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  • When COVID-19 first started popping up in the news, its symptoms were described as a

  • fever, a dry cough and sometimes shortness of breath.

  • But now, researchers have compiled a more exhaustive list, including skin problems,

  • a loss of smell or taste and even neurological symptoms, it can harm the lungs, the kidneys

  • and even the circulatory system.

  • And what about those purple COVID toes?

  • When COVID-19 began I think it was surreal for all of us, and as a physician, me and

  • my colleagues around me in really every specialty recognized this was a special time in our

  • careers where we had an opportunity to potentially make more of a difference in the world than

  • we may ever have in our entire lives.

  • Dr. Fernandez is

  • one of the many doctors and researchers focusing on the symptoms or manifestations of COVID-19,

  • to better understand what exactly we're dealing with.

  • My name is Dr. Anthony Fernandez, I am a dermatologist and a dermatopathologist at the Cleveland

  • Clinic in Cleveland, Ohio. Every virus is unique in three dimensional structure, and

  • because of that activates the immune system in different ways, and that creates different

  • manifestations.

  • Collecting information about the array of symptoms associated with COVID is a good way

  • for experts to understand what exactly the virus is doing in the human body and how it's

  • moving around,

  • when a patient is first infected with SARS-CoV-2, the virus that causes COVID-19, it's

  • usually inhaled, and it begins to infect cells in the respiratory tract and produces more

  • and more virus.

  • This is why we wear masks... Duh!

  • From here, the virus can work its way into tiny air sacs in the lungs.

  • These air sacs are filled with a protein receptor called ACE2 and this is what the virus

  • uses to break into cells where it can replicate and spread.

  • Another group of cells that produces ACE2 is the cells that line blood vessels throughout

  • the body, and because of this the virus can invade those too.

  • This can cause the blood vessels to leak and the blood to clot.

  • That virus, as do most viral infections, eventually involve that virus getting into the bloodstream

  • and circulating throughout the body.

  • Blood clots can lead to heart attacks, strokes and tissue damage.

  • So, this is where those cardiovascular and neurological symptoms can come into play.

  • The virus can also interfere with your nervous system but this needs more research, there

  • are some clues that the virus infects nasal cells, potentially causing a block in how

  • these cells communicate with the brain, hence the loss of smell and taste that some

  • patients experience.

  • And of course there's a reason we wanted to talk to a dermatologist

  • slash dermatopathologist. In the skin, it still seems to be a little bit unclear, but

  • it may infect the blood vessel cells that traffic through the skin, or it may be that

  • the immune system cells in the blood are simply activated by the presence of that virus and

  • emits signals that then activate the immune system cells that are in the skin.

  • You may have heard of

  • those infamous COVID toes, red or purple, itchy bumps on the toes and sometimes the

  • fingers.

  • One of the arguments for why patients may get these COVID toe lesions, if it is specific

  • to COVID-19, is that these young patients have very well functioning immune systems

  • and mount a very robust response against that virus as soon as it enters the body, and eliminate

  • it effectively and rapidly before it can reproduce to high numbers in the body.

  • So the rash might be an indicator of really high immune system activity.

  • But then again these toe troubles might have nothing to do with the virus at all.

  • And so another theory is that it's really lifestyle changes during quarantine. Individuals

  • walking around bare feet around their house or spending their days doing different activities

  • than they otherwise normally would, is really what is precipitating more cases of the so

  • called COVID toes.

  • So while COVID toes are still a bit of a mystery, the skin matters when it comes to understanding

  • COVID-19 because it's such a vital part of the immune system.

  • If you think about your body as a castle, then you can think about your skin as that

  • big wall around the castle.

  • That is put there to serve as a main barrier to keep all the bad things in the outside

  • world out, and your body recognizes the importance of the skin and in defending that wall, and

  • so it invests a lot of energy in lining that wall with troops, which represent immune system

  • cells.

  • Many things can cause those cells to become activated invading things from the outside

  • world can immediately cause those cells to become activated as they try to defend that

  • wall that barrier from anything getting inside of it, but also those immune system cells

  • can hear signals from

  • within the body. The skin can be a hint at how a disease will progress. With COVID, there's

  • a particular rash that dermatologists are studying to see if it might indicate the internal

  • blood clotting that we talked about earlier.

  • The other manifestation that we have seen, especially in severely ill patients with COVID-19.

  • Typically patients who are intubated who need a mechanical ventilator to breathe for them

  • because of the degree of inflammation in their lungs, is what we call retiform purpura or

  • a violaceous rash, but what we recognize as being a clue that there is some vascular insult

  • going on underneath the skin, either clotting in the blood vessels or inflammation around

  • the blood vessels, which we call vasculitis.

  • And as for side effects of the vaccine...

  • One of the most common manifestations in the skin has now been dubbed COVID arm and essentially represents

  • a large oval to round, pink to red rash raised area called a plaque on the arm, the lateral arm at the injection site.

  • It's usually asymptomatic, and it really has no consequences so it does not need to

  • be treated.

  • It is not an indication that the vaccine will not be effective or is going to cause some

  • other problem in the patient.

  • It probably simply represents activation of the immune system, and that area of the

  • body.

When COVID-19 first started popping up in the news, its symptoms were described as a

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Strange Symptoms: Why COVID-19 Affects the Skin, Sense of Smell, and More

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    Summer に公開 2021 年 06 月 17 日
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