Prevalence of skin manifestations in patients with COVID-19: a systematic review and meta-analysis

Beatriz Regina Lima de Aguiar; Elaine Barros Ferreira; Graziela De Luca Canto; Eliete Neves Silva Guerra; Paula Elaine Diniz Dos Reis

doi:10.3389/fmed.2024.1390775

Prevalence of skin manifestations in patients with COVID-19: a systematic review and meta-analysis

Front Med (Lausanne). 2024 Aug 21:11:1390775. doi: 10.3389/fmed.2024.1390775. eCollection 2024.

Authors

Beatriz Regina Lima de Aguiar^#^{1

2}, Elaine Barros Ferreira^#², Graziela De Luca Canto^#³, Eliete Neves Silva Guerra^#^{1

2

4}, Paula Elaine Diniz Dos Reis^#^{1

2}

Affiliations

¹ Health Science Graduate Program, School of Health Sciences, University of Brasilia, Brasília, Brazil.
² Interdisciplinary Laboratory of Research Applied to Clinical Practice in Oncology, School of Health Sciences, University of Brasilia, Brasília, Brazil.
³ Department of Dentistry, Brazilian Centre for Evidence-Based Research, Federal University of Santa Catarina, Florianopolis, Brazil.
⁴ Laboratory of Oral Histopathology, School of Health Sciences, University of Brasilia, Brasília, Brazil.

^# Contributed equally.

Abstract

Background: COVID-19 presents extrapulmonary manifestations that can aid in the diagnosis. Skin manifestations have been reported but their characteristics are not yet clear. Health professionals need information about its prevalence and main characteristics.

Methods: This systematic review followed the PRISMA criteria. The protocol was registered in the PROSPERO (number CRD42020193173). Seven electronic databases and the gray literature were searched independently by two researchers. Observational analytical studies that presented data on the prevalence of skin manifestations in patients aged 19 or older with COVID-19 were included. Prevalence estimates were synthesized through a meta-analysis using random-effects models. Association meta-analysis and comparisons were performed for individual characteristics.

Results: We included 31 studies with 10,934 patients, of which 10,121 tested positive for COVID-19. The general prevalence of skin manifestations was 29% (95% CI: 17.0-43.0; I²: 99%), the most in Africa, with a mean duration between 7 and 9 days and the most frequently affecting feet+hands (75%) and the trunk (71%). Patients with mild/moderate COVID-19 had more of chilblain-like+pernio-like lesions (97%) and inflammatory lesions (86%) than patients with severe or critical COVID-19. Manifestations of vascular origin were only in elderly patients and were significant with the severity of COVID-19 (p = 0).

Conclusion: The global prevalence of skin manifestations is similar to other signs and symptoms of COVID-19. Skin assessment should be considered when investigating and diagnosing COVID-19 in adult and elderly patients.Systematic review registration: PROSPERO, identifier CRD42020193173, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193173.

Keywords: COVID-19; adult; aged; meta-analysis; skin manifestation; systematic review.

Publication types

Systematic Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This systematic review was supported by FINATEC (Fundação de Empreendimentos Científicos e Tecnológico) and DPI-COPEI of the University of Brasilia through a research grant under process number 23106.104670/2021–54. BA was a doctoral fellow by CAPES (Coordination for the Improvement of Higher Education Personnel). GL, EG, and PR were research fellows by CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico), Ministry of Science and Technology, Brazil.