The Oral Lesion in the COVID-19 Patient: Is It True Oral Manifestation or Not?

Figures & data

Figure 1 Schematic literature search.

Table 1 A Systematic and Meta-Analysis Result of Correlation Between COVID-19 and Oral Manifestation

Type of Study	Conclusion	Reference
A systematic review of systematic reviews	The presence of oral lesion cannot make an accurate estimation of the prevalence of lesions, the association with COVID-19 severity and occurrence in the natural history of the disease.	[22]
Systematic review and meta-analysis	Dry mouth was the most prevalent oral health condition, followed by oral lesions, orofacial pain, and periodontal symptoms	[21]
Systematic review and meta-analysis	Oral lesions in COVID-19 patients were identified and further observational studies focusing on this issue and on the causal relationships between oral lesions and COVID-19 are needed	[17]
Systematic review and meta-analysis	More studies will be necessary to confirm oral lesion association with direct SARS-CoV-2 infection in the oral cavity.	[30]
Systematic review	The SARS-CoV-2 virus may infect oral mucosa in small numbers of patients with specific oral mucosa findings have been reported.	[19]
Systematic review	It is not clear that oral signs are due to COVID-19 infection itself or are the result of extensive treatment regimen followed.	[27]
Systematic review	Multisystemic inflammatory syndrome in children and Kawasaki disease share the same oral manifestations and their identification may lead to an early diagnosis.	[18]
Systematic review	The ulcerated oral lesions may have relationship with mild to moderate symptoms for COVID-19 or had acute COVID-19.	[29]
Systematic review	The effect on oral mucosa is unclear	[24]
Systematic review	Oral manifestations in SARS-CoV-2 infection cannot be clearly established due to the possible association of other factors, eg, individual or environmental factors.	[16]
Systematic review	A wide variety of orofacial mucocutaneous lesions manifest in COVID-19 likely to be secondary to the disease-associated immune impairment and/or pharmaco-therapy rather than a direct result of SARS-CoV-2 infection	[28]
Systematic review	Clinical evidence-based studies are required to investigate the actual prevalence and possible correlation between COVID-19 and jaw-related disorders.	[31]
Systematic review	SARS-CoV-2 infection-related immunosuppression, steroid therapy, as well as comorbidities such as diabetic hyperglycaemia appear to be the major predisposing factors for the onset of oral and maxillofacial mycoses in patients with COVID-19 across all age groups.	[32]
Systematic review	Very heterogeneous denominations on primary oral lesions emerged from the data extracted	[33]
Systematic review	The development of ulcers are alterations that are related to moderate to severe COVID-19. It is important to discriminate between lesions or alterations that actually develop from SARS-CoV2 and the alterations that the patient already had.	[14]
Systematic review	The oral lesion could be related directly to COVID-19, while the latter could be caused by medical devices, treatments, prone position, and immunological impairment.	[15]
Systematic review	The oral mucosal lesions found at various locations within the oral cavity	[26]
Systematic review	Amidst the SARS-CoV-2 pandemic in which many doubts about the disease still remain, caution is needed when evaluating patients and establishing correlations with other diseases that could be associated	[25]
Systematic review	The manifestations of the SARS-CoV-2 infection in the oral cavity are non-specific.	[34]
Systematic review	Oral mucosal lesions are more likely to present as coinfections and secondary manifestations with multiple clinical aspects	[35]
Comprehensive review	Current scientific evidence still could not affirm that most of the oral lesions observed in patients with COVID‐19 are related to the virus’s direct or indirect action on the oral mucosa	[36]

