关注新型冠状病毒感染后重症皮肤病

doi:10.35541/cjd.20230339

Abstract

Abstract: 【Abstract】 Since the outbreak of COVID-19, many skin diseases related to or secondary to COVID-19 have been reported globally, and the infection can trigger or exacerbate skin diseases and other systemic symptoms. The review aims to discuss the manifestations and management of severe skin diseases following COVID-19, such as systemic lupus erythematosus, severe psoriasis, pemphigus, dermatomyositis, and Beh?et's syndrome, with the goal of improving the diagnosis and treatment of severe skin diseases after COVID-19.

Key words: COVID-19, Severe skin disease, Therapy, Lupus erythematosus, systemic, Psoriasis, Pemphigus, Dermatomyositis

Li Ziyu, Lu Yan. Paying attention to severe skin diseases after COVID-19[J]. Chinese Journal of Dermatology, 2025, 58(4): 378-383.doi:10.35541/cjd.20230339

References ［63］

［1］	鲁严, 骆丹, 张美华. 危重皮肤病救治［M］. 北京: 人民卫生出版社, 2013.
［2］	Mohaghegh F, Hatami P, Refaghat A, et al. New⁃onset pemphigus foliaceus following SARS⁃CoV⁃2 infection and unmasking multiple sclerosis: a case report［J］. Clin Case Rep, 2022,10（6）:e05910. doi: 10.1002/ccr3.5910.
［3］	Narang I, Panthagani AP, Lewis M, et al. COVID⁃19⁃induced toxic epidermal necrolysis［J］. Clin Exp Dermatol, 2021,46（5）:927⁃929. doi: 10.1111/ced.14574.
［4］	Fernandez⁃Ruiz R, Paredes JL, Niewold TB. COVID⁃19 in patients with systemic lupus erythematosus: lessons learned from the inflammatory disease［J］. Transl Res, 2021,232:13⁃36. doi: 10.1016/j.trsl.2020.12.007.
［5］	Tsang⁃A⁃Sjoe M, Bultink I. New developments in systemic lupus erythematosus［J］. Rheumatology （Oxford）, 2021,60（Suppl 6）:vi21⁃vi28. doi: 10.1093/rheumatology/keab498.
［6］	Gianfrancesco M, Hyrich KL, Al⁃Adely S, et al. Characteristics associated with hospitalisation for COVID⁃19 in people with rheumatic disease: data from the COVID⁃19 Global Rheumatology Alliance physician⁃reported registry［J］. Ann Rheum Dis, 2020,79（7）:859⁃866. doi: 10.1136/annrheumdis⁃2020⁃217871.
［7］	Bennardo L, Nisticò SP, Dastoli S, et al. Erythema multiforme and COVID⁃19: what do we know?［J］. Medicina （Kaunas）, 2021,57（8）:828. doi: 10.3390/medicina57080828.
［8］	Ruiz⁃Ordóñez I, Santos VA, Bonilla⁃Abadía F, et al. Lymphoid follicular hyperplasia in patients with systemic lupus erythematosus after multiple cycles of rituximab［J］. Mod Rheumatol Case Rep, 2023,7（1）:78⁃81. doi: 10.1093/mrcr/rxac066.
［9］	Levy G, Guglielmelli P, Langmuir P, et al. JAK inhibitors and COVID⁃19［J］. J Immunother Cancer, 2022,10（4）:e002838. doi: 10.1136/jitc⁃2021⁃002838.
［10］	Zhou B, Li S, Ye J, et al. Immunopathological events surrounding IL⁃6 and IFN⁃α: a bridge for anti⁃lupus erythematosus drugs used to treat COVID⁃19［J］. Int Immunopharmacol, 2021,101（Pt B）:108254. doi: 10.1016/j.intimp.2021.108254.
［11］	Mason A, Rose E, Edwards CJ. Clinical management of Lupus patients during the COVID⁃19 pandemic［J］. Lupus, 2020,29（13）:1661⁃1672. doi: 10.1177/0961203320961848.
［12］	Goyal PK, Mohammed TO, Mahmoud A, et al. COVID⁃19 infection leading to acute pustular dermatoses［J］. Arch Dermatol Res, 2023,315（4）:685⁃697. doi: 10.1007/s00403⁃022⁃02450⁃z.
［13］	Kutlu Ö, Metin A. A case of exacerbation of psoriasis after oseltamivir and hydroxychloroquine in a patient with COVID⁃19: Will cases of psoriasis increase after COVID⁃19 pandemic?［J］. Dermatol Ther, 2020,33（4）:e13383. doi: 10.1111/dth.13383.
