The trend of cutaneous lesions during COVID‐19 pandemic: lessons from a meta‐analysis and systematic review

Background Besides predominant respiratory and gastrointestinal manifestations, reports on cutaneous manifestations in COVID‐19 patients are being noted increasingly. Objectives To estimate the prevalence of cutaneous manifestations in COVID‐19 patients. Methods This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines. A detailed literature search was done in PubMed and Embase from December 1, 2019, till May 1, 2020. Studies reporting cutaneous manifestations in COVID‐19 patients were included. Irrespective of the heterogeneity of data, a random effects model with inverse‐variance approach was used for pooling the prevalence using meta package in R version 3.6.2. Results Out of 15,143 articles, 2086 articles were selected for full‐text read. Forty‐three articles were selected for qualitative analysis, of which 10 articles (N = 1682) were included for meta‐analysis. The pooled prevalence of overall cutaneous lesions was 5.69 (95% confidence interval [CI]: 1.87–15.98; I2 88%). The pooled prevalence of other outcome parameters were as follows: viral exanthem‐like presentation 4.15 (95% CI: 1.33–12.23; I2 88%), maculopapular rash 3.81 (95% CI: 1.02–13.18; I2 87%), vesiculobullous lesions 1.67 (95% CI: 0.70–3.96; I2 0%). Conclusion The estimated prevalence of cutaneous manifestations in COVID‐19 was 5.69%. Other manifestations were urticaria, chilblain‐like lesions, livedo reticularis, and finger/toe gangrene. Although it is premature to conclude the prevalence of the cutaneous manifestations during this ongoing pandemic, our report may be a stimulating factor for the physicians to perform further vigilant streamlined reporting of cutaneous manifestations in COVID‐19 patients to estimate the final prevalence.