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Erschienen in: Die Pathologie 1/2022

05.10.2022 | COVID-19 | Hauptreferate: Hauptprogramm der DGP

Dermatopathology of COVID-19 infection and vaccination

verfasst von: María-Teresa Fernández-Figueras

Erschienen in: Die Pathologie | Sonderheft 1/2022

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Abstract

Background

Many peculiar skin changes have been described in relation to both coronavirus disease 2019 (COVID-19) infection and vaccination.

Objective

This paper provides an overview of these dermatologic manifestations, focusing on their dermatopathological appearances.

Results

Most COVID-19 patients develop variegated maculopapular eruptions with a combination of histological patterns commonly including keratinocyte apoptosis and eosinophilia. Urticaria-like lesions often show a combination of spongiotic and lichenoid patterns and are more frequent in individuals with severe disease. Vesicular lesions can be disseminated; in some cases, they become pustular and in others show dyskeratosis and a peculiar form of ballooning. Some patients develop vesicular Grover disease on the trunk. Young patients with a strong immunological response can eliminate the virus easily but may develop chilblains as a consequence of the high interferon response. Conversely, older individuals with immunosenescence and a tendency toward hypercoagulability can present livedoid and ischemic areas. Regarding COVID-19 vaccination, hypersensitivity reactions are most frequent, including “COVID-arm.” Nonetheless, a combination of local and systemic cutaneous manifestations (reactogenicity) is commonly seen. Histopathologically, lichenoid and spongiotic changes and a variable number of eosinophils are typical of rashes characterized by papules and plaques. Other dermatological side effects of COVID-19 vaccination include lesions mimicking well-defined dermatoses such as lichen planus or bullous pemphigoid and triggering of collagenous diseases.

