Skin manifestations in patients with covid-19: A literature review

Danny Gunawan*  -  Department of Dermatology and Venereology, Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
Maureen Miracle Stella  -  Medical Professional Education, Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
Veronika Maria Sidharta  -  Department of Histology, Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia

(*) Corresponding Author

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. In December 2019, cases of pneumonia with unknown cause were first reported in Wuhan, Hubei Province, China. Confirmed cases and death rates due to COVID-19 in the world are still increasing. One part of the body that is affected and causes clinical symptoms in COVID-19 is the skin. This review aims to describe and analyze cutaneous manifestation in COVID-19. This study method is a review of the literature sourced from Google Scholar and PubMed. The literature was selected using English language criteria, using the clinical study method in the form of case reports. Meanwhile, literature review, systematic literature, and meta-analysis were excluded. Journal searches were carried out using the keywords "skin" OR "cutaneous" AND "manifestation" AND "COVID-19" OR "coronavirus". The skin manifestations of COVID-19 have been observed. The most common clinical symptoms of COVID-19 were fever (47%), dry or productive cough (25%), sore throat (16%), generalized sore throat (6%), and pain (5%). However, currently there has been a shift in the approach to diagnosing COVID-19 because it can cause symptoms in other organ systems, one of which is skin manifestations. There are early reports of skin involvement (erythematous rash, extensive urticaria, and chickenpox-like vesicles) occurring in 20% of patients in the course of the COVID-19 disease. In addition, several case reports provide descriptions of petechiae and chilblains. Based on the cases that have been reported, patients with COVID-19 who have manifestations on the skin can give a picture of maculopapular eruptions, vesicular eruptions, petechiae, and also childblains.

