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COVID-19 and cutaneous manifestations: a systematic review
Qing Zhao1, Xiaokai Fang1, Zheng Pang1
1Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China.
Summary
Skin rashes are common in COVID-19 patients, with erythema, chilblain-like, and urticarial lesions being most frequent. Angiotensin-converting enzyme 2 (ACE2) expression on skin suggests it may be a target for SARS-CoV-2 infection.
Area of Science:
- Dermatology
- Virology
- Infectious Diseases
Background:
- Cutaneous manifestations of COVID-19 are increasingly reported but lack comprehensive summarization.
- The underlying mechanisms of these skin conditions require further investigation.
Purpose of the Study:
- To comprehensively review and summarize the clinical characteristics of cutaneous manifestations in COVID-19 patients.
- To investigate the potential mechanisms of skin involvement in SARS-CoV-2 infection, focusing on ACE2 expression.
Main Methods:
- A systematic literature review was conducted using PubMed, CNKI, medRxiv, and bioRxiv.
- Search terms included COVID-19/SARS-CoV-2 related terms and dermatology/skin/rash/cutaneous terms, as well as ACE2 and skin-related terms.
- Data from 44 eligible articles, encompassing 507 patients, were analyzed.
Main Results:
- The majority of patients (96.25%) were from Europe, with an average age of 49.03 years and a 60.44% female ratio.
- Polymorphic skin lesions were observed, with erythema, chilblain-like, and urticarial lesions being most common, appearing approximately 9.92 days after systemic symptom onset.
- Angiotensin-converting enzyme 2 (ACE2), the SARS-CoV-2 receptor, is expressed in the skin, primarily on keratinocytes.
Conclusions:
- This review systematically presents the clinical features of 507 COVID-19 patients with skin manifestations.
- Skin may serve as a potential target for SARS-CoV-2 infection, supported by ACE2 expression in epidermal cells.
- Further research is necessary to elucidate the pathogenesis of COVID-19-related skin conditions.
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