［14］	Shakoei S, Ghanadan A, Hamzelou S. Pustular psoriasis exacerbated by COVID⁃19 in a patient with the history of psoriasis［J］. Dermatol Ther, 2020,33（6）:e14462. doi: 10.1111/dth.14462.
［15］	Shahidi Dadras M, Diab R, Ahadi M, et al. Generalized pustular psoriasis following COVID⁃19［J］. Dermatol Ther, 2021,34（1）:e14595. doi: 10.1111/dth.14595.
［16］	Peng G, Okumura K, Ogawa H, et al. Psoriatic lesional expression of SARS⁃CoV⁃2 receptor ACE2 is reduced by blockade of IL⁃17 signaling but not by other biologic treatments［J］. J Am Acad Dermatol, 2022,87（3）:714⁃715. doi: 10.1016/j.jaad.2022.01.041.
［17］	Xu Q, Chen L, Li X, et al. If skin is a potential host of SARS⁃CoV⁃2, IL⁃17 antibody could reduce the risk of COVID⁃19［J］. J Am Acad Dermatol, 2021,84（3）:e173. doi: 10.1016/j.jaad.2020. 10.084.
［18］	Gisondi P, Facheris P, Dapavo P, et al. The impact of the COVID⁃19 pandemic on patients with chronic plaque psoriasis being treated with biological therapy: the Northern Italy experience［J］. Br J Dermatol, 2020,183（2）:373⁃374. doi: 10.1111/bjd.19158.
［19］	Kamal K, Riew GJ, Hijaz B, et al. Generalized pustular psoriasis⁃like widespread eruption following COVID⁃19 infection in a patient with spondyloarthropathy on adalimumab［J］. Exp Dermatol, 2024,33（1）:e14889. doi: 10.1111/exd.14889.
［20］	Samotij D, Gawron E, Szczęch J, et al. Acrodermatitis continua of hallopeau evolving into generalized pustular psoriasis following COVID⁃19: a case report of a successful treatment with infliximab in combination with acitretin［J］. Biologics, 2021,15:107⁃113. doi: 10.2147/BTT.S302164.
［21］	Sadeghinia A, Daneshpazhooh M. Immunosuppressive drugs for patients with psoriasis during the COVID⁃19 pandemic era. A review［J］. Dermatol Ther, 2021,34（1）:e14498. doi: 10.1111/dth.14498.
［22］	Bashyam AM, Feldman SR. Should patients stop their biologic treatment during the COVID⁃19 pandemic［J］. J Dermatolog Treat, 2020,31（4）:317⁃318. doi: 10.1080/09546634.2020.1742438.
［23］	Wang G, Gu H,Zheng M, et al.Experts opinion on the use of biologic agents in psoriatic patients during COVID⁃19 outbreak［J］. Int J Dermatol Venerol, 2020,3（2）:68⁃69. doi:10.1097/JD9. 0000000000000097.
［24］	Agharbi FZ, Basri G, Nejjari S, et al. Erythrodermic psoriasis following SARS⁃CoV⁃2 infection［J］. Actas Dermosifiliogr, 2024,115（2）:202⁃203. doi: 10.1016/j.ad.2022.07.014.
［25］	Mugheddu C, Pizzatti L, Sanna S, et al. COVID⁃19 pulmonary infection in erythrodermic psoriatic patient with oligodendroglioma: safety and compatibility of apremilast with critical intensive care management［J］. J Eur Acad Dermatol Venereol, 2020,34（8）:e376⁃e378. doi: 10.1111/jdv.16625.
［26］	Zhang L, Guo L, Wang L, et al. The efficacy and safety of tofacitinib, peficitinib, solcitinib, baricitinib, abrocitinib and deucravacitinib in plaque psoriasis ⁃ a network meta⁃analysis［J］. J Eur Acad Dermatol Venereol, 2022,36（11）:1937⁃1946. doi: 10.1111/jdv.18263.
［27］	Kim YH, Kang HY. Pemphigus vulgaris possibly associated with COVID⁃19 infection［J］. Cureus, 2023,15（1）:e33897. doi: 10.7759/cureus.33897.
［28］	Joly P, Maho⁃Vaillant M, Prost⁃Squarcioni C, et al. First⁃line rituximab combined with short⁃term prednisone versus prednisone alone for the treatment of pemphigus （Ritux 3）: a prospective, multicentre, parallel⁃group, open⁃label randomised trial［J］. Lancet, 2017,389（10083）:2031⁃2040. doi: 10.1016/S0140⁃6736（17）30070⁃3.
［29］	Kasperkiewicz M, Woodley DT. Association between vaccination and autoimmune bullous diseases: a systematic review［J］. J Am Acad Dermatol, 2022,86（5）:1160⁃1164. doi: 10.1016/j.jaad. 2021.04.061.
