CUTANEOUS MANIFESTATIONS OF POST-COVID SYNDROME

Authors:

Abstract:

Cutaneous manifestations after coronavirus disease 2019 remain clinically relevant because they may persist after apparent recovery, recur during the postinfectious period, or reveal immune and vascular disturbances that require differential diagnosis. This literature review summarized publications indexed in PubMed and Scopus from 2021 to 2026 that addressed skin and hair changes associated with post-COVID syndrome. The analysis showed that the most frequently discussed dermatological consequences are telogen effluvium, urticarial and maculopapular eruptions, chilblain-like lesions, livedoid and purpuric changes, small-vessel vasculitis, and reactivation or aggravation of chronic dermatoses. The diagnostic approach should be based on a history of confirmed or probable coronavirus disease 2019, timing of lesion onset, clinical morphology, dermoscopic assessment when needed, laboratory markers of inflammation and coagulation in selected patients, and exclusion of drug reactions, autoimmune disease, and other infections. Treatment should be individualized and should prioritize dermatological evaluation, supportive care, anti-inflammatory and antihistamine therapy, topical agents, vascular risk assessment, and referral for systemic therapy only when clinically justified.

Keywords:

long COVID skin lesions telogen effluvium cutaneous vasculitis urticaria chilblain-like lesions dermatological diagnosis

References:

