Covid-19 and skin manifestations

The Coronavirus disease (COVID-19), which is caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) emerged in December 2019 in China, and later in March of 2020 was declared a pandemic by the World Health Organisation. The main symptoms include fever, cough, fatigue, shortness of breath and myalgia. Major complications of patients with COVID-19 include acute respiratory distress syndrome (ARDS), needing ventilatory support, with some cases progressing to multi-organ failure.

Treatment of severe cases of COVID-19 is still a conundrum. Clinically approved antiviral drugs are currently available for only 4% of viruses known to infect humans. The essence of the treatment is supportive, including oxygen therapy, mechanical ventilation (whether invasive or noninvasive), extracorporeal carbon dioxide removal and extra corporeal membrane oxygenation. Corticosteroids have potent anti-inflammatory effects and are commonly used as adjuvant therapy for ARDS, and COVID-19 is no exception. Trial data suggest a decrease in mortality with dexamethasone. Nevertheless, this treatment is highly controversial for patients with severe viral pneumonia. Indications for antiviral treatment or other COVID-19-specific therapies have not been formally defined. Remdesivir may hasten recovery time but does not seem to reduce mortality. No other therapies have been proven effective in hospitalized patients. New repurposed antiviral drugs such as remdesivir, ribavirin, galidesivir, favipiravir, darunavir, oseltamivir, ivermectine and arbidol are currently in ongoing clinical trials.

COVID-19 is a life-threatening infection especially in the older age groups. However, the disease course is much milder in children, who rarely suffer an unfavourable outcome. Children exposed to COVID-19, even in the absence of viral detection in the nasopharynx by conventional PCR studies, have been reported to show skin manifestations that are still puzzling in terms of pathophysiology, definite relation with SARS-CoV-2 infection and long-term outcome. Such skin manifestations may alert physicians about a possible outbreak of the disease in the child’s environment.

Some of the Spring Symposium’s lectures will cover all the above mentioned topics, and they will also focus on the relationship of pernio/chilblains with Sars-CoV-2 (known as ‘COVID toes’), exploring the underlying pathophysiology. Unique patient populations will be discussed, including those with long COVID-19 and recurrent pernio after initial Sars-CoV-2 infection. Finally, data on pernio/chilblains triggered by COVID-19 vaccinations will also be presented.