Marzano A V, Cassano N, Genovese G, Moltrasio C, Vena G A
Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Br J Dermatol. 2020 Sep;183(3):431-442. doi: 10.1111/bjd.19264. Epub 2020 Jul 5.
The infection caused by the recently identified SARS-CoV-2, called coronavirus disease-19 (COVID-19), has rapidly spread throughout the world. With the exponential increase of patients worldwide, the clinical spectrum of COVID-19 is being better defined and new symptoms are emerging. Numerous reports are documenting the occurrence of different cutaneous manifestations in patients with COVID-19.
To provide a brief overview of cutaneous lesions associated with COVID-19.
A literature search was performed in the PubMed, Scopus and Web of Science databases up to 30 April 2020. This narrative review summarizes the available data regarding the clinical and histological features of COVID-19-associated skin manifestations.
The literature reports showed a great heterogeneity in COVID-19-associated cutaneous manifestations, as well as in their latency periods and associated extracutaneous symptoms. Pathogenic mechanisms are unknown, although the roles of a hyperactive immune response, complement activation and microvascular injury have been hypothesized. Based on our experience and the literature data, we subdivided the reported cutaneous lesions into six main clinical patterns: (i) urticarial rash; (ii) confluent erythematous-maculopapular-morbilliform rash; (iii) papulovesicular exanthem; (iv) chilblain-like acral pattern; (v) livedo reticularis-livedo racemosa-like pattern; and (vi) purpuric 'vasculitic' pattern. These six patterns can be merged into two main groups: the first - inflammatory and exanthematous - includes the first three groups listed above, and the second includes the vasculopathic and vasculitic lesions of the last three groups.
The possible presence of cutaneous findings leading to suspect COVID-19 puts dermatologists in a relevant position. Further studies are needed to delineate the diagnostic and prognostic values of such cutaneous manifestations.
最近发现的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的感染，即冠状病毒病19（COVID-19），已在全球迅速传播。随着全球患者数量呈指数级增长，COVID-19的临床谱正在得到更好的界定，新的症状也不断出现。大量报告记录了COVID-19患者出现的不同皮肤表现。
简要概述与COVID-19相关的皮肤病变。
截至2020年4月30日，在PubMed、Scopus和科学网数据库中进行了文献检索。本叙述性综述总结了关于COVID-19相关皮肤表现的临床和组织学特征的现有数据。
文献报告显示，COVID-19相关皮肤表现及其潜伏期和相关皮肤外症状存在很大异质性。虽然有人推测过度活跃的免疫反应、补体激活和微血管损伤的作用，但致病机制尚不清楚。根据我们的经验和文献数据，我们将报告的皮肤病变分为六种主要临床类型：（i）荨麻疹样皮疹；（ii）融合性红斑-丘疹-斑丘疹样皮疹；（iii）丘疹水疱性皮疹；（iv）冻疮样肢端型；（v）网状青斑-蔓状青斑样型；（vi）紫癜性“血管炎”型。这六种类型可合并为两个主要组：第一组——炎症性和发疹性——包括上述前三组，第二组包括后三组的血管病变和血管炎病变。
可能出现导致怀疑COVID-19的皮肤表现，这使皮肤科医生处于重要地位。需要进一步研究来阐明这些皮肤表现的诊断和预后价值。
