Vestnik dermatologii i venerologiiVestnik dermatologii i venerologii0042-46092313-6294Rossijskoe Obschestvo Dermatovenerologov i Kosmetologov114110.25208/vdv1141Research ArticleSkin manifestations of a new coronovirus infection COVID-19 caused by SARS-CoV-2KhryaninAleksey A.<p>Doctor of Medical Sciences, Professor of the Department of Dermatovenereology and Cosmetology of the Novosibirsk State Medical University under the Ministry of Health of Russian Federation, Vice President of the Association of Obstetricians-Gynecologists and Dermatovenereologists</p>khryanin@mail.ruhttps://orcid.org/0000-0001-9248-8303SturovViktor G.<p>MD, Professor of the Institute of Medicine and Psychology Named After V. Zelman, in the Novosibirsk National Research State University under the Ministry of Science and Higher Education of Russian Federation</p>sturov@mail.ruhttps://orcid.org/0000-0001-8243-247XNadeevAlexander P.<p>MD, Professor, Head at the Department of Pathological Anatomy in the Novosibirsk State Medical University under the Ministry of Health of Russian Federation</p>nadeevngma@mail.ruhttps://orcid.org/0000-0003-0400-1011BocharovaValentina К.<p>6th-year student of the Pediatric Faculty of the Novosibirsk State Medical University under the Ministry of Health of Russian Federation</p>valuha-95@yandex.ruhttps://orcid.org/0000-0003-4671-7288Novosibirsk State Medical UniversityAssociation Obstetricians-Gynecologists and DermatovenerologistsV. Zelman Institute of medicine and psychology, Novosibirsk National Research State University2909202096353622805202026062020Copyright © 2020, Khryanin A.A., Sturov V.G., Nadeev A.P., Bocharova V.К.2020<p>The review is devoted to the skin manifestations of new coronovirus infection (SARS-CoV-2), information about which is constantly updated. However, this information has not been systematized yet. The purpose of this review is to analyze the dermatological manifestations of a new coronavirus infection. On average, 12.520.4% of patients with confirmed COVID-19 have developed skin manifestations. The question of whether the skin symptoms are a secondary consequence of a respiratory infection or a primary infection of the skin itself remains open at the moment. The possible mechanisms of development of skin lesions and the role of diseases of complement system and blood hypercoagulation in the pathogenesis of the disease are discussed in the article. The review also provides descriptive and clinical examples of skin manifestations in COVID-19. Since COVID-19 tends to be asymptomatic within 14 days, skin manifestations can be an indicator of infection, which leads to the timely diagnosis. In addition, doctors' awareness about skin symptoms associated with COVID-19 infection plays a big role in preventing misdiagnosis of the disease. The authors cite their own clinical сase of a patient with COVID-19 and associated skin angiitis.</p>COVID-19skin manifestationcomplement systeminfectious DIC-syndromeCOVID-19кожные проявлениясистема комплементаинфекционный ДВС-синдром[Han Y., Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID‐19): a Chinese perspective. J. Med. Virol. 2020; 6 (March).][Guo Y.R., Cao Q.D., Hong Z.S., Tan Y.Y., Chen S.D., Jin H.J., Tan K.S., Wang D.Y., Yan Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak — an update on the status. Mil. Med. Res. 2020; 13 (March (1)): 11.][Zhai P., Ding Y., Wu X., Long J., Zhong Y., Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int. J. Antimicrob. Agents. 2020; 28 (March): 105955.][Lai C.C., Shih T.P., Ko W.C., Tang H.J., Hsueh P.R. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges. Int. J. Antimicrob. Agents. 2020; 55 (March (3)): 105924.][Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395 (February (10223)): 507—513.][Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395 (February (10223)): 497—506.][Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020 (March 26).][Sachdeva M., Gianotti R., Shah M., Lucia B., Tosi D., Veraldi S., Ziv M., Leshem E., Dodiuk-Gad R. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci. 2020 (April 29).][Mahé A., Birckel E., Krieger S., Merklen C., Bottlaender L. A distinctive skin rash associated with Coronavirus Disease 2019-J. Eur. Acad. Dermatol. Venereol. 2020 (April 15).][Estébanez A., Pérez-Santiago L., Silva E., Guillen-Climent S., García-Vázquez A., Ramón M. Cutaneous manifestations in COVID-19: a new contribution. J. Eur. Acad. Dermatol. Venereol. 2020 (April 15).][Tsai J., Nagel M.A., Gilden D. Skin rash in meningitis and meningoencephalitis. Neurology. 