Table 2 The Original Study of a Reported Oral Lesion in a COVID-19 Patient

Number of Samples	Number of Patients with Oral Lesion	Original Paper Type	Reference
58	58	Pilot study	[37]
154	154	Cohort study	[38]
123	123	Observational study	[39]
74	58	Observational study	[40]
38	16	Observational study	[41]
713	9	Observational study	[42]
14	14	Observational study	[43]
58	42	Observational study	[44]
338	338	Prospective study	[45]
27	27	Retrospective study	[46]
472	332	Retrospective study	[47]
332	242	Retrospective study	[48]
69	5	Retrospective study	[50]
89	18	Retrospective study	[49]
21	6	Cross-sectional study	[51]
573	117	Cross-sectional study	[52]
895	6	Cross-sectional study	[53]
2870	29	Cross-sectional study	[54]
55	22	Cross-sectional study	[55]
217	139	Cross-sectional study	[56]
100	100	Cross-sectional study	[57]
204	165	Cross-sectional study	[58]
434	40	Cross-sectional study	[59]
500	77	Cross-sectional study	[60]
195	57	Cross-sectional study	[61]
124	112	Cross-sectional study	[62]
1856	470	Cross-sectional study	[63]
402	63	Cross-sectional study	[64]
46	10	Cross-sectional study	[65]
380	12	Cross-sectional study	[66]
109	58	Cross-sectional study	[67]
666	78	Cross-sectional study	[68]

Figure 2 The large-scale study reported the number of cases of COVID-19 and those with oral lesions.

Table 3 The Original Study of an Oral Lesion in a COVID-19 Patient without Underlying Disease and Mediation Related

Gender (n or %)	Ages	Oral Lesions	Reference
M (31) F (27)	≤30	Ulcers Macule Bleeding	[39]
	>30	Ulcers Macule Bleeding
M (70) F (53)	63–81	Ulcers Pseudomembrane Petechiae Depapilation Blisters Bullous Fissure	[39]
M (38) F (20)	52.8	Ulcer Macula	[40]
F	60 65	Ulcers Erythema Atrophy Erosion	[42]
M (10) F (4)	23–88	Ulcers Petechiae Vesicobullae Ecchymosis	[43]
M F	42.1	Ulcer Macula Vesicobullae	[45]
M (9) F (8)	4.2	Pseudomembrane Macula	[46]
M (64.5%) F (35.5%)		Ulcers Erosion Hematoma Petechiae	[48]
M F	1–12	NS	[49]
M F	18–24	Swelling Bleeding	[50]
F (408) M (165)	36.19	Ulcers	[52]
F	10–17 18 – 34	Ulcers	[53]
M (367) F (133)	53	Ulcers Macules Erosion Pseudomembrane Plaque Nodule Atrophy	[60]
M (37%) F (62.3%)	34	Ulcers	[63]
M F	57 −68	Ulcers	[66]
M F	39.1	Ulcers Macules Depapilation Pseudomembrane Blister	[67]
M F	55.67	Ulcers Depapilation	[68]

Abbreviations: NS, not mentioned specifically.

Table 4 The Original Study of an Oral Lesion in a COVID-19 Patient with an Underlying Disease

Gender (n or %)	Ages	Underlying Disease	Medication	Oral Lesions	Reference
M (59.7%) F (40.3%)	20–88	Hypertension Diabetes mellitus Obesity Pulmonary diseases Hypothyroidism AIDS Dyslipidemia	NR	Ulcers Pseudomembranous Depapilation Erosions Crusts	[38]
F	50–70	Hypertension Hyperthyroidism	NR	Ulcers Pseudomembrane Maculae Erosion Crusts	[42]
M	43–69	Diabetes mellitus	NR	Ulcers Atrophy Erosion Vesicle
M (28) F (20)	63.3	Diabetes mellitus Hypertension Coronary arterial disease Kidney disease Neoplasia Obesity	NR	Ulcers Pseudomembrane Fissure	[44]
M F		Diabetes mellitus Hypertension Respiratory disease Heart disease Liver disease Renal disease Blood disease Gastrointestinal disease	NR	Ulcers Macula Vesicobulous	[45]
M F	1–12	NS	NR	NS	[49]
M (66) F (104)	18–23 (138) 15–17 (12) 11–14 (20)	NS	NR	Ulcers	[54]
M (71.4%) F (28.6%)	18–49 (138) 50–60 (80) > 60 (25)	Hypertension Coronary artery disease Diabetes mellitus Bronchial asthma	NR	Ulcers Erythema Macula Erosion Nodule Vesicles Ecchymosis Atrophy	[56]
M (51) F (49)	> 35 (54) < 35 (46)	Myocardial infarc Diabetes mellitus Hypertension	NR	Ulcers Atrophy	[57]
M (41.5%) F (58.5%)	NR	NS	NR	Ulcers Pseudomembrane Plaque	[59]
M (55.56%) F (44.44%)	47	NS	NR	Ulcers	[64]

Abbreviations: NS, not specified mention; NR, not reported.

