“It is believed that the changes observed in the skin are due to the inflammatory process to which the whole body is subjected in the course of this disease, the most expressive being the condition similar to Kawasaki’s disease”, added the specialist. This disease has been the target of pediatricians at the forefront of the fight against Covid-19 since some children infected with SARS-CoV-2, both in Portugal and abroad, reported symptoms similar to those of this complication: fever, reddish patches on the skin, conjunctivitis and infection of the heart muscle or blood vessels.
These cases are still being studied by doctors, but everything indicates that we are facing a complication other than Kawasaki’s disease, but with similar symptoms: the autoinflammatory syndrome. “In fact, it cannot be said that there is a specific dermatological condition of Covid-19, but we should be suspicious of the presence of the disease in a cutaneous inflammatory situation with somewhat bizarre characteristics, different from the usual ”, advised Miguel Peres Correia.
Anyone who develops a severe clinical picture of Covid-19 and recovers may have sequelae at the dermatological level, confirms the doctor: “People who have been admitted to hospital with more severe clinical situations show changes. Hair loss is especially disturbing due to its impact on appearance“.
But even those who have never been infected with the new coronavirus can suffer dermatological consequences due to the Covid-19 pandemic. And it is the fault of the masks, alcohol-gel and the high frequency with which people wash their hands in compliance with sanitary rules, recalls Miguel Peres Correia: “If the skin manifestations of those infected are not specific, already regular mask use and very frequent hand washing have caused problems for countless people“.
According to the doctor, the droplets of saliva and the hot and humid environment that appears inside the masks during use can trigger an inflammatory disease. In addition, the number of people with hand dermatitis (an inflammation of the skin) “has increased significantly due to regular, sometimes more aggressive, hand washing,” he continues.
Infected kidneys can be attacked on four fronts
Other consequences of Covid-19 that are only now beginning to be identified involve the impact of severe forms of the disease on the kidneys. And that can happen on four fronts, explains José António Lopes, vice president of the Portuguese Society of Nephrology. On the one hand, as renal cells have ACE2 receptors, to which the SARS-CoV-2 protein S binds to introduce itself into cells, the virus can directly attack these organs.
On the other hand, as the virus can trigger a generalized inflammatory reaction in the body – the storm of cytokines, molecules involved in the communication between cells when the body triggers an immune response -, the kidney, like other organs, can also be affected indirectly by the exaggerated response in the immune system to infection.
Third, the kidneys can also suffer damage from the SARS-CoV-2 attack on the lungs. “The virus often causes pneumonia and hypoxia itself, the low oxygen supply, can compromise the kidneys. All cells need oxygen to function. As pneumonia hinders gas exchange, the kidney will also be affected because the cells need oxygen ”, describes the doctor. In such cases, the cells may even die from lack of oxygen.
Finally, there is a mechanism typically associated with SARS-CoV-2 infection: the emergence of microthrombi, clots in the blood vessels that irrigate the kidneys. It is estimated that 30% of those infected by Covid-19 who had no previous kidney disease develop an acute kidney injury and will need dialysis.