2013; 80 (May (19)): 1808—1811.][Joob B., Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J. Am. Acad. Dermatol.2020; 82 (May (5)): 177.][Marzano A.V., Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini B, Veraldi S, Rubegni P, Cusini M, Caputo V, Rongioletti F, Berti E, Calzavara-Pinton P. Varicella- like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. Journal of the American Academy of Dermatology (2020).][Gianotti R., Zerbi P., Dodiuk-Gad R. Histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy. J. Cosmet. Dermatol. Sci. Appl. 2020.][Gianotti R. COVID 19 and the skin — heuristic review. DermoSprint. 2020; (April 06).][Manalo I.F., Smith M.K., Cheeley J., Jacobs R. A dermatologic manifestation of COVID-19: transient livedo reticularis. J. Am. Acad. Dermatol. 2020; (April 10).][Magro C., Mulvey J., Berlin D., Nuovo G., Salvatore S., Harp J., Baxter-Stoltzfus A., Laurence J. Complementary associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl. Res. 2020.][Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb. Haemost., 2020, pr, 18 (4). Р. 844—847.][Deng Y., Liu W., Liu K., Fang Y.Y. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin. Med. J. (Engl), 2020, no. 20, supl. 32209890.][Tang N., Bai H., Chen X., Gong J. et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Thromb Haemost. 2020 (Mar 27).][Kandeel M, Al-Nazawi M. Virtual Screening and Repurposing of FDA Approved Drugs Against COVID-19 Main Protease Life Sci., 2020, 3. Р. 117—127.][Zhou F., Ting Yu, Ronghui Du, Guohui F. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. 2020 Elsevier Ltd.][Zhang Y., Cao W., Xiao M., Li Y.J. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Za Zhi., 2020, 41 (0), E006.][Хавинсон В.Х., Кузник Б.И., Стуров В.Г., Гладкий П.А. Применение препарата Тималин при заболеваниях органов дыхания и инфекциях. Перспективы использования при COVID-19. РМЖ. 2020; 1 (*): 1—10. [Khavinson V.Kh., Kuznik B.I., Sturov V.G., Gladkii P.A. Thymalin use for respiratory diseases and infections. Application potential in COVID-19. RMJ. 2020; 1 (*): 1—10 (Russia).]][Hong-Long J., Runzhen Z., Sadis M., Michael A., Elevated Plasmin (ogen) as a Common Risk Factor for COVID-19 Susceptibility. Physiol. Rev., 2020, 100 (3). Рр. 1065—1075.][Потекаев Н.Н., Жукова О.В., Проценко Д.Н., Кожевникова Г.Н., Демина О.М., Голуб В.П., Рассохина О.И., Хлыстова Е.А. Клиническая характеристика кожных проявлений при новой коронавирусной инфекции COVID-19, вызванной SARS-CoV-2. Клиническая дерматология и венерология. 2020. Т. 21, март. [Potekaev N.N., Zhukova O.V., Protsenko D.N., Kozhevnikova G.N., Demina O.M., Golub V.P., Rassokhina O.I., Khlystova E.A. Clinical characteristics of skin manifestations in a new COVID-19 coronavirus infection caused by SARS-CoV-2. Clinical dermatology and venereology. 2020. Vol. 21, March (Russia).]][Jimenez-Cauhe J., Ortega-Quijano D., Prieto-Barrios M., Moreno-Arrones Om, Fernandez-Nieto D. Reply to “COVID-19 can present with a rash and be mistaken for Dengue”: petechial rash in a patient with COVID-19 infection. J. Am. Acad. Dermatol. 2020 (April 10).][Hunt M., Koziatek C. A case of COVID-19 pneumonia in a young male with full body rash as a presenting symptom. Clin Pract Cases Emerg Med. 2020 (March 28).][Fernandez-Nieto D., Ortega-Quijano D., Segurado-Miravalles G., Pindado-Ortega C., Prieto-Barrios M., Jimenez-Cauhe J. Comment on: cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies. J. Eur. Acad. Dermatol. Venereol. 2020 (April 15).][Henry D., Ackerman M., Sancelme E., Finon A., Esteve E. Urticarial eruption in COVID-19 infection. J. Eur. Acad. Dermatol. Venereol. 2020 (April 15).][Kamali Aghdam M., Jafari N., Eftekhari K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect. Dis. (Lond). 2020; 52 (June (6)): 427—429.][Mazzotta F., Troccoli T. 2020. Acute Acro-Ischemia in the Child at the time of COVID-19. Dermatologia Pediatrica, Bari. In press.][Alramthan A., Aldaraji W. Clin Exp Dermatol. 2020. A case of COVID‐19 presenting in clinical picture resembling chilblains disease. First report from the Middle East. (April 17).][Najarian D.J. Morbilliform exanthem associated with COVID-19. JAAD Case Rep. 2020.][Kolivras A., Dehavay F., Delplace D., Feoli F., Meiers I., Milone L. Coronavirus (COVID-19) infection- induced chilblains: a case report with histopathological findings. JAAD Case Rep. 2020 (April 18).][Kaissi A.A., Marrakchi Z., Nassib N.M., Hofstaetter J., Grill F., Ganger R., Kircher S.G. Craniosynostosis, Scheuermann's disease, and intellectual disability resembling Shprintzen–Goldberg syndrome: a report on a family over 4 generations. Medicine (Baltimore). 2017 Mar; 96 (12): e6199.]