Table 5 The Original Study of an Oral and Skin Lesion in a COVID-19 Patient with Medication-Related

Gender (n or %)	Ages	Underlying Disease	Medication	Oral Lesions	Skin Lesion	Reference
NS	40–60	NR	Lopinavir/ritonavir Hydroxychloroquine Azithromycin Tocilizumab Corticosteroids	Macula Petechiae	Exanthema	[51]

Abbreviation: NR, not reported.

Table 6 The Original Study of an Oral and Skin Lesion in a COVID-19 Patient without Underlying Disease and Medication-Related

Gender (n or %)	Ages	Underlying Disease	Medication	Oral Lesions	Skin Lesion	Reference
M (3) F (7)	3–8	NR	NR	Ulcers Depapilation Crust Pseudomembrane Macula	Exanthema	[65]

Abbreviation: NR, not reported.

Table 7 The Original Study of an Oral Lesion in a COVID-19 Patient with Underlying Disease and Medication-Related

Gender (n or %)	Ages	Underlying Disease	Medication	Oral Lesions	Reference
M (6) F (10)	44–93	Hypertension Diabetes Cerebrovascular disease Renal disease Cardiac disease Obesity	Antibiotic Corticosteroids Anticoagulant	Ulcers Crusts Erosion Depapillation Ecchymosis	[41]
M (54.5%) F (45.5%)	21–89	Hypertension Hypertension and Diabetes Mellitus Asthma	Dexamethasone Remdesivir Lopinavir Ritonavir	Ulcers Erythema Pseudomembrane Erosion Macule Plaques Papule Atrophy	[55]
M (76) F (128)	≤ 30 (43) 31–60 (87) > 60 (74)	Hypertension Cardiovascular disease Diabetes mellitus Asthma Rheumatoid arthritis Obesity Thyroid disorders	Favipiravir Hydroxychloroquine Pain killer	Ulcers	[58]
M (48) F (147)	18–24 (64) 25–34 (64) 35–44 (41) 45–54 (13) >55 (13)	Hypertension Allergic Hyperthyroid Diabetes mellitus Asthma Epileptics Depressants Osteoarthritis Benign condition	Antihypertension Antihistamines Thyroid medication Antidiabetics Anti-asthmatics Proton pump inhibitors Nutritional supplements Antiepileptics Antidepressants Osteoarthritis medication Benign prostatic hyperplasia medication Hormone replacements Laxatives	Ulcers Petechiae Pseudomembrane Vesiculobullous Atrophy Erosion	[61]
M (92) F (32)	50.32 ± 12.47	Hypertension Diabetes mellitus Renal disease Liver disease Cardiac	Zithrocin Iverzine Vitamin C Zinc Anticoagulant Prednisolone Antibiotic Remdesivir Foradil Hydroxychloroquine colchicine Acetylcysteine Silymarin	Ulcers Vesicula Pseudomembrane Macule Atrophy Petechiae	[62]

Table 8 The Individual Case of Oral Lesion in COVID-19 Patient

Number of Patient	Type of Paper	Reference
1	Case report	[69]
1	Case report	[70]
4	Case report	[71]
1	Case report	[72]
1	Case report	[73]
1	Case report	[74]
1	Case report	[75]
1	Case report	[76]
1	Case report	[77]
1	Case report	[78]
1	Case report	[79]
1	Case report	[80]
1	Case report	[81]
1	Case report	[82]
1	Case report	[83]
1	Case report	[84]
1	Case report	[85]
1	Case report	[86]
1	Case report	[87]
1	Case report	[88]
3	Case report	[89]
4	Case report	[90]
3	Case report	[91]
3	Case report	[92]
6	Case report	[93]
6	Case report	[94]
3	Case report	[95]
1	Case report	[96]
1	Case report	[97]
1	Case report	[98]
1	Case report	[99]
4	Case report	[100]
5	Case report	[101]
1	Case report	[102]
1	Case report	[103]
1	Case report	[10]
1	Case report	[104]
1	Case report	[105]
1	Case report	[106]
8	Case series	[107]
4	Case series	[108]
26	Case series	[109]
3	Case series	[110]
2	Case series	[111]
21	Case series	[112]
1	Letter to editor	[113]
1	Letter to editor	[114]
2	Letter to editor	[115]
1	Letter to editor	[116]
2	Letter to editor	[117]
1	Letter to editor	[118]
1	Letter to editor	[119]
2	Letter to editor	[120]
1	Letter to editor	[121]
1	Letter to editor	[122]
1	Letter to editor	[123]
1	Letter to editor	[124]
1	Letter to editor	[125]
1	Letter to editor	[126]
3	Letter to editor	[127]
1	Letter to editor	[128]
1	Letter to editor	[129]
1	Letter to editor	[130]
1	Correspondence	[131]
1	Correspondence	[132]
1	Clinical image	[133]
1	Clinical image	[134]
1	Clinical image	[135]

