Cutaneous Manifestations of SARS-CoV-2 Infection

Thy Huynh; Xavier Sanchez-Flores; Judy Yau; Jennifer T. Huang


Am J Clin Dermatol. 2022;23(3):277-286. 

In This Article

Maculopapular/Morbilliform Eruptions

Clinical Presentation

Maculopapular or morbilliform eruptions are frequent dermatologic manifestations secondary to SARS-CoV-2 but are nonspecific to SARS-CoV-2 and may occur with other viral infections. The prevalence of maculopapular eruptions is between 16 and 47% in patients infected with SARS-CoV-2. These lesions last for 9 days and are widespread but spare mucosa, palms, and soles.[13] Catala et al. reported 176 cases of morbilliform eruptions, which were characterized by erythematous macules with areas of normal-appearing skin on the trunk and extremities with pruritus.[19]


Maculopapular eruptions may be caused by viral SARS-CoV-2 particles and immune complex deposition that damage dermal vessels, causing lymphocytic vasculitis. These viral proteins can target Langerhans cells and keratinocytes.[13]


The histopathology of maculopapular eruptions shows spongiotic dermatitis, vacuolar degeneration, as well as superficial perivascular and mixed inflammatory infiltrate.[13] The timing of biopsy is important: early-onset lesions present with epidermal spongiosis and mixed perivascular lymphocytic infiltrate consisting of eosinophils, while delayed lesions show mixed perivascular lymphocytic infiltrate with histiocytes within collagen fibers.[13]


Unlike CBLL, maculopapular eruptions are not indicative of disease severity.[20] Morey-Olive et al. reported a 6-year-old male with a positive SARS-CoV-2 PCR nasopharyngeal swab sample and developed a maculopapular rash on the trunk and extremities which self-resolved in 5 days without complications or treatments.[19] On the other hand, Hunt and Koziatek presented a 20-year-old healthy male with fever and diffuse maculopapular eruptions on the trunk and extremities that spared the face, mucosa and eyes; he was positive for SARS-CoV-2 by PCR and later required intensive care.[21] Given the non-specificity of maculopapular rashes to SARS-CoV-2, it is important to consider other causes for these lesions, such as adverse cutaneous drug reactions from hydroxychloroquine, azithromycin, chloroquine or others.

Management of these eruptions depends on the severity of the illness. In mild cases, topical corticosteroids can be used for pruritus. In severe cases, systemic corticosteroids may be used.[22]