Significance of cutaneous manifestations of COVID-19

The COVID-19 pandemic has brought the whole world to a grinding halt. With the pandemic still ongoing, it is worthwhile to recapitulate the cutaneous manifestations for dermatologists, their significance, and spectrum of COVID-19 disease. COVID-19 is a highly contagious respiratory tract disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first reported on December 1, 2019, from Wuhan, China and was declared a pandemic by the World Health Organization on March 11, 2020. COVID-19 indirectly involves the skin just like any other viral infection and is independent of the disease stage or severity. Cutaneous manifestations of COVID-19 may present a few days before or after the first general symptoms of the disease. The appearance of cutaneous manifestations before early respiratory symptoms can promote early recognition of COVID-19 in such cases. The pathophysiology of cutaneous lesions in COVID-19 is still unclear. It is attributed to immune dysregulation, vasculitis, vessel thrombosis, neogenesis, hypercoagulable states, or simple hypersensitivity in COVID-19. Endothelial swelling with the presence of SARS-CoV-2 viral particles in the endothelial cells has also been seen on electron microscopy. Thus, the clinical features indicative of viral exanthems/enanthems which can be found in other diseases therefore fail to provide specific clues for diagnosis and prognosis of COVID-19. On the other hand, vasculopathy-related skin manifestations may provide prognostic values by indicating severe complications due to COVID-19 and may help in monitoring disease severity. Early detection of cutaneous signs associated with severe disease is crucial to improve patient outcomes.