Table 9 The Oral Lesion in COVID-19 Patients without Systematic Condition and Medication

Number	Gender	Ages	Oral Lesions	Location	Reference
1	F	16	Multiple ulcers	Tongue	[109]
1	F	16	Ulcer	Labial	[112]
1	F	17	Ulcer	Buccal	[112]
1	F	19	Multiple ulcers	Tongue	[109]
1	F	19	Multiple ulcers	Tongue	[109]
1	F	19	Multiple ulcers	Tongue	[109]
1	F	20	Ulcer	Buccal	[112]
1	F	21	Multiple ulcers	Tongue	[109]
1	F	23	Vesiculobulous	Lips	[131]
1	F	24	Ulcer	Tongue	[109]
1	F	24	Ulcer	Tongue	[112]
1	F	25	Ulcer	Gingiva	[112]
1	F	25	Multiple ulcers	Tongue	[109]
1	F	26	Ulcer	Buccal	[112]
1	F	27	Ulcer	Labial	[112]
1	F	27	Ulcer	Palate	[112]
1	F	29	Multiple ulcers	Tongue	[109]
1	F	29	Multiple ulcers	Tongue	[109]
1	F	29	Multiple ulcers	Tongue	[109]
1	F	32	Multiple ulcers	Tongue	[109]
1	F	32	Multiple ulcers	Tongue	[107]
1	F	35	Edematous Necrotic Bleeding	Gingiva	[114]
1	F	36	Ulcer	Tongue	[109]
1	F	37	Multiple ulcer	Tongue	[109]
4	F	< 40	Ulcer	Gingiva	[93]
1	F	40	Multiple ulcers Non-specific white lesions	Palatal	[124]
1	F	42	Multiple ulcers	Tongue	[109]
1	F	43	Multiple ulcers	Tongue	[109]
1	F	43	Ulcers Depapilation	Tongue	[127]
1	F	43	Ulcer	Buccal	[71]
1	F	45	Multiple ulcers	Palatal	[135]
1	F	57	Multiple ulcers	Tongue	[109]
1	F	66	Hemorrhagic bleeding	Palatal	[94]
1	F	70	Multiple ulcers	Tongue	[109]
1	F	78	Pseudomembrane Macula Erosion	Tongue Commisure	[127]
1	M	19	Multiple ulcers	Labial	[71]
1	M	19	Ulcer	Buccal	[112]
1	M	19	Ulcer	Pharynx	[101]
1	M	20	Ulcer	Palate	[112]
1	M	22	Swelling	Tongue	[120]
1	M	25	Ulcer	Tongue Pharynx Palatal Gingival	[130]
1	M	28	Ulcers	Labial	[107]
1	M	29	Multiple ulcers	Tongue	[109]
1	M	30	Petechiae	Tongue	[134]
1	M	31	Multiple ulcers	Tongue	[109]
1	M	31	Ulcer	Labial	[112]
1	M	32	Ulcer	Labial	[101]
1	M	33	Ulcer	Mucogingival junction	[71]
1	M	35	Ulcer	Tonsillar pillar	[107]
1	M	37	Multiple ulcers	Tongue	[71]
1	M	37	Multiple ulcers	Tongue	[109]
1	M	37	Ulcer	Buccal	[112]
1	M	38	Multiple ulcers	Tongue	[109]
2	M	< 40	Ulcer	Gingiva	[93]
1	M	41	Multiple ulcers	Tongue	[109]
1	M	44	Pustule	Gingiva Bone Maxilla	[102]
1	M	47	Multiple ulcers	Tongue	[109]
1	M	48	Petechiae	Palatal	[94]
1	M	50	Multiple ulcers	Tongue	[109]
1	M	51	Macula	Oropharynx Palatal	[69]
1	M	53	Swelling	Tongue Floor of the mouth	[120]
1	M	56	Ulcer	Palatal	[89]
1	F	58	Ulcer Desquamation Crust Papula	Lip Buccal Tongue	[104]
1	M	68	Multiple ulcers	Tongue	[109]
1	M	69	Multiple ulcers	Tongue	[109]
1	M	NS	Ulcer	Labial Tongue	[106]

Abbreviation: NS, not mentioned specifically.

