Proposal for Clinical Classification of Cutaneous Manifestations in Covid-19 and in Post Vaccination Against Sars-Cov-2: An Observational Study

Background: This is a clinical evaluation of patients with the incident, acute, or related cutaneous manifestations associated with coronavirus disease 2019 (COVID-19) and/or vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives: We aimed to propose a classification of dermatological manifestations related to either COVID-19 or vaccination against SARS-CoV-2. Methods: In an observational descriptive study, a classification of cutaneous manifestations is proposed based on groups of etiological hypotheses, which came from a systematic characterization and record of the observed skin lesions of patients who were evaluated personally and via teleconsultation from July 2020 to July 2022 in two reference dermatology services located in the state of Mato Grosso, Brazil. Results: A total of 108 patients were included. Eighty-six patients (79.6%) had incident, acute, or COVID-19-related skin manifestations, 15 (13.9%) had dermatological lesions exclusively after vaccination against SARS-CoV-2, and seven (6.5%) %) had cutaneous manifestations related to both COVID-19 and the vaccine. A total of 143 different dermatological manifestations were diagnosed, for which different etiological hypotheses were established based on the clinical and evolutionary characteristics of the lesion, the use of concomitant medications, and the temporal link with COVID-19 and/or the vaccine against SARS-CoV-2. The observed skin manifestations were classified as peri-infectious and post-infectious immune-inflammatory reactions related to COVID-19 (62.2%); exacerbation, by COVID-19, of pre-existing skin diseases in the patient (4.2%); skin manifestations resulting from the socio-sanitary context of the pandemic (2.1%); adverse drug reactions from the treatment of COVID-19 (14%); and adverse skin reactions from SARS-CoV-2 vaccines (17.5%). Conclusions: The proposed clinical classification may assist physicians who are faced with dermatological lesions associated with COVID-19 or after active immunization against SARS-CoV-2.