Cutaneous Manifestations of Emerging Arbovirus Infections Including West Nile, Dengue, Zika, Chikungunya, Usutu, and Toscana Viruses: A Clinical Overview for Dermatologists.

Arboviral infections, notably those caused by West Nile virus (WNV), Dengue virus (DENV), Zika virus (ZIKV), and Chikungunya virus (CHIKV), represent a growing global health concern due to their expanding geographic distribution and evolving clinical spectrum. While systemic and neurologic complications are well recognized, cutaneous manifestations are frequently overlooked despite their diagnostic and prognostic value. These viruses, transmitted primarily by Aedes or Culex mosquitoes, share overlapping symptoms such as fever, headache, arthralgia, myalgia, and malaise but can often be distinguished by specific dermatologic features. WNV may present with a subtle truncal exanthem; DENV is characterized by flushing, petechiae, and the 'white islands in a sea of red' pattern; ZIKV typically is associated with a fine, pruritic maculopapular rash with palmar-plantar involvement, edema and erythema of the malar region of the face, and conjunctival injection; CHIKV frequently shows an asymptomatic or pruritic macular or maculopapular rash that can result in pigmentary changes mostly on the face and mucocutaneous involvement. Other arboviral infections such as Usutu virus (USUV) and Toscana virus (TOSV) more rarely exhibit cutaneous signs. These include transient macular or urticarial rashes, conjunctivitis, and aphthous-like ulcers on the palate during early or prodromal phases. This review synthesizes current clinical, virologic, and pathophysiologic insights into these cutaneous presentations, highlighting their diagnostic relevance, underlying mechanisms, and implications for dermatologic and interdisciplinary care. Recognizing these dermatologic signs can significantly aid early diagnosis and improve patient management in endemic and outbreak settings.