［30］	Breglio KF, Sarver MM, Hall RP 3rd, et al. SARS⁃CoV⁃2 infections in patients with autoimmune blistering disorders: A case series and retrospective analysis［J］. JAAD Int, 2022,7:38⁃43. doi: 10.1016/j.jdin.2022.01.003.
［31］	Uzuncakmak TK, Özkoca D, Askin O, et al. Can rituximab be used in the treatment of pemphigus vulgaris during the COVID⁃19 pandemic?［J］. Dermatol Ther, 2021,34（1）:e14647. doi: 10.1111/dth.14647.
［32］	Banciu ML, Dobrica C, Malciu AM, et al. Diagnosis and treatment challenges of an atypical case of pemphigus vulgaris during the COVID⁃19 pandemic［J］. Cureus, 2022,14（1）:e21739. doi: 10.7759/cureus.21739.
［33］	EULAR guidance for patients Covid⁃19 outbreak \| EULAR［EB/OL］. ［2024⁃08⁃18］. https://www.eular.org/eular⁃guidance⁃for⁃patients⁃covid19⁃outbreak.
［34］	Greenberg SA, Pinkus JL, Pinkus GS, et al. Interferon⁃alpha/beta⁃mediated innate immune mechanisms in dermatomyositis［J］. Ann Neurol, 2005,57（5）:664⁃678. doi: 10.1002/ana.20464.
［35］	Kondo Y, Kaneko Y, Takei H, et al. COVID⁃19 shares clinical features with anti⁃melanoma differentiation⁃associated protein 5 positive dermatomyositis and adult Still's disease［J］. Clin Exp Rheumatol, 2021,39（3）:631⁃638. doi: 10.55563/clinexprheumatol/ 44kaji.
［36］	Saud A, Naveen R, Aggarwal R, et al. COVID⁃19 and myositis: what we know so far［J］. Curr Rheumatol Rep, 2021,23（8）:63. doi: 10.1007/s11926⁃021⁃01023⁃9.
［37］	Gokhale Y, Patankar A, Holla U, et al. Dermatomyositis during COVID⁃19 pandemic （a case series）: is there a cause effect relationship?［J］. J Assoc Physicians India, 2020, 68（11）: 20⁃24.
［38］	Lakota K, Perdan⁃Pirkmajer K, Hočevar A, et al. COVID⁃19 in association with development, course, and treatment of systemic autoimmune rheumatic diseases［J］. Front Immunol, 2020,11:611318. doi: 10.3389/fimmu.2020.611318.
［39］	Kalil AC, Patterson TF, Mehta AK, et al. Baricitinib plus remdesivir for hospitalized adults with Covid⁃19［J］. N Engl J Med, 2021,384（9）:795⁃807. doi: 10.1056/NEJMoa2031994.
［40］	鲁锦玥, 沈海丽. 托法替布治疗MDA5阳性皮肌炎出现快速进展型间质性肺病1例［DB/OL］. 中国临床案例成果数据库, 2023,5（1）：E00021⁃E00021.doi:10.3760/cma.j.cmcr.2023.e00021.
［41］	Chen Z, Wang X, Ye S. Tofacitinib in amyopathic dermatomyositis⁃associated interstitial lung disease［J］. N Engl J Med, 2019,381（3）:291⁃293. doi: 10.1056/NEJMc1900045.
［42］	Pagh P, Rossau A⁃K. COVID⁃19⁃induced Stevens⁃Johnson syndrom［J］. Ugeskrift for Laeger, 2022,184（10）:V10210804.
［43］	Emadi SN, Hamzelou S, Saffarian Z, et al. Challenges in the treatment of a patient with toxic epidermal necrolysis associated with COVID⁃19: a case report［J］. Dermatol Ther, 2021,34（1）:e14656. doi: 10.1111/dth.14656.
［44］	Saha M, D'Cruz A, Paul N, et al. Toxic epidermal necrolysis and co⁃existent SARS⁃CoV⁃2 （COVID⁃19） treated with intravenous immunoglobulin: 'Killing 2 birds with one stone'［J］. J Eur Acad Dermatol Venereol, 2021,35（2）:e97⁃e98. doi: 10.1111/jdv. 16887.
［45］	谢小慧, 陈辉. 新型冠状病毒肺炎合并Stevens⁃Johnson综合征样皮损一例［J］. 中华皮肤科杂志, 2020,53（8）:649⁃650. doi: 10.35541/cjd.20200228.
［46］	Shahidi⁃Dadras M, Araghi F, Ahmadzadeh A, et al. TEN/SJS⁃like lupus erythematosus presentation complicated by COVID⁃19［J］. Dermatol Ther, 2021,34（1）:e14612. doi: 10.1111/dth.14612.
［47］	Robustelli Test E, Vezzoli P, Carugno A, et al. Acute generalized exanthematous pustulosis with erythema multiforme⁃like lesions induced by Hydroxychloroquine in a woman with coronavirus disease 2019 （COVID⁃19）［J］. J Eur Acad Dermatol Venereol, 2020,34（9）:e457⁃e459. doi: 10.1111/jdv.16613.
