Cutaneous Manifestations of COVID-19 Infection

Cutaneous manifestations of COVID-19 encompass a broad spectrum of skin lesions that have emerged as both diagnostic clues and indicators of disease trajectory. Clinical patterns range from maculopapular and vesicular eruptions to urticarial wheals, chilblain-like (pernio) lesions and livedo or necrotic vascular changes. The timing of cutaneous signs is variable: some arise concurrently with respiratory or systemic symptoms, while others precede or follow the acute phase. Underlying mechanisms appear to involve immune dysregulation, microvascular injury and thrombotic vasculopathy, with neutrophil activation and formation of neutrophil extracellular traps contributing to dermal vessel occlusion. Chilblain-like lesions in younger patients often correlate with mild systemic disease, whereas retiform purpura or livedo patterns in older or critically ill individuals may herald severe coagulopathy. Although prevalence estimates vary—ranging from under 2 per cent in large cohorts to over 20 per cent in targeted series—awareness of these presentations can facilitate early isolation, prompt management of complications and tailored supportive care.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Cutaneous Manifestations of COVID-19 Infection publication trend

The graph below shows the total number of articles in cutaneous manifestations of covid-19 infection across all publications each year (not limited to Nature Index journals).

Technical terms

Chilblain-like lesions: Pernio-type inflammatory plaques on fingers or toes, often cold-induced in non-COVID contexts but linked here to microvascular immune responses.

Thrombotic vasculopathy: Occlusion of dermal vessels by fibrin and platelet aggregates, leading to local ischaemia and necrosis.

Maculopapular eruption: A mixed flat and raised rash, typically erythematous, seen in viral exanthems and drug reactions.

Urticaria: Transient pruritic wheals caused by dermal oedema and mast cell degranulation.

Neutrophil extracellular traps (NETs): Networks of DNA and antimicrobial proteins expelled by neutrophils that can promote endothelial damage and thrombosis.

Acral skin: The peripheral extremities, notably hands and feet, where vascular and inflammatory phenomena often manifest.

References

1. Abnormal thrombosis and neutrophil activation increase hospital-acquired sacral pressure injuries and morbidity in COVID-19 patients. Frontiers in Immunology (2023).
2. The Impact of the COVID-19 Pandemic on Cutaneous Drug Eruptions in a Swedish Health Region without Lockdown. Microorganisms (2023).
3. Diagnostic value of cutaneous manifestation of SARS‐CoV‐2 infection*. British Journal of Dermatology (2021).
4. Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature. Dermatopathology (2020).
5. A Comprehensive Review of Cutaneous Manifestations Associated with COVID‐19. BioMed Research International (2020).
6. Skin Manifestations in COVID-19: Prevalence and Relationship with Disease Severity. Journal of Clinical Medicine (2020).
7. COVID-19 and Skin Manifestations: An Overview of Case Reports/Case Series and Meta-Analysis of Prevalence Studies. Frontiers in Medicine (2020).