Are the Cutaneous Manifestations During or Due to SARS-CoV-2 Infection/COVID-19 Frequent or Not? Revision of Possible Pathophysiologic Mechanisms

    June 2020 in “ Inflammation Research ”
    Paulo Ricardo Criado, Beatrice Martinez Zugaib Abdalla, Isabelle Carvalho de Assis, Cristina van Blarcum de Graaff Mello, Gabriela Cacciolari Caputo, Ingrid Campos Vieira
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    TLDR Skin problems in COVID-19 patients are rare and may be due to the body's complex immune response or blood clotting issues.
    The review article from June 2020 investigated the occurrence and underlying mechanisms of skin manifestations in COVID-19 patients. It found that while over 4 million cases of COVID-19 were reported worldwide, there were fewer than 600 cases of skin manifestations, indicating possible underreporting. The review suggested that the pathophysiology of these manifestations is complex, involving the innate immune response, hypercoagulability, lung tissue damage, and cytokine storms. Various skin lesions, such as chilblain, urticarial eruptions, and erythema, were described. The review called for better documentation and differential diagnosis of these skin conditions in COVID-19 patients. It also discussed the role of the ACE2 receptor and TMPRSS2 protease in the virus's entry into cells, the potential impact of androgens on disease severity, and the presence of thrombophilia factors contributing to coagulopathy and higher mortality. The document concluded that severe COVID-19 is characterized by an upregulated immune response and a hypercoagulable state, leading to fatal outcomes in severe cases, and that cutaneous manifestations may be caused by direct viral effects or cytokine stimulation.
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