Cutaneous signs in  COVID ‐19 patients: A review

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Abstract

Coronavirus disease (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) primarily affects the epithelium of the airways. With the increasing involvement of dermatologist in management of this crisis, cutaneous symptoms gained more and more attention. In this review, we will describe cutaneous symptoms of patients of all ages in association with COVID‐19. We will focus on such disorders that are caused by direct action of SARS‐CoV‐2 on tissues, complement, and coagulation system and on nonspecific eruption of the systemic viral infection. Drug‐induced reactions are only mentioned in the differential diagnoses. Although more systematic investigations are warranted, it becomes clear that some symptoms are clinical signs of a milder COVID‐19 course, while others are a red flag for a more severe course. Knowledge of the cutaneous manifestations of COVID‐19 may help in early diagnosis, triage of patients, and risk stratification.

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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A Novel Coronavirus from Patients with Pneumonia in China, 2019

Na Zhu, Dingyu Zhang, Wenling Wang … (2020)

Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)

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SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

Markus Hoffmann, Hannah Kleine-Weber, Simon Schroeder … (2020)

Summary The recent emergence of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread pose a global health emergency. Cell entry of coronaviruses depends on binding of the viral spike (S) proteins to cellular receptors and on S protein priming by host cell proteases. Unravelling which cellular factors are used by SARS-CoV-2 for entry might provide insights into viral transmission and reveal therapeutic targets. Here, we demonstrate that SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option. Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between SARS-CoV-2 and SARS-CoV infection and identify a potential target for antiviral intervention.

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Author and article information

Contributors

Uwe Wollina:

ORCID: https://orcid.org/0000-0001-5933-2913

uwe.wollina@klinikum-dresden.de

Journal

Journal ID (nlm-ta): Dermatol Ther

Journal ID (iso-abbrev): Dermatol Ther

Journal ID (doi): 10.1111/(ISSN)1529-8019

Journal ID (publisher-id): DTH

Title: Dermatologic Therapy

Publisher: John Wiley & Sons, Inc. (Hoboken, USA )

ISSN (Print): 1396-0296

ISSN (Electronic): 1529-8019

Publication date (Electronic): 29 May 2020

Electronic Location Identifier: e13549

Affiliations

[ ¹ ] Department of Dermatology and Allergology, Städtisches Klinikum Dresden Academic Teaching Hospital of the Technical University of Dresden Dresden Germany

[ ² ] Department of Dermatology Istanbul Medeniyet University, School of Medicine Istanbul Turkey

[ ³ ] Department of Dermatology The London Clinic Marylebone London United Kingdom

[ ⁴ ] Department of Dermatology Apollonia University Iasi Romania

[ ⁵ ] Division of Dermatology Nicolina Medical Center Iasi Romania

[ ⁶ ] "P. Poni" Institute of Macromolecular Chemistry Romanian Academy Iasi Romania

[ ⁷ ] Department of Dermatology and Venereology University of Rome G. Marconi Rome Italy

Author notes

[*] [* ] Correspondence

Uwe Wollina, Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Friedrichstrasse 41, 01067 Dresden, Germany.

Email: uwe.wollina@ 123456klinikum-dresden.de

Author information

Uwe Wollina https://orcid.org/0000-0001-5933-2913

Ayşe Serap Karadağ https://orcid.org/0000-0003-4333-8274

Christopher Rowland‐Payne https://orcid.org/0000-0001-6114-9691

Torello Lotti https://orcid.org/0000-0003-0840-1936

Article

Publisher ID: DTH13549

DOI: 10.1111/dth.13549

PMC ID: 7273098

PubMed ID: 32390279

SO-VID: 51f1c3ff-0e36-4665-9dff-206b7de576c1

License:

This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

History

Date received : 04 May 2020

Date accepted : 06 May 2020

Page count

Figures: 4, Tables: 1, Pages: 6, Words: 4427

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details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.3 mode:remove_FC converted:05.06.2020

Keywords: acro‐ischemia,androgenetic alopecia,chilblain‐like eruptions,covid‐19,maculopapular rash,purpuric rash,sars‐cov‐2,urticaria

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Keywords: acro‐ischemia, androgenetic alopecia, chilblain‐like eruptions, covid‐19, maculopapular rash, purpuric rash, sars‐cov‐2, urticaria

Cutaneous signs in COVID‐19 patients: A review

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Novel Coronavirus Disease COVID-19

Most cited references 42

Clinical Characteristics of Coronavirus Disease 2019 in China

A Novel Coronavirus from Patients with Pneumonia in China, 2019

SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

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