Rash Morphology as a Predictor of COVID-19 Severity: A Systematic Review of the Cutaneous Manifestations of COVID-19

May 2022 in “ Skin health and disease ”

Zachary Holmes, Ashling Courtney, Marc Lincoln, Richard Weller

chilblain-like lesions maculopapular urticaria acro-ischaemia livedo reticularis pruritus pain burning

TLDR Certain types of rashes in COVID-19 patients may indicate more severe illness and higher risk of death.

This systematic review analyzed 240 papers and 2056 patients to study the relationship between rash morphology and COVID-19 severity. The most common skin manifestation was chilblain-like lesions (54.2%), followed by maculopapular (13.6%) and urticaria (8.3%). The study found a significant relationship between rash type and COVID-19 severity, with 20.9% of patients having a rash as their only symptom. Acro-ischaemia and livedo reticularis were associated with a higher risk of ICU transfer and mortality. The most common dermatological symptoms were pruritus (35.1%), pain (16.4%), and burning (4.7%). Hair and nail changes were observed in 1.9% of cases, typically 3 months after the COVID-19 episode. The study suggests that rash morphology could be a useful prognostic tool in managing COVID-19.

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