Conclusion

Well-characterized skin manifestations of coronavirus disease 2019 (COVID-19) include chilblains, livedo necrotic lesions, vesicular eruptions, urticarial lesions, and maculopapular eruptions. Hypersensitivity reactions are common after SARS-CoV‑2 mRNA vaccination. Vaccine reactions may also mimic other dermatosis such as bullous pemphigoid or lichen planus, stimulate herpes reactivation, or trigger the development of autoimmune diseases.
Literatur
1.
Zurück zum Zitat Tan SW, Tam YC, Oh CC (2021) Skin manifestations of COVID-19: a worldwide review. JAAD Int 2:119–133CrossRef Tan SW, Tam YC, Oh CC (2021) Skin manifestations of COVID-19: a worldwide review. JAAD Int 2:119–133CrossRef
2.
Zurück zum Zitat Fernandez-Nieto D, Ortega-Quijano D, Suarez-Valle A et al (2021) Lack of skin manifestations in COVID-19 hospitalized patients during the second epidemic wave in Spain: a possible association with a novel SARS-CoV‑2 variant—a cross-sectional study. J Eur Acad Dermatol Venereol 35:e183–e185CrossRef Fernandez-Nieto D, Ortega-Quijano D, Suarez-Valle A et al (2021) Lack of skin manifestations in COVID-19 hospitalized patients during the second epidemic wave in Spain: a possible association with a novel SARS-CoV‑2 variant—a cross-sectional study. J Eur Acad Dermatol Venereol 35:e183–e185CrossRef
3.
Zurück zum Zitat Wang CJ, Worswick S (2021) Cutaneous manifestations of COVID-19. Dermatol Online J 27:13030/qt2m54r7nvCrossRef Wang CJ, Worswick S (2021) Cutaneous manifestations of COVID-19. Dermatol Online J 27:13030/qt2m54r7nvCrossRef
4.
Zurück zum Zitat Gambichler T, Boms S, Susok L et al (2022) Cutaneous findings following COVID-19 vaccination: review of world literature and own experience. Acad Dermatol Venereol 36:172–180CrossRef Gambichler T, Boms S, Susok L et al (2022) Cutaneous findings following COVID-19 vaccination: review of world literature and own experience. Acad Dermatol Venereol 36:172–180CrossRef
5.
Zurück zum Zitat Galván Casas C, Català A, Carretero Hernández G et al (2020) Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 183:71–77CrossRef Galván Casas C, Català A, Carretero Hernández G et al (2020) Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 183:71–77CrossRef
6.
Zurück zum Zitat Battesti G, El Khalifa J, Abdelhedi N et al (2020) New insights in COVID-19-associated chilblains: a comparative study with chilblain lupus erythematosus. J Am Acad Dermatol 83:1219–1222CrossRef Battesti G, El Khalifa J, Abdelhedi N et al (2020) New insights in COVID-19-associated chilblains: a comparative study with chilblain lupus erythematosus. J Am Acad Dermatol 83:1219–1222CrossRef
7.
Zurück zum Zitat Seirafianpour F, Sodagar S, Pour MA et al (2020) Cutaneous manifestations and considerations in COVID-19 pandemic: a systematic review. Dermatol Ther 33:e13986CrossRef Seirafianpour F, Sodagar S, Pour MA et al (2020) Cutaneous manifestations and considerations in COVID-19 pandemic: a systematic review. Dermatol Ther 33:e13986CrossRef
8.
Zurück zum Zitat Gehlhausen JR, Little AJ, Ko CJ et al (2022) Lack of association between pandemic chilblains and SARS-CoV‑2 infection. Proc Natl Acad Sci U S A 119:e2122090119CrossRef Gehlhausen JR, Little AJ, Ko CJ et al (2022) Lack of association between pandemic chilblains and SARS-CoV‑2 infection. Proc Natl Acad Sci U S A 119:e2122090119CrossRef
9.
Zurück zum Zitat Kolivras A, Dehavay F, Delplace D et al (2020) Coronavirus (COVID-19) infection-induced chilblains: a case report with histopathologic findings. JAAD Case Rep 6:489–492CrossRef Kolivras A, Dehavay F, Delplace D et al (2020) Coronavirus (COVID-19) infection-induced chilblains: a case report with histopathologic findings. JAAD Case Rep 6:489–492CrossRef
10.
Zurück zum Zitat Rongioletti F, Ferreli C, Sena P et al (2021) Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns. Clin Dermatol 39:149–162CrossRef Rongioletti F, Ferreli C, Sena P et al (2021) Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns. Clin Dermatol 39:149–162CrossRef
11.
Zurück zum Zitat Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J et al (2020) Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital. Clin Exp Dermatol 45:872–875CrossRef Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J et al (2020) Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital. Clin Exp Dermatol 45:872–875CrossRef
12.
Zurück zum Zitat Llamas-Velasco M, Chicharro P, Rodríguez-Jiménez PM et al (2020) Comment on “Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital”. Pseudoherpetic Grover disease seems to occur in patients with COVID-19 infection. Clin Exp Dermatol 45:896–898CrossRef Llamas-Velasco M, Chicharro P, Rodríguez-Jiménez PM et al (2020) Comment on “Clinical and histological characterization of vesicular COVID-19 rashes: a prospective study in a tertiary care hospital”. Pseudoherpetic Grover disease seems to occur in patients with COVID-19 infection. Clin Exp Dermatol 45:896–898CrossRef
13.
Zurück zum Zitat Egido-Moreno S, Valls-Roca-Umbert J, Jané-Salas E et al (2021) COVID-19 and oral lesions, short communication and review. J Clin Exp Dent 13:e287–e294CrossRef Egido-Moreno S, Valls-Roca-Umbert J, Jané-Salas E et al (2021) COVID-19 and oral lesions, short communication and review. J Clin Exp Dent 13:e287–e294CrossRef
14.
