19 Most of the contributors were dermatologists in private practice with milder cases of possible COVID‐19 disease. The most common cutaneous finding was chilblain‐like eruption with 146 posts. 15 In a WhatsApp group of French dermatologists, 295 cases with cutaneous manifestations were collected. Among 375 COVID‐19 patients of Spain, 19% presented with “pseudo‐chilblains.” They may be associated with itch or pain and disappear on average after 2 weeks. 18 Chilblain like eruptions are mostly asymmetrically distributed. 13Ĥ. CHILBLAIN‐LIKE ERUPTIONS ON FINGERS AND TOESĬhilblain‐like edematous and erythematous eruptions have been observed in milder cases of COVID‐19 and in particular in youngsters and young adults, which disappear after the infection without leaving scars. Genetic factors might also contribute, but further studies are needed.Īn important initiative to gain valid data has recently been created by the American Academy of Dermatology (AAD) COVID‐19 Task Force, who has launched an online COVID‐19 dermatology registry: The primary purpose is to rapidly collect the various cutaneous manifestations. Patients with severe disease in intensive care unit (ICU) will get more attention for all possible clinical findings compared to those with mild disease and outpatient care. One explanation might be the involvement of dermatologists in the triage, which will result in a higher rate of skin diseases diagnosed. We do not know the reason for these different pictures. There were no cutaneous signs reported from Tibetan patients living in the high‐attitude plateau area, where the course of the disease was generally mild. In a recent letter from Thailand, it was stated that almost all COVID‐19 patients had cutaneous signs. 10 Unfortunately, neither photographs nor histology was available. The first report from Northern Italy on 88 COVID patients observed cutaneous symptoms in 18 patients (20.4%) of whom 8 patients developed cutaneous signs at the onset, 10 patients after the hospitalization. 9 With a closer involvement of dermatologist in the battle against the latest pandemic, the interest on cutaneous signs of SARS‐CoV‐2 infection increased. Among 1099 confirmed cases in Wuhan, only 0.2% presented with cutaneous symptoms. The initial studies from Central China reported low frequencies of skin disease in COVID‐19 patients. 6, 7 So far, no specific cutaneous pathological findings were reported in autopsied COVID‐19 patients. 5 Independent factors for severe disease and poor outcome are age > 65 years of life, male gender, cardiovascular disorders, and diabetes mellitus. About 50% of nasopharyngeal swabs may be false negative. 2 Confirmation is done by detection of viral RNA by reverse‐transcriptase polymerase chain reaction (RT‐PCR) for nasopharyngeal swabs or bronchoalveolar fluid. Diagnosis is based on medical and travel history, contact to COVID‐19 patients, and clinical symptoms. Typical clinical symptoms include fever, dry cough, sore throat, fatigue, diarrhea, conjunctivitis, hyposmia, and hypogeusia. Incubation time of COVID‐19 is up to 14 days. Adipocytes can serve as a viral reservoir. In both cutaneous and pulmonary fibrosis, transdifferentiation of adipocytes or lipofibroblasts into myofibroblasts is involved. SARS‐CoV‐2 induces pulmonary fibrosis in a tumor growth factor‐beta (TGF‐beta)/Smad‐dependent pathway. 3 One of the main reasons of pulmonary consolidation during the active disease is the development of extensive pulmonary fibrosis. 2 Expression of the SARS‐CoV‐2 cell receptor gene ACE2 has been demonstrated in a number of human tissues including skin and adipose tissue. The primary target of SARS‐CoV‐2 is the upper respiratory mucosa, and angiotensin‐converting enzyme 2 (ACE2) acts as a functional receptor for the viral spikes and eventually viral entry into host cells. The virus is mainly spread by droplets, but direct contact and fecal excretions are other possible sources of infection. Since the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) induced infectious disorder named coronavirus disease (COVID‐19) pandemic started in Wuhan city in Central China at the end of 2019, a total of 3.5 million patients have been tested positive worldwide with >240 000 related death recorded.
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