［48］	Cruz VB, Júnior L, Kobal CR, et al. Does sensitization by SARS⁃CoV⁃2 immune complexes trigger DRESS syndrome?［J］. Braz J Infect Dis, 2022,26（2）:102337. doi: 10.1016/j.bjid.2022.102337.
［49］	Balconi SN, Lopes NT, Luzzatto L, et al. Detection of SARS⁃CoV⁃2 in a case of DRESS by sulfasalazine: could there be a relationship with clinical importance?［J］. Int J Dermatol, 2021,60（1）:125⁃126. doi: 10.1111/ijd.15316.
［50］	Roujeau JC, Dupin N. Virus reactivation in drug reaction with eosinophilia and systemic symptoms （Dress） results from a strong drug⁃specific immune response［J］. J Allergy Clin Immunol Pract, 2017,5（3）:811⁃812. doi: 10.1016/j.jaip.2016. 11.027.
［51］	Ramirez GA, Della⁃Torre E, Tresoldi M, et al. Drug reaction with eosinophilia and systemic symptoms （DRESS） in patients with COVID⁃19［J］. Clin Microbiol Infect, 2021,27（8）:1190⁃1192. doi: 10.1016/j.cmi.2021.05.023.
［52］	Manjaly Thomas ZR, Leuppi⁃Taegtmeyer A, Jamiolkowski D, et al. Emerging treatments in COVID⁃19: adverse drug reactions including drug hypersensitivities［J］. J Allergy Clin Immunol, 2020,146（4）:786⁃789. doi: 10.1016/j.jaci.2020.07.008.
［53］	Elmas ÖF, Demirbaş A, Bağcıer F, et al. Treatment considerations for Behçet disease in the era of COVID⁃19: a narrative review［J］. Dermatol Ther, 2021,34（1）:e14507. doi: 10.1111/dth.14507.
［54］	Nas K, Dilek G, Kalçık Unan M, et al. The clinical outcomes of COVID⁃19 in patients with Behçet's disease: a series of 7 cases and brief review of the literature［J］. Eurasian J Med, 2022,54（3）:305⁃309. doi: 10.5152/eurasianjmed.2021.21203.
［55］	Hendry BM, Stafford N, Arnold AD, et al. Hypothesis: pentoxifylline is a potential cytokine modulator therapeutic in COVID⁃19 patients［J］. Pharmacol Res Perspect, 2020,8（4）:e00631. doi: 10.1002/prp2.631.
［56］	Trevisini S, Trevisan G, Zalaudek I, et al. Adamantiades⁃Behçet's disease therapy: current treatment options and recommendations with regard to the COVID⁃19 pandemic［J］. Dermatol Ther, 2022,35（3）:e15286. doi: 10.1111/dth.15286.
［57］	Dursun R, Temiz SA, Özer İ, et al. Management of patients with Behçet's disease during the COVID⁃19 pandemic［J］. Dermatol Ther, 2020,33（6）:e14063. doi: 10.1111/dth.14063.
［58］	Mashayekhi F, Seirafianpour F, Pour Mohammad A, et al. Severe and life⁃threatening COVID⁃19⁃related mucocutaneous eruptions: a systematic review［J］. Int J Clin Pract, 2021,75（12）:e14720. doi: 10.1111/ijcp.14720.
［59］	Dotan A, Muller S, Kanduc D, et al. The SARS⁃CoV⁃2 as an instrumental trigger of autoimmunity［J］. Autoimmun Rev, 2021,20（4）:102792. doi: 10.1016/j.autrev.2021.102792.
［60］	Zhang S, Liu Y, Wang X, et al. SARS⁃CoV⁃2 binds platelet ACE2 to enhance thrombosis in COVID⁃19［J］. J Hematol Oncol, 2020,13（1）:120. doi: 10.1186/s13045⁃020⁃00954⁃7.
［61］	Levy JH, Iba T, Olson LB, et al. COVID⁃19: thrombosis, thromboinflammation, and anticoagulation considerations［J］. Int J Lab Hematol, 2021,43 Suppl 1（Suppl 1）:29⁃35. doi: 10.1111/ijlh.13500.
［62］	Calabretta E, Moraleda JM, Iacobelli M, et al. COVID⁃19⁃induced endotheliitis: emerging evidence and possible therapeutic strategies［J］. Br J Haematol, 2021,193（1）:43⁃51. doi: 10.1111/bjh.17240.
［63］	Teuwen LA, Geldhof V, Pasut A, et al. COVID⁃19: the vasculature unleashed［J］. Nat Rev Immunol, 2020,20（7）:389⁃391. doi: 10.1038/s41577⁃020⁃0343⁃0.

