Dermatol Venereol. 2020;34(5).
  8. Jamshidi P, Hajikhani B, Mirsaeidi M, Vahidnezhad H, Dadashi M, Nasiri MJ. Skin Manifestations in COVID-19 Patients: Are They Indicators for Disease Severity? A Systematic Review. Front Med. 2021;8:634208.
  9. Putra BE, Adiarto S, Dewayanti SR, Juzar DA. Viral exanthem with "Spins and needles sensation" on extremities of a COVID-19 patient: A self-reported case from an Indonesian medical frontliner. Int J Infect Dis. 2020;96:355–8.
  10. Gunawan C, Angela A, Widysanto A. Urticarial eruption in coronavirus disease 2019 infection: a case report in Tangerang, Indonesia. J Eur Acad Dermatol Venereol. 2020;34(8):e372-e373.
  11. Zhang Y, Geng X, Tan Y, Li Q, Xu C, Xu J, et al.. New understanding of the damage of SARS-CoV-2 infection outside the respiratory system. Biomed Pharmacother. 2020;127:110195.
  12. Xue X, Mi Z, Wang Z, Pang Z, Liu H, Zhang F. High expression of ACE-2 on keratinocytes reveals skin as a potential target for SARS-CoV-2. J Invest Dermatol. 2021;141(1):206-209.
  13. Bourgonje AR, Abdulle AE, Timens W, Hillebrands J, Navis GJ, Gordijn SJ, , et al.. Angiotensin?converting enzyme 2 (ACE-2), SARS?CoV?2, and the pathophysiology of coronavirus disease 2019 (COVID?19). J Pathol. 2020;251(3):228–48.
  14. Singh H, Kaur H, Singh K, Sen CK. Cutaneous manifestations of COVID-19: A systematic review. Adv Wound Care. 2021;10(2):51–80.
  15. Wang CJ, Worswick S. Cutaneous manifestations of COVID-19. Dermatol Online J. 2021;27(1):13030.
  16. Rahimi H, Tehranchinia Z. A Comprehensive review of cutaneous manifestations associated with COVID-19. BioMed Res Int. 2020. 2020; 1236520.
  17. Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, Veraldi S, , et al.. Cutaneous manifestations of COVID-19: Report of three cases and a review of the literature. J Dermatol Sci. 2020;98(2):75–81.
  18. Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020;82(5):e177.
  19. Tan SW, Tam YC, Oh CC. Skin manifestations of COVID-19: A worldwide review. J Am Acad Dermatol. 2021;2:119–33.

How to Cite

Novena, O. D. (2021). Skin manifestations in coronavirus disease 2019 (COVID-19): A literature review. Indonesia Journal of Biomedical Science, 15(2), 113–116.




Search Panel

Odilia Dea Novena
Google Scholar
IJBS Journal