Cutaneous manifestation during COVID-19 pandemic
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, causing COVID-19, poses novel challenges for all physicians since the novel coronavirus can often be responsible for unusual and unsuspected pictures. There have been increasing reports of various cutaneous manifestations for COVID-19, until recent reports of Kawasaki disease, even if the virus does not seem dermatotropic.

Different cutaneous clinical patterns were described, showing a wide polymorphism.
1) Erythematous rash
The evidence of erythematous rash was reported in several case series of COVID-19 patients. In 14/18 patients (77.8%) with confirmed COVID-19 this was the skin manifestation.

2) Maculopapular exanthem
A review article analyzed 6 case series and 12 case reports identified in the maculopapular exanthem (morbilliform) as the most common cutaneous manifestation of COVID-19 since it was found to be present in 36.1% (26/72) patients.

3) Urticaria and urticaria-like rush
Several case reports described urticaria or urticariform rush in COVID-19 patients, mostly distributed in the trunk and often before the onset of fever or respiratory symptoms. Among patients with confirmed COVID-19 and skin manifestations, the prevalence of urticaria varies from 9.7% to 16.7%.

4) Chickenpox-like vesicles
Case reports described varicella-like papulovesicular exanthem. (5.6%) patients with confirmed COVID-19 had this skin manifestations but current reports show a higher prevalence of this manifestation, raising to 34.7%.

5) Acral ischemic lesions
COVID-19 could be responsible for coagulation disorders, increasing the D-dimer and fibrinogen degradation products, and leading to acro-ischemia with finger and toe cyanosis. Other case reports described acro-ischemia in children and critical patients, or acral ischemic lesions presenting as red-purple papules. Painful acral red-purple papules were reported in 15.3% of patients with COVID-19 and skin lesions.

6) Other less frequent cutaneous manifestations were described, in adults and the pediatric population, such as livedo reticularis lesions, a rash mistaken for dengue, rash with petechiae, and confluent erythematous yellowish plaques in the heels,

7) Kawasaki-like disease. It is an acute febrile vasculitis that usually affects children less than 5 years old. The early recognition of KD and KDSS and the prompt referral to a hospital setting is essential to prevent complications and to improve the outcome of these patients. However, even if data suggest an association between SARS-CoV-2 infection and KD, some caution is needed in concluding that the novel coronavirus is a trigger for KD.