[1]	Liu Lihao, Hu Yu, Chen Kun. Clinical application and development of photobiomodulation in dermatology [J]. Chinese Journal of Dermatology, 2026, 59(3): 278-282.
[2]	Yang Wanqing, Chen Nuoran, Meng Xiaoqi, Liu Tingwei, Xu Yang. Application of focused ultrasound in dermatology beyond the anti?aging aspects [J]. Chinese Journal of Dermatology, 2026, 0(3): 20240433-e20240433.
[3]	Zeng Wanxin, Wen Xiang. Photoelectric therapy for hypertrophic scars [J]. Chinese Journal of Dermatology, 2026, 59(3): 269-273.
[4]	Xia Zhikuan, Ge Ge. Laser therapy for vitiligo: clinical applications and prospects [J]. Chinese Journal of Dermatology, 2026, 59(3): 213-217.
[5]	Committee on Psoriasis, Chinese Society of Dermatology. Expert consensus on management of psoriasis with comorbidities （2026） [J]. Chinese Journal of Dermatology, 2026, 59(3): 193-207.
[6]	Expert Group on the Interpretation of the "Chinese expert consensus on the clinical application of photobiomodulation therapy in dermatology （）", Laser Medicine Group, Chinese Society of Dermatology. Interpretation of the Chinese expert consensus on the clinical application of photobiomodulation therapy in dermatology （2025） [J]. Chinese Journal of Dermatology, 2026, 59(3): 208-212.
[7]	Wang Juncheng, Liu Jie. Artificial intelligence in psoriasis: diagnosis, treatment and patient management [J]. Chinese Journal of Dermatology, 2026, 0(3): 20240061-e20240061.
[8]	Xu Zhuohong, Zhou Huan, Hu Yu, Gu Heng. Balneotherapy in skin diseases [J]. Chinese Journal of Dermatology, 2026, 0(3): 20250531-e20250531.
[9]	Guo Lan, Jin Hongzhong. Tryptophan and arginine metabolism in immune regulation and their role in the pathogenesis of psoriasis [J]. Chinese Journal of Dermatology, 2026, 0(3): 20240377-e20240377.
[10]	Liu Jia, Gu Yinghua, He Xiaoning, . Treatment and disease burden of hereditary angioedema [J]. Chinese Journal of Dermatology, 2026, 59(3): 282-286.
[11]	Wang Li, Wang Qianqiu, Zhang Ruili. Research progress in latent syphilis [J]. Chinese Journal of Dermatology, 2026, 59(3): 286-289.
[12]	Chinese Society of Dermatology, China Dermatologist Association. Guidelines on the diagnosis and treatment of dermatitis and eczematous diseases in China （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(2): 97-106.
[13]	Yan Kexin, Zhang Wei, Song Hao, Xu Xiulian. Application of nanomedicine in the diagnosis and treatment of melanoma [J]. Chinese Journal of Dermatology, 2026, 59(2): 189-192.
[14]	Chinese Society of Dermatology, China Dermatologist Association, Dermatology Branch of China International Exchange and Promotive Association for Medical and Health Care, Rare Skin Diseases Committee, China Alliance for Rare Diseases. Expert consensus on spesolimab in the treatment of inflammatory skin diseases （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(2): 113-119.
[15]	Li Yanhong, Jang Kun, Wu Zhuoxuan, Zhang Jianlan, Fang Meizhen, Liu Shuting, Wang Linlin, Hu Lei, Zhou Xiaoyong, Chen Liuqing, Chen Jinbo. Analysis of 18 cases of cutaneous adverse reactions associated with programmed death-1 inhibitors [J]. Chinese Journal of Dermatology, 2026, 0(2): 20240002-e20240002.

Paying attention to severe skin diseases after COVID-19

PDF

Knowledge

Abstract

Cite this article

share this article

References ［63］

Related Articles 15

Metrics

Comments

Recommended 10