COVID-19 dermatoses

Management Strategy

The best way to mitigate the effects of SARS-CoV-2 is to prevent its spread. In the setting of a pandemic, this means maintaining excellent hand hygiene, keeping 6 feet (2 m) apart from others when in public, and wearing a mask when this is not possible, as well as self-isolating/quarantining when appropriate. With the introduction of safe and effective vaccines, individuals who can be vaccinated against COVID-19 should receive the vaccine.

Often fever and respiratory symptoms in the setting of an epidemic allow for the clinical diagnosis of COVID-19 infection. If there is any question, reverse-transcription polymerase chain reaction (RT-PCR) of samples, such as nasal swabs, often establishes the diagnosis. Unfortunately, more needs to be learned about the sensitivity of this test as several studies using chest computed tomography (CT) scans have found the sensitivity of RT-PCR to be as low as 71%. In diagnosing COVID-19, CT scan can identify viral pneumonia, but cannot distinguish what specific virus is implicated. The presence of SARS-CoV-2 antibodies suggests prior infection, however more studies are needed to determine the sensitivity and utility of this test.

For mild cases of COVID-19 the therapy is supportive care . Supportive care includes anti-pyretics for fever in addition to hydration . More severe disease requires hospitalization and supplemental oxygen as needed. Skin findings are generally mild and resolve without specific therapy.

The cutaneous manifestations of COVID-19 infection are typically self-limited and resolve without intervention. Antihistamines are helpful for urticarial presentations; systemic corticosteroids are seldom needed for the maculopapular rash; topical steroids may be tried, especially if the eruption is pruritic; and anticoagulation with agents like enoxaparin may help the ischemic manifestations. For the chilblain-like changes called “COVID toes”, topical nitroglycerin preparations may be helpful.

Treatments for systemic complications of COVID-19 are still evolving or controversial and will not be covered in detail.

Laboratory abnormalities seen in COVID-19 include leukopenia, leukocytosis, and elevated CRP. While leukopenia is seen more commonly, leukocytosis has been associated with a worse prognosis. Other laboratory abnormalities reported include elevated aspartate aminotransferase (AST) and elevated ESR. More severe cases have been associated with elevated levels of alanine transaminase, creatinine, lactate dehydrogenase (LDH), and prothrombin time. Additionally, the cytokine storm seen in severely ill patients results in elevated proinflammatory cytokines including interleukin (IL)-2, IL-6, IL-8, IL-10, interferon-γ, IL-1β, tumor necrosis factor-alpha (TNF-α), and granulocyte colony stimulating factor.