Zurück zum Zitat Andina D, Belloni-Fortina A, Bodemer C et al (2021) Skin manifestations of COVID-19 in children: part 3. Clin Exp Dermatol 46:462–472CrossRef Andina D, Belloni-Fortina A, Bodemer C et al (2021) Skin manifestations of COVID-19 in children: part 3. Clin Exp Dermatol 46:462–472CrossRef
15.
Zurück zum Zitat Gracia-Ramos AE, Martin-Nares E, Hernández-Molina G (2021) New onset of autoimmune diseases following COVID-19 diagnosis. Cells 10:3592CrossRef Gracia-Ramos AE, Martin-Nares E, Hernández-Molina G (2021) New onset of autoimmune diseases following COVID-19 diagnosis. Cells 10:3592CrossRef
17.
Zurück zum Zitat Fernández-Figueras M‑T, Moreno JA, Pérez-Muñoz N et al (2021) Disseminated inflammatory lesions in 2 patients with COVID-19: answer. Am J Dermatopathol 43:459–460CrossRef Fernández-Figueras M‑T, Moreno JA, Pérez-Muñoz N et al (2021) Disseminated inflammatory lesions in 2 patients with COVID-19: answer. Am J Dermatopathol 43:459–460CrossRef
18.
Zurück zum Zitat Lee JY, Ang ASY, Mohd AN et al (2021) Incidence of adverse reaction of drugs used in COVID-19 management: a retrospective, observational study. J of Pharm Policy and Pract 14:84CrossRef Lee JY, Ang ASY, Mohd AN et al (2021) Incidence of adverse reaction of drugs used in COVID-19 management: a retrospective, observational study. J of Pharm Policy and Pract 14:84CrossRef
19.
Zurück zum Zitat Ohadi L, Hosseinzadeh F, Dadkhahfar S, Nasiri S (2022) Oncolytic effect of SARS-CoV‑2 in a patient with mycosis fungoides: a case report. Clin Case Rep 10:e5682CrossRef Ohadi L, Hosseinzadeh F, Dadkhahfar S, Nasiri S (2022) Oncolytic effect of SARS-CoV‑2 in a patient with mycosis fungoides: a case report. Clin Case Rep 10:e5682CrossRef
20.
Zurück zum Zitat Snowden C, Ng S, Choi J (2022) Partial remission of advanced untreated Sézary syndrome after COVID-19. JAAD Case Rep 21:165–168CrossRef Snowden C, Ng S, Choi J (2022) Partial remission of advanced untreated Sézary syndrome after COVID-19. JAAD Case Rep 21:165–168CrossRef
21.
Zurück zum Zitat Sun Q, Fathy R, McMahon DE, Freeman EE (2021) COVID-19 vaccines and the skin. Dermatol Clin 39:653–673CrossRef Sun Q, Fathy R, McMahon DE, Freeman EE (2021) COVID-19 vaccines and the skin. Dermatol Clin 39:653–673CrossRef
22.
Zurück zum Zitat Freeman EE, Sun Q, McMahon DE et al (2022) Skin reactions to COVID-19 vaccines: an American Academy of Dermatology/International League of Dermatological Societies registry update on reaction location and COVID vaccine type. J Am Acad Dermatol 86:e165–e167CrossRef Freeman EE, Sun Q, McMahon DE et al (2022) Skin reactions to COVID-19 vaccines: an American Academy of Dermatology/International League of Dermatological Societies registry update on reaction location and COVID vaccine type. J Am Acad Dermatol 86:e165–e167CrossRef
23.
Zurück zum Zitat Kempf W, Kettelhack N, Kind F et al (2021) ‘COVID arm’—histological features of a delayed-type hypersensitivity reaction to Moderna mRNA-1273 SARS-CoV2 vaccine. J Eur Acad Dermatol Venereol 35:e730–e732CrossRef Kempf W, Kettelhack N, Kind F et al (2021) ‘COVID arm’—histological features of a delayed-type hypersensitivity reaction to Moderna mRNA-1273 SARS-CoV2 vaccine. J Eur Acad Dermatol Venereol 35:e730–e732CrossRef
24.
Zurück zum Zitat Chen Y, Xu Z, Wang P et al (2022) New-onset autoimmune phenomena post-COVID-19 vaccination. Immunology 165:386–401CrossRef Chen Y, Xu Z, Wang P et al (2022) New-onset autoimmune phenomena post-COVID-19 vaccination. Immunology 165:386–401CrossRef
25.
Zurück zum Zitat Lee E, Cines DB, Gernsheimer T et al (2021) Thrombocytopenia following Pfizer and Moderna SARS-CoV‑2 vaccination. Am J Hematol 96:534–537CrossRef Lee E, Cines DB, Gernsheimer T et al (2021) Thrombocytopenia following Pfizer and Moderna SARS-CoV‑2 vaccination. Am J Hematol 96:534–537CrossRef
26.
Zurück zum Zitat McMahon DE, Amerson E, Rosenbach M et al (2021) Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases. J Am Acad Dermatol 85:46–55CrossRef McMahon DE, Amerson E, Rosenbach M et al (2021) Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases. J Am Acad Dermatol 85:46–55CrossRef
27.
Zurück zum Zitat Kong J, Cuevas-Castillo F, Nassar M et al (2021) Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: case report. J Infect Public Health 14:1392–1394CrossRef Kong J, Cuevas-Castillo F, Nassar M et al (2021) Bullous drug eruption after second dose of mRNA-1273 (Moderna) COVID-19 vaccine: case report. J Infect Public Health 14:1392–1394CrossRef
28.
Zurück zum Zitat Merrill ED, Kashem SW, Amerson EH et al (2021) Association of facial pustular neutrophilic eruption with messenger RNA-1273 SARS-CoV‑2 vaccine. JAMA Dermatol 157:1128–1130CrossRef Merrill ED, Kashem SW, Amerson EH et al (2021) Association of facial pustular neutrophilic eruption with messenger RNA-1273 SARS-CoV‑2 vaccine. JAMA Dermatol 157:1128–1130CrossRef
29.
Zurück zum Zitat Panou E, Nikolaou V, Marinos L et al (2022) Recurrence of cutaneous T‑cell lymphoma post viral vector COVID-19 vaccination. Acad Dermatol Venereol 36:e91–e93CrossRef Panou E, Nikolaou V, Marinos L et al (2022) Recurrence of cutaneous T‑cell lymphoma post viral vector COVID-19 vaccination. Acad Dermatol Venereol 36:e91–e93CrossRef
Metadaten
Titel
Dermatopathology of COVID-19 infection and vaccination
verfasst von
María-Teresa Fernández-Figueras
Publikationsdatum
05.10.2022

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