Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review.
Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review.
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DOI：
10.3390/biology9120449
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发表时间：
2020-12-05
期刊：
影响因子：
4.2
通讯作者：
Neagu N
中科院分区：
文献类型：
--
作者：
Conforti C;Dianzani C;Agozzino M;Giuffrida R;Marangi GF;Meo ND;Morariu SH;Persichetti P;Segreto F;Zalaudek I;Neagu N
被诊断患有COVID-19并伴有皮疹的患者经常被报道。我们总结了迄今为止所描述的病例，仅包括鼻咽拭子RT-PCR检测阳性的患者。655例患者出现不同类型的皮疹，从黄斑丘疹、血管性、水疱性、荨麻疹到不典型形式和眼部受累。冻疮是一种类似冻伤的病变，在年轻人群中更为常见，似乎预示着一种较温和的疾病病程。血管紫癜病变出现在老年患者中，并与更严重的进化有关。在水疱性皮疹的情况下，疱疹病毒合并感染的可能性提高了。此外，皮肤羟基氯喹药物反应已被描述。结膜炎患者的眼分泌物可能具有传染性。这些皮肤表现可能有助于在某些情况下识别无症状的COVID-19携带者，或预测其他情况下更严重的演变。COVID-19患者出现皮肤症状的报道越来越多。我们进行了一项系统综述，并纳入了描述鼻咽拭子RT-PCR冠状病毒检测阳性并出现皮肤表现的患者的手稿。共有655名患者入选,不同类型的皮疹,红斑的斑丘疹的(n = 250),血管(n = 146),水泡(n = 99)、荨麻疹的(n = 98)、多形性红斑/广义脓疱的形成图案的红斑/史蒂文斯—约翰逊综合征(n = 22),眼/眼周的(n = 14),多态模式(n = 9),广义瘙痒(n = 8),川崎病(n = 5),非典型结节性红斑(n = 3),和非典型甜综合征(n = 1)。冻疮样病变在年轻人群中更常见，与较轻的疾病病程有关，而固定的总状斑和网状紫癜出现在老年患者中，似乎预示着更严重的预后。对于水疱性皮疹，聚合酶链反应确定了水疱液中疱疹病毒的存在，这增加了疱疹病毒合并感染的可能性。多形性红斑、全身性脓疱状红斑和Stevens-Johnson综合征最常与羟氯喹摄入有关。结膜拭子PCR检测SARS-COV-2阳性表明眼分泌物也可能具有传染性。这些皮肤表现可能有助于在某些情况下识别无症状的COVID-19携带者，或预测其他情况下更严重的演变。
Patients diagnosed with COVID-19 and concomitant skin rashes have been frequently reported. We summarized the cases described to date, including only patients with positive RT-PCR testing from nasopharyngeal swabs. Six hundred and fifty-five patients were found who presented different types of skin rashes, from maculopapular, vascular, vesicular, urticarial, to atypical forms and ocular involvement. Chilblains which are lesions resembling frostbite have been more frequent in the younger population and seemed to predict a milder disease course. Vascular-purpuric lesions appeared in older patients and were linked to a more severe evolution. In the case of vesicular rashes, the possibility of herpesvirus co-infections was raised. Moreover, cutaneous hydroxychloroquine drug reactions have been described. For patients with conjunctivitis, eye discharge might be contagious. These skin manifestations may help identify asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others. There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.
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