Skin manifestations in coronavirus disease 2019 (COVID-19): A literature review

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.