Cutaneous Manifestations in Chikungunya- A Systematic Review and Meta-analysis

Chikungunya fever is an emerging arboviral disease of international significance. While fever and arthralgia are its key symptoms, the wide range of cutaneous manifestations remains dispersed throughout the literature. This review consolidates available data on dermatological manifestations of Chikungunya.

A systematic review and meta-analysis were conducted as per PRISMA guidelines with PROSPERO ID-CRD42024612162. Eligible studies documenting cutaneous symptoms in suspected or confirmed Chikungunya cases were searched and included through database search in PubMed, Embase, Scopus, and Web of Science up to 13th May 2025. Two reviewers independently conducted two-stage screening and data extraction. Meta-analysis was performed using a random-effects model, heterogeneity measured using the I2 statistic.

A total of 65 studies covering 42011 Chikungunya cases were included. The pooled prevalence of rash exhibited was 41% (95% CI: 34%-48%) and erythematous maculopapular rash was 29% (95% CI: 21%-37%). Additional pooled prevalence estimates comprised hyperpigmented macules 13% (95% CI: 6%-24%), Centro-facial hyperpigmentation (10% (95% CI: 4%-20%), pruritus (29% (95% CI: 19%-40%), vesiculobullous lesions (8% 95% (95% CI: 2%-18%). Heterogeneity was substantial (I2 > 95%) with publication bias evident for hyperpigmented and vesiculobullous lesions. Overall certainty of evidence was low to very low.

Cutaneous manifestations are common and clinically diverse in Chikungunya infection. Erythematous maculopapular rash, hyperpigmentation, and pruritus predominate. The high heterogeneity and potential reporting bias indicate a need for standardized dermatological documentation and higher-quality studies to strengthen clinical characterization and outbreak surveillance.