Vascular cutaneous manifestations of COVID-19 and RNA viral pathogens: a systematic review.

BACKGROUND: COVID-19, the widely recognized and highly contagious respiratory tract infection, has had a substantial impact on the field of dermatology since its emergence in 2019. SARS-CoV-2, the causative virus of COVID-19, is classified as an RNA virus. Various skin-related symptoms have been reported in patients with COVID-19, most notably the distinctive purple-red acral rash resembling chilblain lesions, commonly referred to as 'COVID toe'; similarly, skin-related symptoms have been observed in connection with other RNA viruses. OBJECTIVES: To explore the relationship between RNA viruses and their associated vascular cutaneous manifestations vs. those observed in patients infected with SARS-CoV-2. METHODS: A systematic literature review was conducted using PubMed and medical subject heading terms related to RNA viruses and related skin manifestations. RESULTS: In total, 3994 patients diagnosed with COVID-19 presenting with skin rashes were included. Chilblain-like lesions were most frequently observed (30.2%), followed by erythematous maculopapular/morbilliform rashes (9.1%) and urticarial rashes (4.7%). Of 8362 patients diagnosed with RNA viruses, more than half of the skin findings reported were erythematous/maculopapular/morbilliform rashes (52.3%), followed by unspecified (11.3%) and purpuric rashes (10.6%). CONCLUSIONS: When comparing RNA viral infections with COVID-19 infection, we observed similarities in the reported skin manifestations and their presumed pathways, with many implicated in the proinflammatory response. Owing to the wide range of cutaneous symptoms associated with RNA viruses and our currently limited understanding of the underlying mechanisms, additional research is warranted to investigate the pathology behind viral-induced skin lesions.

Epidemiology, clinical profiles, and prognostic value of COVID-19-related cutaneous manifestations in African populations: a rapid narrative review.

BACKGROUND: Skin manifestations' true prognostic value, and clinical and epidemiological pictures in SARS-CoV-2 infection in African populations are poorly described and understudied. More familiarity with COVID-19 cutaneous manifestations may aid in early clinical diagnosis or guide prognosis. METHODS: In this literature review, we looked for potential studies published from December 2019 to March 2023 on COVID-19 cutaneous lesions in African populations. Our key questions were focused on the prognostic values of cutaneous manifestations related to COVID-19. RESULTS: Our findings show that cutaneous manifestations of COVID-19 vary by country and severity of COVID-19, primarily multisystem inflammatory syndrome (MIS). Significant differences were also found between various dermatological lesions, primarily MIS, erythema multiforme-like, livedoid, vesicular, or varicella-like rashes, urticarial, maculopapular or morbilliform rashes, and chilblain-like or pernio-like rashes. There were 47.5% (115/242) of MIS cases reported in nine published African studies. Our findings also revealed that MIS may be diagnosed in 2-7 days due to early onset rash. Advanced age, obesity, diabetes, cardiovascular disease, HIV, tuberculosis, asthma, atopic disease, underweight, malnutrition, and malignancy were found to be associated with COVID-19 cutaneous manifestations in African populations. CONCLUSIONS: COVID-19-related skin manifestations in African populations are important as a driving force in COVID-19 prognosis.

Cutaneous sarcoidosis: Lupus pernio and more.

Sarcoidosis is a multiorgan disease commonly evident with skin involvement. Cutaneous manifestations occur in about 25% of sarcoid patients and are of two types: histologically specific sarcoidal infiltrations and a cutaneous reaction pattern not containing sarcoidal changes, usually erythema nodosum. Cutaneous plaques, nodules, and tumors, sometimes with disfiguring facial features are associated with pain and paresthesia. The disease itself may produce substantial morbidity due to visceral involvement. Advances in therapeutic options include tocilizumab, an IL-6 inhibitor, and tofacitinib - a Janus kinase inhibitor. This review discusses sarcoidosis etiology and pathogenesis, its clinical features, differential diagnosis, and management.

From Your Nose to Your Toes: A Review of Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic‒Associated Pernio.

