Abstract

Background: Skin lesions have been reported as early symptoms in several COVID-19 patients. Objective: To summarize the reported early skin manifestations in confirmed COVID-19 patients and determine its utility for diagnosis and prognosis. Methods: A primary search for peer-reviewed literature published until May 1st, 2021 was conducted with PubMed and EMBASE. Inclusion criteria: Studies documenting early skin lesions in confirmed COVID-19 cases which appeared prior to other symptoms. 31 studies (23 case reports and 8 case series) with a total of 59 confirmed COVID-19 patients were included. Results: Early cutaneous lesions reported in the 59 COVID-19 patients (age range = 0.5-78 years, 53.3% males) were: 25.4% pernio-like lesions, 20.3% urticarial, 18.6% maculopapular, 8.4% papulosquamous, 8.4% vesicular, 6.7% morbilliform, 6.7% purpuric and 6.7% other lesions. The timing of onset for skin lesions varied from 2 to 20 days before the onset of COVID-19 symptoms. Skin lesions were the only presentation in 17 patients (28.8%). Histopathology reported in 6 studies revealed non-specific viral changes with lymphocytic infiltration and microscopic changes compatible with the skin lesion. 15.2% patients had a severe disease requiring hospitalization. Conclusions: The description of early cutaneous and pathological manifestations in COVID-19 patients may help clinicians in early recognition in paucisymptomatic cases. However, further investigation is needed to determine the prognostic significance of skin lesions in predicting COVID-19 severity which may facilitate early interventions and improve outcomes.

Financial Disclosure:
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