Table 10 The Oral Lesion with Skin Lesion in COVID-19 Patients without Underlying Disease and Medication

Number	Gender	Ages	Oral Lesions	Location	Skin Lesion	Reference
1	F	30	Erosions & hemorrhagic crusts Ulcers Blisters	Lips Palatal Tongue Buccal Pharynx	Bilateral itchy erythematous macules with rounded erythema	[98]
1	F	30	Depapilation	Tongue	Urticarial rash on her abdomen, legs, and hands	[72]
1	F	31	Multiple ulcers	Tongue Labial	Skin rash	[118]
1	F	46	Ulcer	Tongue	Erythematous in the toe	[122]
1	M	3	Desquamation	Gingiva	Exanthema	[117]
1	M	6	Crust	Lips	Rash of the extremities	[117]
1	M	38	Erythema Ulcer	Tonsillar	Maculopapular rash on trunk	[76]
1	M	53	Ulcer	Commisure	Perioral ulcer	[127]

Table 11 The Oral Lesion in COVID-19 Patients Related to Medication

Gender	Ages	Drug	Oral Lesions	Location	Reference
F	3	Amoxicillin-clavulanic Acetaminophen Ibuprofen Bronchodilator	Depapilation	Tongue	[101]
F	18	Paracetamol Azithromycin Vitamin C Zinc Lactoferrin Dextromethorphan	Depapilation	Tongue	[101]
F	20	Azithromycin Dipyrone	Crust	Lip	[83]
F	23	Azithromycin Acetaminophen Vitamin C Zinc	Ulcer	Pharynx	[101]
F	25	Moxifloxacin Pantoprazole Multivitamin	Macula	Tongue	[91]
F	37	Dexamethasone Dipyrone	Macula Depapilation	Tongue	[113]
F	41	Acetaminophen Fexofenadine	Bulla	Palatal	[90]
F	55	Acetaminophen	Bulla	Tongue	[90]
F	88	Azithromycin Prednisone Levofloxacin Dexamethasone Acetylsalicylic acid Acetylcysteine Ipratropium bromide	Ulcers Pseudomembrane	Lip all oral mucosa	[77]
M	25	Paracetamol	Bleeding	Gingiva	[95]
M	30	Hydroxychloroquine Ceftriaxone Enoxaparin	Bleeding	Gingiva	[95]
M	33	Ivermectin Azithromycin	Ulcer	Labial Buccal	[126]
M	34	Ivermectin Doxycycline Remdesivir Methylprednisolone Enoxaparin	Ulcer	Tongue	[100]
M	42	Acetaminophen	Macule	Palatal	[90]
M	42	Piperacillin-tazobactam Doxycycline Favipiravir	Ulcers	Palate	[100]
M	43	Steroids	Ulcer	Palatal	[94]
M	44	Vitamin B	Bleeding	Gingiva	[95]
M	55	Dexamethasone Colchicine Acetylcysteine Apixaban Omeprazole Mirtazapine Vitamins	Ulcers Pseudomembranous	Labial Palatal Tongue Oropharyngeal	[111]
M	68	Ceftriaxone Remdesivir Methylprednisolone Enoxaparin	Depapilation	Tongue	[100]

