Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

Carlo Alberto Maronese; Enrico Zelin; Gianluca Avallone; Chiara Moltrasio; Maurizio Romagnuolo; Simone Ribero; Pietro Quaglino; Angelo Valerio Marzano

doi:10.3389/fmed.2022.996288

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

Front Med (Lausanne). 2022 Aug 23:9:996288. doi: 10.3389/fmed.2022.996288. eCollection 2022.

Authors

Carlo Alberto Maronese^{1

2}, Enrico Zelin³, Gianluca Avallone⁴, Chiara Moltrasio^{1

5}, Maurizio Romagnuolo^{1

2}, Simone Ribero⁴, Pietro Quaglino⁴, Angelo Valerio Marzano^{1

2}

Affiliations

¹ Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
² Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
³ Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy.
⁴ Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy.
⁵ Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.

Abstract

Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.

Keywords: COVID vaccines; COVID-19; cutaneous manifestation; vasculitis; vasculopathy.

Publication types

Review