Zheng Yue, Gong Zijian, Chen Jian, Lin Yao, Liu Yufang
Dermatology Department, Third Affiliated Hospital of Sun-Yat Sen University, Guangzhou, People's Republic of China.
Clin Cosmet Investig Dermatol. 2021 Jan 6;14:1-7. doi: 10.2147/CCID.S278833. eCollection 2021.
COVID-19 can affect various organ systems including the skin. Cutaneous manifestations of COVID-19 in infected patients are poorly characterized.
To summarize retrospectively the skin features of COVID-19 infection and to analyze the skin rash incidence rate, clinical onset time, cutaneous manifestations, pathological characteristics and relationship with the novel coronavirus pneumonia severity.
The literature up to Sep 20, 2020, were searched and analyzed. Information on clinical features including skin manifestations, disease severity, stage and onset day, and cutaneous pathological characteristics was extracted. Data were analyzed using descriptive non-parametric statistics. For categorical data, the number and percentage of patients are presented. A Spearman correlation test was used to analyze the associations between rash type, rash onset and severity of COVID-19. All statistical analysis was performed with IBM SPSS software (version 20) using two-tailed tests. P values <0.05 were considered statistically significant.
Twenty-three cases of COVID-19 patients with cutaneous manifestations from seven reports were collected. Inflammatory dermatosis, skin vasculitis and vascular dermatosis were the main lesion types of COVID-19 patients. Microvascular and endothelial cell injury, perivascular lymphocytic infiltrate, thrombosis, extremely dilated vessels and prominent deposits of C5b-9 were the main dermatologic pathological changes. The onset day analysis showed that out of 19 patients, 63.2% of cutaneous manifestations were within 10 days, 21.1% in 10-20 days and 15.8% were 20 days after the time the patient presented with COVID-19 main symptoms. Spearman rho analysis found no correlation between skin rash type, onset day and COVID-19 severity.
COVID-19 induced skin changes are one of the manifestations of immune responses to the novel coronavirus. Clinical and pathological characteristics were identified as dermal inflammatory reactions and/or skin vascular injury. External or systematic use of anti-inflammatories, protection of blood vessels and circulation-improving medicines should be considered in the skin treatments for novel coronavirus pneumonia patients.
新型冠状病毒肺炎（COVID-19）可影响包括皮肤在内的多个器官系统。COVID-19感染患者的皮肤表现特征尚不明确。
回顾性总结COVID-19感染的皮肤特征，分析皮疹发生率、临床发病时间、皮肤表现、病理特征以及与新型冠状病毒肺炎严重程度的关系。
检索并分析截至2020年9月20日的文献。提取包括皮肤表现、疾病严重程度、阶段和发病日期以及皮肤病理特征等临床特征信息。采用描述性非参数统计方法进行数据分析。对于分类数据，列出患者数量和百分比。采用Spearman相关性检验分析皮疹类型、皮疹发病与COVID-19严重程度之间的关联。所有统计分析均使用IBM SPSS软件（版本20）进行双侧检验。P值<0.05被认为具有统计学意义。
收集了7篇报告中的23例有皮肤表现的COVID-19患者。炎症性皮肤病、皮肤血管炎和血管性皮肤病是COVID-19患者的主要皮损类型。微血管和内皮细胞损伤、血管周围淋巴细胞浸润、血栓形成、血管极度扩张以及C5b-9的显著沉积是主要的皮肤病理变化。发病日期分析显示，在19例患者中，63.2%的皮肤表现在10天内出现，21.1%在10 - 20天出现，15.8%在患者出现COVID-19主要症状20天后出现。Spearman秩相关分析发现皮疹类型、发病日期与COVID-19严重程度之间无相关性。
COVID-19引起的皮肤变化是对新型冠状病毒免疫反应的表现之一。临床和病理特征表现为皮肤炎症反应和/或皮肤血管损伤。在新型冠状病毒肺炎患者的皮肤治疗中，应考虑外用或系统使用抗炎药、血管保护药和改善循环的药物。