Table 12 The Oral and Skin Lesion in COVID-19 Patients Related Medication

Gender	Ages	Drug	Oral Lesions	Location	Skin Lesion	Reference
F	26	Acetaminophen	Ulcer	Lip	Maculopapular rash	[119]
F	32	Cefadroxil Benostamin Etabion Alphamol Vitammin	Ulcer Crust	Labial Lip	Macula	[105]
F	38	Hydroxychloroquine Azithromycin Oseltamivir	Ulcer Crust	Lip Tongue	Erythematous targetoid lesions	[116]
F	40	Ibuprofen Azithromycin Vitamin D2	Petechiae Ulcer Pseudomembranous Macula	Lip Gingiva Tongue	Petechiae	[81]
M	9	Acetaminophen	Vesicles Erosions Crust	Lips Tongue Buccal	Deep red, edematous papules and plaques involving the dorsal hands and feet	[132]
M	17	Penicillin Acetaminophen Nadroparin calcium	Bullous Erosive Vesiculobullous Ulcerations with crusts	Lips Labial	Dark red, purpuric, irregular maculopapular lesions on abdomen	[96]
M	29	Azithromycin Paracetamol Hydroxychloroquine Oseltamivir Vitamin C Vitamin D	Ulcer	Mucosa	Viral Exanthem	[73]
M	64	Tianeptine Trazodone Cefixime	Hemorrhagic ulcers	Lips	Viral exanthem/macules	[110]

Table 13 The Oral Lesion Found in COVID-19 Patient with Underlying Disease

Number	Gender	Ages	Underlying Disease	Oral Lesions	Location	Reference
1	F	23	HIV	Plaque	Oral mucosa	[103]
1	F	49	Hypertension Osteoarthritis Maxillary sinusitis	Vesicles Erythema	Palate	[80]
1	F	50	Diabetes mellitus	Ulcers	Palate	[85]
1	F	58	Diabetes mellitus type 2 Hypothyroidism	Hemorrhagic crusts	Tongue Lips	[111]
1	F	59	Rheumatoid arthritis	Atrophy Petechiae	Tongue Whole mouth	[94]
1	M	9	Severe dystonia Epilepsy	Ulcers	Labial	[123]
1	M	24	Hyperthyroidism	Ulcers Depapilation	Labial	[74]
1	M	24	Asthma	Ulcers	Labial Buccal	[99]
1	M	58	Diabetes mellitus Hypertension	Ulcers	Palate	[89]
1	M	68	Arterial hypertension Chronic hepatopathy Hypercholesterolemia Gastroesophageal reflux disease	Hemorrhagic ulcers	Tongue	[110]

Table 14 The Oral Lesion Accompanies Skin Lesions Found in COVID-19 Patient with Underlying Disease

Number	Gender	Ages	Underlying Disease	Oral Lesions	Location	Skin Lesion	Refere nce
1	M	60	Chronic cholecystitis Renal cyst Inguinal hernia	Erosive	Buccal Tongue	Pruritic macule on skin arm	[79]
1	M	63	Chronic cholecystitis Renal cyst Inguinal hernia	Erosive Radiating striae	Buccal Tongue	Brown pruritic macules on the flexure surface of the arm	[79]

Table 15 The Oral Lesion is Found in COVID-19 Patient with Underlying Disease and Medication Related