Keywords: Cutaneous; Skin; Manifestation; COVID-19

  1. Bursal Duramaz, B., Yozgat, C.Y., Yozgat, Y. and Turel, O. (2020). Appearance of skin rash in pediatric patients with COVID-19: Three case presentations. Dermatologic Therapy, 33(4): 2–3. doi:10.1111/dth.13594.
  2. Català, A, Galván-Casas, C, Carretero-Hernández, G, et al. (2020). Maculopapular eruptions associated to COVID-19: A subanalysis of the COVID-Piel study. Dermatologic Therapy, 33(6): 1–10. doi:10.1111/dth.14170.
  3. Chen, Y., Liu, Q. and Guo, D. (2020). Emerging coronaviruses: Genome structure, replication, and pathogenesis. Journal of Medical Virology. 92(4): 418–423. doi:10.1002/jmv.25681.
  4. Covid19.who.int. 2021. WHO Coronavirus (COVID-19) Dashboard. [online] Available at: [Accessed 12 March 2021].
  5. Criado, P.R., Abdalla, B.M.Z., de Assis, I.C., van Blarcum de Graaff Mello C, Caputo GC, Vieira IC.. (2020). Are the cutaneous manifestations during or due to SARS-CoV-2 infection/COVID-19 frequent or not? Revision of possible pathophysiologic mechanisms. Inflammation Research. 69(8): 745–756. doi:10.1007/s00011-020-01370-w.
  6. Diaz-Guimaraens, B, Dominguez-Santas, M, Suarez-Valle, A, et al. (2020). Petechial Skin Rash Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Dermatology, 156(7): 820–822. doi:10.1001/jamadermatol.2020.1741.
  7. Fernandez-Nieto, D., Ortega-Quijano, D., Jimenez-Cauhe, J., Burgos-Blasco, P., de Perosanz-Lobo, D., Suarez-Valle, A., Cortes-Cuevas, J.L., Carretero, I., Garcia-Del Real, C. and Fernandez-Guarino, M. (2020). Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital. Clinical and Experimental Dermatology, 45(7), pp. 872–875. doi:10.1111/ced.14277.
  8. Fernandez-Nieto, D., Ortega-Quijano, D., Jimenez-Cauhe, J., Burgos-Blasco, P., de Perosanz-Lobo, D., Suarez-Valle, A., Cortes-Cuevas, J.L., Carretero, I., Garcia-Del Real, C. and Fernandez-Guarino, M. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18): 1708–1720. doi:10.1056/nejmoa2002032.
  9. Freeman, E.E., McMahon, D.E., Lipoff, J.B., Rosenbach, M., Kovarik, C., Desai, S.R., Harp, J., Takeshita, J., French, L.E., Lim, H.W., Thiers, B.H., Hruza, G.J, Fox LP. (2020). The spectrum of COVID-19–associated dermatologic manifestations: An international registry of 716 patients from 31 countries. Journal of the American Academy of Dermatology, 83(4), pp. 1118–1129. doi:10.1016/j.jaad.2020.06.1016.
  10. Gianotti, R., Zerbi, P. and Dodiuk-Gad, R.P. (2020) “Clinical and histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy,” Journal of Dermatological Science, 98(2): 141–143. doi:10.1016/j.jdermsci.2020.04.007.
  11. Gottlieb, M. and Long, B. (2020). Dermatologic manifestations and complications of COVID-19. American Journal of Emergency Medicine, 38(9): 1715–1721. doi:10.1016/j.ajem.2020.06.011.
  12. Hunt, M. and Koziatek, C. (2020). A Case of COVID-19 Pneumonia in a Young Male with Full Body Rash as a Presenting Symptom. Clinical Practice and Cases in Emergency Medicine, 4(2):0–3. doi:10.5811/cpcem.2020.3.47349.
  13. Infeksiemerging.kemkes.go.id. 2021. Infeksi Emerging Kementerian Kesehatan RI. [online] Available at: [Accessed 12 March 2021].
  14. Joob, B. and Wiwanitkit, V. (2020). COVID-19 can present with a rash and be mistaken for dengue. Journal of the American Academy of Dermatology, 82(5): e177. doi:10.1016/j.jaad.2020.03.036.
  15. Landa, N., Mendieta-Eckert, M., Fonda-Pascual, P. and Aguirre, T.. (2020). Chilblain-like lesions on feet and hands during the COVID-19 Pandemic. International Journal of Dermatology, 59(6): 739–743. doi:10.1111/ijd.14937.
  16. Lim, S.Y.D. and Tey, H.L. (2020). Response to ‘Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases’: vesicular eruption in COVID-19 – to exclude varicella, British Journal of Dermatology, 183(4): 790–791. doi:10.1111/bjd.19347.
  17. Liu, J, Zheng, X, Tong, Q. (2020). Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. Journal of Medical Virology., 92 : 491–494. doi:10.1002/jmv.25709.
  18. Moreno R.A, Estela Villa LM., Avellana Moreno V., Estela Villa C., Moreno Aparicio MA., Avellana Fontanella JA. (2020). Cutaneous manifestation of COVID-19 in images: a case report. Journal of the European Academy of Dermatology and Venereology. 34(7): e307–e309. doi:10.1111/jdv.16531.
  19. Murt, A., Eskazan, A.E., Yılmaz, U., Ozkan, T. and Ar, M.C. (2021). COVID-19 presenting with immune thrombocytopenia: A case report and review of the literature. Journal of Medical Virology, 93(1): 43–45. doi:10.1002/jmv.26138.
  20. Nurulain T. Zaveri (2016). 乳鼠心肌提取 HHS Public Access. Physiology & behavior, 176(10): 139–148. doi:10.1146/annurev-immunol-051116-052331.Intracellular.
  21. Ortega-Quijano, D, Jimenez-Cauhe, J, Selda-Enriquez,G, Fernandez-Guarino, M, Fernandez-Nieto D.. et al. (2020) Algorithm for the classification of COVID-19 rashes. Journal of the American Academy of Dermatology, 83(2):
  22. Prompetchara, E., Ketloy, C. and Palaga, T. (2020). IImmune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pacific Journal of Allergy and Immunology, 38(1):1–9. doi:10.12932/AP-200220-0772.
  23. Suchonwanit, P., Leerunyakul, K. and Kositkuljorn, C. (2020). Diagnostic and prognostic values of cutaneous manifestations in COVID-19. Dermatologic Therapy. doi:10.1111/dth.13650.
  24. Torres, T. and Puig, L. (2020). Managing Cutaneous Immune-Mediated Diseases During the COVID-19 Pandemic,” American Journal of Clinical Dermatology, 21(3), pp. 307–311. doi:10.1007/s40257-020-00514-2.
  25. Vesely, M.D. and Perkins, S.H. (2020). Caution in the time of rashes and COVID-19. Journal of the American Academy of Dermatology, 83(4): e321–e322. doi:10.1016/j.jaad.2020.07.026.

Open Access Copyright (c) 2022 Sains Medika: Jurnal Kedokteran dan Kesehatan
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Sains Medika : Jurnal Kedokteran dan Kesehatan
is published by Fakultas Kedokteran Universitas Islam Sultan Agung Semarang, Indonesia.
Jl. Raya Kaligawe Km.4, PO BOX 1054/SM Semarang 50112
Website: https://fkunissula.ac.id/
Email: sainsmedika@unissula.ac.id

ISSN: 2339-093X (Online) | 2085-1545 (Print)
DOI : 10.30659/sainsmed

This work is licensed under a Creative Commons Attribution 4.0 International License

Get a feed by atom here, RRS2 here and OAI Links here

apps