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Cutaneous Manifestations of Dental Interest in Patients Diagnosed With COVID-19

Dear editor, The new 2019 coronavirus (COVID-19), initially identified in Wuhan, China, spread rapidly around the world due to its high infectivity and asymptomatic transmission, being considered by the World Health Organization as a Pandemic on 11 March 2020. Clinical manifestations such as cough, fever, dyspnea, sore throat, fatigue, myalgia, headache, diarrhea and rhinorrhea are the most common symptoms (Young et al., 2020). However, in more recent studies, authors have called attention to skin manifestations in adult and pediatric patients who tested positive for COVID-19, which may represent a new clinical sign of the disease (Galván Casas et al., 2020). This could act as a warning signal of interest to the dental community, as well as the general public. A dentist can often be the health professional who will have first contact with an infected person and this knowledge could assist in the referral of patients and provide guidelines for controlling the spread of the virus. When skin lesions appear, the most prevalent forms are erythematous rash, petechiae, urticaria and vesicles that can appear on the soles of the feet, fingers and heels, resembling “chilblains” (mycoses in the feet) (Sachdeva et al., 2020). The detection of these symptoms is important during general and dental anamnesis, because can suggest an initial diagnosis to aid of infected patients that have few symptoms or who were asymptomatic until then. Although there is still no consensus on the mechanism which triggers skin lesions in patients with COVID-19, it is believed that these injuries are related to vascular changes. Viral particles can cause lymphocytic vasculitis in the skin tissues or decrease blood flow in the skin’s vascularization, due to the accumulation of microthrombosis from other organs, which may be responsible for these skin manifestations (Gianotti et al., 2020). Furthermore, an recent study reported that the viral particles in the skin tissues in patients with COVID-19 could lead immune response at keratinocytes causing the skin manifestations (Joob & Wiwanitkit, 2020). It is important to emphasize the importance knowledge and of the observations of skin manifestations during the dental consultation, as COVID-19 tends to be asymptomatic for an average period of up to 14 days after infection, and skin lesions may appear as a first clinical sign of infection, serving as an alert for the professional and the patient (Sachdeva et al., 2020). Such observations may assist in proper management of cases and may be necessary in the diagnosis of COVID-19, since a pathognomonic sign of the disease has not yet been found. Furthermore, the knowledge of such lesions, allows healthcare professionals to have a lower chance of misdiagnosis as reported by Joob e Wiwanitkit, preventing COVID-19 infection from being confused with other viral infections, such as dengue. Thus, the dissemination of this information to the general population, as well as the dental community, is of fundamental importance.