Number	Gender	Ages	Underlying Disease	Drug	Oral Lesions	Location	Reference
1	F	42	Hypothyroidism CVD Diabetes mellitus	Levothyroxine Azithromycin Linezolid Ceftriaxone	Pseudomembrane White plaques	Tongue Palate	[129]
1	F	50	Obesity Hypertension Diabetes mellitus	Intensive care medication	Crusted	Lip	[84]
1	F	51	Hypertensions	Dexamethasone Azithromycin Indomethacin	Macule Papule-plaque	Palate	[90]
1	F	56	Hypertension Chronic sinusitis	Azithromycin Levofloxacin Montelukast Naproxen Acetaminophen	Vesicles	Lip mucosa	[70]
1	F	56	Diabetes mellitus Rheumatoid arthritis	Azithromycin	Pseudomembrane	Labial Palate Tongue	[91]
1	F	56	Diabetes mellitus	Remdesivir azithromycin	Ulcers	Palate	[115]
1	F	70	Depression Peripheral neuropathy Vascular disease	Azithromycin Levofloxacin Rivaroxaban Lactoferrin	Pseudomembrane	Tongue Mouth Floor Palate Oropharynx Buccal	[91]
1	F	70	Obese	Remdesivir Dexamethasone Methylprednisolone	Ulcer Pseudomembrane	Tongue Labial	[92]
1	F	71	Hypertension Diabetes mellitus Obesity Renal failure	Azithromycin Ceftriaxone	Hemorrhagic Ulcer	Lip Tongue	[107]
1	F	81	Hypertension COPD	Azithromycin Ceftriaxone	Ulcers Crust	Tongue Lip	[107]
1	F	83	Hypertension Hyperlipidemia Hypothyroidism	Remdesivir Dexamethasone	Ulcer	Tongue	[92]
1	F	83	Obesity Parkinson disease Hypertension Pancreatitis COPD	Piperacillin/tazobactam Ceftriaxone	Ulcer	Tongue palate	[107]
1	F	84	Hypertension Hypothyroidism Rectal tumor	Piperacillin tazobactam	Ulcer	Lip	[108]
1	M	46	Hypercholesterinaemia CVD	Meropenem azithromycin	Ulcer	NR	[121]
1	M	51	HIV infection	Anti-viral	Ulcer	Gingiva	[78]
1	M	57	Hypertension	Azithromycin Ceftriaxone	Crust	Lip	[108]
1	M	58	Cardiac	Cardiac drug	Depapilation	Tongue	[10]
1	M	62	Diabetes mellitus hypertension	Azithromycin	Ulcer	Tongue	[87]
1	M	67	CVD, Hypertension autosomal dominant polycystic kidney disease kidney transplant	Enoxaparin sodium Hydroxychloroquine sulfate Ceftriaxone sodium Azithromycin Meropeném Sulfamethoxazole Trimethoprim	White plaque Ulcers	Tongue	[82]
1	M	71	Hypertension Diabetes mellitus Allergies	Anti-hypertensive drugs Insulin injections Anti-allergic agents	Erosion Pseudomembrane Ecchymosis	Tongue Palate	[94]
1	M	72	Diabetes mellitus Hypertension	Piperacillin/tazobactam Azithromycin Ceftriaxone	Hemorrhagic	Lips	[107]
1	M	72	Hypertension Diabetes mellitus	Anti-hypertensive drugs Anti-diabetic drugs	Hemorrhagic Erosion	Palate Lips	[94]
1	M	75	COPD Coronary and peripheral Artery disease Diabetes mellitus Renal disease Lung carcinoma	Remdesivir Dexamethasone Convalescent plasma	Ulcers	Labial Tongue	[92]
1	M	75	Hypertension	Azithromycin	Ulcers	Tongue	[115]
1	M	78	Follicular Lymphoma	Hydroxychloroquine Steroids Ciprofloxacin tocilizumab.	Ulcer Erosive Plaque	Labial	[125]
1	M	86	Obesity Myeloid sarcoma	Warfarin sodium AAS Axetilcefurs	Ulcers	Lip	[107]
1	M	84	COPD Hypertension Stroke	Meropenem Remdesivir Methylprednisolone Heparin	Ulcer Crust	Lip Labial	[100]

Table 16 The Oral and Skin Lesion Found in COVID-19 Patient with Underlying Disease and Medication Related

Number	Gender	Ages	Underlying Disease	Drug	Oral Lesions	Location	Skin Lesion	Reference
1	F	43	Hodgkin’s lymphoma stage II	Adriamycin Bleomycin Vinblastine Dacarbazine Acyclovir	Ulcers	Oral mucosa	Monomorphic flaccid Bullae over edematous plaques ad erosions on the chest, abdomen, between the scapulas, arms, and thighs	[86]
1	F	65	Obesity Hypertension	Lopinavir Ritonavir Hydroxychloroquine	Blister Bulla	Lip mucosa	Rash under breasts, back, and genital	[89]
1	F	70	Hypertension Dyslipidemia Hypothyroidism	Azithromycin Ceftriaxone	Crust and ulcer	Lip	Fungal infections several areas	[108]
1	F	70	Hypertension Obesity Hypothyroidism	Azithromycin Ivermectin	Crust	Lip	Crust perioral	[108]
1	F	82	Hypertension Hyperlipidemia	NS	Ulcer	Lip	Perioral ulceration	[88]
1	M	42	Diabetes mellitus Hypertension	Dexamethasone Dipyrone	Macula Ulcer	Palate Tongue Lip Buccal	Petechiae-like small vesico-bullous	[128]
1	M	61	Obesity Arterial hypertension Myocardial infarction Septic shock	Egiramlon Ebrantil Tenaxum Metoprolol	Hemorrhagic ulcers White patches	Lip Tongue	Viral exanthem on the skin in the form of painless macules	[110]

Abbreviations: NS, not mentioned specifically.

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