A Looking Beyond the Cutaneous Manifestations of Covid 19- Part 1: The Clinical Spectrum - A Review

Ever since the first case of Covid 19 pneumonia-like condition was reported from Wuhan, China, researchers were seriously engaged in uncovering evidence of the involvement of organs other than the lung, like kidney, heart, brain, liver and gut. From the dermatologists, world over, specifically from UK, USA, France and Italy etc., reports of Cutaneous involvement in Covid 19 started to pour in, since April - May of 2020. From the localised and benign cutaneous lesions-like Covid toes to moderately severe exanthematous rashes like the morabilliform and vesicular rashes, to more severe, livedoid /necrotic and haemorrhagic rashes were reported. The last group in particular, was associated with underlying potentially fatal pathological conditions like hypercoagulable state and disseminated intravascular coagulation (DIC).These types of cutaneous lesions could be clinically the fore-runner of the underlying pathological states and indicate grave prognosis. Such cases need intensive care management, not because of the skin lesions but for the fatal underlying processes which cause them. In many instances of less severe to moderately severe manifestations as mentioned above, the link to Covid 19, is more circumstantial than direct, as most of them are negative for SARS CoV 2 virus. The one reason for attributing some of these lesions to Covid 19, was due to the fact that they were observed at the height of the Covid 19 epidemic in the countries concerned. Even some researchers expressed doubt, that some of the exanthematous lesions of Covid 19 could be due to an independent seasonal virus or due to the coexistence of another concurrent viral disease. The latest report of the coexistent CMV viral infection in Covid 19 patient in April 2020 (Damiano D’Ardes, Andrea Boccatonda, et al.) would support the possibility simultaneous of dual infection. Yet another view was that it could be a delayed manifestation or an epiphenomena of Covid 19. Dengue-like and Kawasaki disease- like lesions were cited as examples of how Covid 19 could mimic other potentially serious diseases. Understandably, all the cutaneous lesions could not be considered on the same footing and hence the necessity to eschew any cavalier approach to any dermatological manifestation that turns up in the context of Covid 19 infection. An attempt was made to review and present the clinical spectrum of cutaneous manifestations of Covid 19, reported till date in the literature, in this part of the article. It was planned to discuss the pathology and pathogenesis of the cutaneous manifestations of Covid 19 in part 2, that would follow.