The exclusion criteria encompassed papers not in English, review articles and those with a lack of clinical data. (ii) Design: case reports, case series, case control studies and cohort studies. Patients with cutaneous manifestations thought to be related to COVID‐19 in the absence of other more typical symptoms such as cough, rhinorrhoea, fever, and so on, were also included. The inclusion criteria were as follows: (i) Population: patients with skin changes in the context of confirmed or suspected COVID‐19 infection. Secondary outcomes include demographics, rash distribution, symptoms, timing, diagnostic method and medication history. To that end, this article summarizes the publications related to the cutaneous manifestations of COVID‐19 infection with the primary outcomes of rash morphology and COVID‐19 severity. This is especially important with regard to allocation of medical resources and informing the pre‐test probability, given the virus' highly infectious nature and logistical factors affecting testing availability and time from test to result. Closely analysing this data may allow us to learn more about the disease process and investigate whether cutaneous findings could provide useful information to help with diagnosis and prognosis. Initial reports from China put the incidence of skin manifestations at 0.2%, while data from the ZOE COVID Symptom Study app estimated the incidence among over 4 million self‐reporting contributors to be approximately 9%.Ī study from Italy where patients were screened by Dermatologists found skin changes in 20% of inpatients infected with COVID‐19, while a large systematic review and meta‐analysis estimated the overall prevalence of cutaneous manifestations in COVID‐19 patients is 5.69%.Īs a result of increased awareness of the cutaneous manifestations of COVID‐19, the amount of literature published on the topic has grown exponentially since the pandemic began. While primarily affecting the respiratory tract, COVID‐19 is known to also affect multiple other systems, including the skin. The World Health Organisation (WHO) declared it a pandemic in March 2020 and as of November 2021, an estimated 250 million people have been infected, resulting in over 5 million deaths. Rash type could be helpful in determining COVID‐19 prognosis.ĬOVID‐19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐Cov‐2), has spread rapidly through human to human transmission worldwide since its first identification in Wuhan, China, in December of 2019. In conclusion, COVID‐19 causes a variety of rashes, which may cause symptoms and add to morbidity. 28.3% had a positive polymerase chain reaction nasopharyngeal swab and 5.4% had positive antibodies, while 21.9% tested negative and 45.1% were not tested. Rash was the only symptom in 20.9% and occurred before or alongside systemic symptoms in 12.4%. 35.1% experienced pruritus, 16.4% had pain and 4.7% reported a burning sensation. Acral lesions were the most common site (83.5%). Conversely, acro‐ischaemia and livedo reticularis were associated with worse outcomes, including a need for ICU (OR 34.01 and OR 5.57, respectively) and mortality (OR 25.66 and OR 10.71, respectively). Chilblain‐like lesions were more frequent in the younger population (mean age 21.5, standard deviation ± 10.8) and were strongly linked with milder disease, not requiring an admission (odds ratio 35.36 ). Of the 2056 patients selected, the most common morphologies were chilblain‐like lesions (54.2%), maculopapular (13.6%) and urticaria (8.3%). Patients with a history of dermatological, rheumatological or occupational skin disorders were excluded. The literature was searched for all patients with skin manifestations thought to be related to suspected or confirmed COVID‐19. Secondary outcomes include demographics, distribution, dermatological symptoms, timeline, diagnostic method and medication history. To that end, we conducted a systematic review primarily to assess rash morphologies associated with COVID‐19 and their relationship with disease severity. Examining data from this cohort could provide useful information to help with the management of COVID‐19. Approximately 6% of those with COVID‐19 will experience cutaneous manifestations.
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