Despite thousands of reported patients with pandemic-associated pernio, low rates of seroconversion and PCR positivity have defied causative linkage to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pernio in uninfected children is associated with monogenic disorders of excessive IFN-1 immunity, whereas severe COVID-19 pneumonia can result from insufficient IFN-1. Moreover, SARS-CoV-2 spike protein and robust IFN-1 response are seen in the skin of patients with pandemic-associated pernio, suggesting an excessive innate immune skin response to SARS-CoV-2. Understanding the pathophysiology of this phenomenon may elucidate the host mechanisms that drive a resilient immune response to SARS-CoV-2 and could produce relevant therapeutic targets.

Pernio-Induced Toe Pain in the Setting of Onychocryptosis: A Case Report.

Pernio is an inflammatory condition of the skin associated with cold exposure. The dermatologic manifestations may vary, and this entity is frequently misdiagnosed. Its association with systemic disease underscores the importance of accurate diagnosis. The authors describe a case report in which a patient who, after initially presenting with a complaint of pain and an ingrown toenail, was eventually diagnosed with pernio as well.

Aicardi-Goutières syndrome: unusual neuro-radiological manifestations.

Aicardi-Goutières syndrome (AGS) is one of the expanding group of inherited congenital infection like syndromes. Here, we describe the detailed clinical and imaging findings of two sibs with AGS. Each shows scattered periventricular intracranial calcifications, severe global delay, seizures, microcephaly and spasticity. Interestingly, chilblains were observed in the two sisters as well as their parents and a paternal uncle. The brain MRI of the older sister showed marked ventricular dilatation as a result of unusual associated porencephalic cysts. Unexpectedly, unilateral cerebellar hypoplasia was also noted. In comparison, her younger sister displayed the classic atrophic changes and white matter loss of AGS. The diagnosis of AGS was confirmed by sequence analysis, which identified a previously reported homozygous RNASEH2B mutation, c.554 T > G (p.V185G). Parents were heterozygous for the same mutation. Further molecular analysis excluded mutations in potentially related manifestations of COL4A1 gene. This is the first report of chilblains associated with heterozygous RNASEH2B mutation. Further, the brain imaging findings appear particularly interesting, which until now has not been reported in any AGS patient. We discuss the possible reasons for this unusual presentation.

Cold-associated perniosis of the thighs histopathologically mimicking lupus. Six observations.

BACKGROUND: Equestrian cold panniculitis has been described since 1980 in horse riders or in stable employees. Histological aspect is underdescribed. PATIENTS AND METHODS: We describe clinical and histological features of six horse riding or stable employees patients presenting with upper lateral thigh lesions during the winter months between 2014 and 2016 in our dermatological department. RESULTS: Six horse riding or stable employees ladies without any known disease presented with similar symptoms. They had urticarial or violaceous, slightly pruritic, sometimes necrotic lesions of the upper lateral thighs. Clinically, equestrian cold panniculitis, insect bite or a caustic dermatitis was suspected. Four of these patients had a cutaneous biopsy. They all showed a similar histological appearance resembling lupus erythematosus, combining dermo-epidermal lesions, with foci of interface dermatitis, an abundant dermal lymphocytic infiltrate and a dermal mucinosis. Hypodermal infiltration was present on samples including subcutis. Laboratory workup for systemic disease was unremarkable for two patients and not performed for the four others, having no other clinical sign of lupus. All patients improved rapidly with very high potent topical steroids. CONCLUSION: Cold-associated perniosis of the thighs should be considered whenever a histopathological appearance of lupus is associated with lesions of the upper lateral thighs in patients practicing horse riding. This disease belongs to the spectrum of miscellaneous cold-induced dermatoses in which histopathological lesions identical to lupus can be encountered.

Does pernio cause nail dystrophy?

Pernio is an abnormal inflammatory response to moisture and cold. It is characterized with inflammatory, erythema or violet, painful or itchy cutaneous lesions affecting distal extremities, particularly the fingers and toes. It is more common in women. A literature search showed no reports of nail deformities due to pernio. Here, we present a pernio case who developed nail deformities after extended exposure to cold, if combined with other facilitating factors.