There have been increasing reports of
skin manifestations in
COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98),
erythema multiforme/generalized pustular figurate
erythema/
Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized
pruritus (n = 8),
Kawasaki disease (n = 5), atypical
erythema nodosum (n = 3), and atypical
Sweet syndrome (n = 1).
Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed
livedo racemosa and retiform
purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus
co-infections. The
erythema-multiforme-like pattern, generalized pustular figurate
erythema and
Stevens-Johnson syndrome were most frequently linked to
hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic
COVID-19 carriers in some cases or predict a more severe evolution in others.