1. Abrantes TF, Artounian KA, Falsey R, Jeunon T, Ezzedine K, Lupi O. Time of onset and duration of post-COVID-19 acute telogen effluvium. J Am Acad Dermatol. 2021;85(4):975-976. doi: 10.1016/j.jaad.2021.07.021.
2. Asakura H, Ogawa H. COVID-19-associated coagulopathy and disseminated intravascular coagulation. Int J Hematol. 2021;113(1):45-57. doi: 10.1007/s12185-020-03029-y.
3. Bostan E, Yalici-Armagan B. Effect of COVID-19 on hair diseases observed by health professionals. Dermatol Pract Concept. 2023;13(1):e2023024. doi: 10.5826/dpc.1301a24.
4. Cayón Figueroa BA, Mendoza Rojas W, Tiburcio Jiménez D. Dermatological complications due to post-COVID-19 syndrome: A systematic review. Med Int (Lond). 2025;5(1):9. doi: 10.3892/mi.2024.208.
5. Conforti C, Dianzani C, Agozzino M, Giuffrida R, Marangi GF, Meo ND, et. al. Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review. Biology (Basel). 2020;9(12):449. doi: 10.3390/biology9120449.
6. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21(3):133-146. doi: 10.1038/s41579-022-00846-2.
7. Genovese G, Moltrasio C, Berti E, Marzano AV. Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives. Dermatology. 2021;237(1):1-12. doi: 10.1159/000512932.
8. Gisondi P, Piaserico S, Naldi L, Dapavo P, Conti A, Malagoli P, et. al. Incidence rates of hospitalization and death from COVID-19 in patients with psoriasis receiving biological treatment. J Allergy Clin Immunol. 2021;147(2):558-560.e1. doi: 10.1016/j.jaci.2020.10.032.
9. Grainger R, Machado PM, Robinson PC. Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes. Best Pract Res Clin Rheumatol. 2021;35(1):101657. doi: 10.1016/j.berh.2020.101657.
10. Guimarães D, Pissarra R, Reis-Melo A, Guimarães H. Multisystem inflammatory syndrome in children: a systematic review. Int J Clin Pract. 2021;75(11):e14450. doi: 10.1111/ijcp.14450.
11. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et. al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232. doi: 10.1016/S0140-6736(20)32656-8.
12. Ică OM, Mitroi G, Ianoşi SL, Tutunaru CV, Leru PM, Matei D, et. al. Defining the short-term and long-term skin manifestations of COVID-19: insights after more than three years of the pandemic. Rom J Morphol Embryol. 2023;64(3):291-304. doi: 10.47162/RJME.64.3.01.
13. Inamadar AC, Palit A. Covid Induced Telogen Effluvium (CITE): An Insight. Indian Dermatol Online J. 2022;13(4):445-448. doi: 10.4103/idoj.idoj_342_22.
14. Leisman DE, Ronner L, Pinotti R, Taylor MD, Sinha P, Calfee CS, et. al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med. 2020;8(12):1233-1244. doi: 10.1016/S2213-2600(20)30404-5.
15. Martora F, Villani A, Fabbrocini G, Battista T, Marasca C. COVID-19 and cutaneous manifestations: A review of the published literature. J Cosmet Dermatol. 2023;22(1):4-10. doi: 10.1111/jocd.15477.
16. Miranda BH, Farjo B, Wambier CG, Shapiro J, Sinclair R. Hair loss following COVID-19 infection: a multicenter prospective study. Int J Dermatol. 2021;60(9):1106-1110. doi: 10.1111/ijd.15702.
17. Mirza FN, Malik AA, Omer SB, Sethi A. Dermatologic manifestations of COVID-19: a comprehensive systematic review. Int J Dermatol. 2021;60(4):418-450. doi: 10.1111/ijd.15168.
18. Moltrasio C, Berti E, Marzano AV. Skin manifestations of COVID-19: from the acute phase to long COVID. Clin Dermatol. 2021;39(4):640-650. doi: 10.1016/j.clindermatol.2021.01.005.
19. Munblit D, Nicholson TR, Needham DM, Seylanova N, Parr C, Chen J, et. al. Studying the post-COVID-19 condition: research challenges, strategies, and importance of Core Outcome Set development. BMC Med. 2022;20(1):50. doi: 10.1186/s12916-021-02222-y.
20. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et. al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615. doi: 10.1038/s41591-021-01283-z.
21. Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun. 2021;117:102592. doi: 10.1016/j.jaut.2020.102592.
22. Olson KO, Patel S, Pathak P, Kelly LP, Antony MA, Thiriveedi M. Cutaneous small vessel vasculitis in the COVID-19 era: a systematic review. Skin Health Dis. 2025;5(2):114-123. doi: 10.1093/skinhd/vzaf004.
23. Peng C, Wang H, Guo YF, Qi GY, Zhang CX, Chen T, et. al. Calcium channel blockers improve prognosis of patients with coronavirus disease 2019 and hypertension. Chin Med J (Engl). 2021;134(13):1602-1609. doi: 10.1097/CM9.0000000000001479.
24. Puig-Domingo M, Marazuela M, Yildiz BO, Giustina A. COVID-19 and endocrine and metabolic diseases. An updated statement from the European Society of Endocrinology. Endocrine. 2021;72(2):301-316. doi: 10.1007/s12020-021-02734-w.
25. Razi-Soofiyani S, Daneshvar A, Mohebbi A, Farhadi E, Rostami-Nejad M. Vasculitis syndromes: the pathogenic roles of COVID-19 and COVID-19 vaccines. Virol J. 2025;22(1):118. doi: 10.1186/s12985-025-03032-x.
26. Sharquie KE, Jabbar RI. COVID-19 infection is a major cause of acute telogen effluvium. Ir J Med Sci. 2022;191(4):1677-1681. doi: 10.1007/s11845-021-02754-5.
27. Silaghi-Dumitrescu R, Patrascu I, Lehene M, Bercea I. Comorbidities of COVID-19 Patients. Medicina (Kaunas). 2023;59(8):1393. doi: 10.3390/medicina59081393.
28. Singh S, Offringa-Hup AK, Logtenberg SJJ, Van der Linden PD, Janssen WMT, Klein H, et. al. Discontinuation of antihypertensive medications on the outcome of hospitalized patients with severe acute respiratory syndrome coronavirus 2. Hypertension. 2021;78(1):165-173. doi: 10.1161/HYPERTENSIONAHA.121.17328.
29. Talwar S, Harker JA, Openshaw PJM, Thwaites RS. Autoimmunity in long COVID. J Allergy Clin Immunol. 2025;155(4):1082-1094. doi: 10.1016/j.jaci.2025.02.005.
30. Tesanovic Perkovic D, Grabovac S, Novak-Bilic G, Vlahovic T. Post COVID telogen effluvium. Acta Dermatovenerol Croat. 2022;30(4):254-256. doi: 10.15570/actaapa.2022.34.
31. Visconti A, Bataille V, Rossi N, Kluk J, Murphy R, Puig S, et. al. Diagnostic value of cutaneous manifestation of SARS-CoV-2 infection. Br J Dermatol. 2021;184(5):880-887. doi: 10.1111/bjd.19807.
32. Weatherhead JE, Clark E, Vogel TP, Atmar RL, Kulkarni PA. Inflammatory syndromes associated with SARS-CoV-2 infection: dysregulation of the immune response across the age spectrum. J Clin Invest. 2020;130(12):6194-6197. doi: 10.1172/JCI145301.
33. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et. al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324(3):259-269. doi: 10.1001/jama.2020.10369.
34. Zimmermann P, Pittet LF, Curtis N. How common is long COVID in children and adolescents? Pediatr Infect Dis J. 2021;40(12):e482-e487. doi: 10.1097/INF.0000000000003328.

Publication:

«World of Medicine and Biology» Vol. 22 No. 96 (2026) , с. 221-225
УДК 616.5-022.6:616.98:578.834.1-06

DOI:

https://doi.org/10.26724/2079-8334-2026-2-96-221-225