Cutaneous manifestations in COVID-19 patients in a district COVID care centre
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20214205Keywords:
COVID-19, Cutaneous manifestions, Asymptomatic casesAbstract
Background: COVID-19, initially started as respiratory illness and evolved to involve various systems. Skin has been the least targeted organ with manifestations limited to case reports and series in a foreign scenario. Here, we tried to understand a same in an Indian scenario.
Methods: This was cross-sectional study done in district COVID centre among patients with a confirmed diagnosis of COVID-19 with cutaneous manifestations for 3 months. A detailed history, complete cutaneous examination was carried out. Timing in relation to other symptoms and severity was assessed.
Results: Among the 1603 patients, 39 (2.4%) had skin manifestations. Urticaria (20.5%), petechiae/purpura (17.9%), pruritis (15.4%) were the most common followed by maculo-papular rash (7.7%), manifestations secondary to drugs (7.7%), diffuse hair fall (7.7%), pseudo-chilblains (5.1%), vesicular eruptions (5.1%), infections (5.1%), cellulitis, gangrene and livedoid vasculitis. Timing of skin lesions ranged from 2 days before (10.3%) onset of COVID-19 symptoms or diagnosis to 10 days after (69.2%). Urticaria, petechiae, maculopapular rash were seen more commonly in patients with fever and respiratory symptoms. Asymptomatic cases showed urticaria, petechiae and pseudo-chilblains. Majority were in mild and moderate disease and livedoid vasculitis patient had severe disease.
Conclusions: Skin manifestations in COVID-19 are relatively uncommon in Indian scenario. However, few of the manifestations give a hint of infection while some correlate with the severity of disease.
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References
Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission, and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak-an update on the status. Mil Med Res. 2020;7(1):11.
Han Y, Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID-19): a Chinese perspective. J Med Virol. 2020;92(6):639-44.
Shaukat S, Butt G, Hussain I. Cutaneous manifestations of COVID-19. J Pak Assoc Dermatol. 2020;30(1):181-9.
Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis, and treatment of COVID-19. Int J Antimicrob Agent. 2020;55(5):105955.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Eng J Med. 2020;382:1708-20.
Hunt M, Koziatek C. A case of COVID-19 pneumonia in a young male with full body rash as a presenting symptom. Clin Pract Cases Emerg Med. 2020;4(2):219-21.
Daneshgaran G, Dubin DP, Gould DJ. Cutaneous manifestations of COVID 19: an evidence based review. Am J Clin Dermatol. 2020;21:627-39.
Tay MZ, Poh CM, Renia L. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20:363-74.
Hamming I, Timens W, Bulthuis M, Lely A, Navis G, Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step inunderstanding SARS pathogenesis. J Pathol. 2004;203(2):631-7.
Sachdeva M, Gianotti R, Shah M, Lucia B, Tosi D, Veraldi S, et al. Cutaneous manifestations of COVID19: Report of three cases and a review of literature. J Dermatol Sci. 2020;98(2):75-81.
Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic manifestation of COVID-19: Transient livedo reticularis. J Am Acad Dermatol. 2020;83(2):700.
Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020;82(5):177.
Guan WJ, Hu Y. Clinical characteristics of Coronavirus disaese 2019 in China. N Engl J Med. 2020;382:1708.
Casas CG, Catala A, Hernandez GC, Rodríguez-Jiménez P, Fernández-Nieto D, Lario AR, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183(1):71-7.
Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020;34(5):212-3.
Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi. 2020;41:006.
Jindal R, Chauhan P. Cutaneous manifestations of coronavirus disease 2019 in 458 confirmed cases: A systematic review. J Family Med Prim Care. 2020;9(9):4563-9.
Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Desai SR, et al. The spectrum of COVID-19 asscociated dermatological manifestations: an international registry of 716 patients from 31 countries. J Am Acad Dermatol. 2020;83(4):1118-29.
Genovese G, Colonna C, Marzano AV. Varicella-like exanthem associated with COVID-19 in an 8-year-old girl: A diagnostic clue? Pediatr Dermatol. 2020;37(3):435-6.
Sernicola A, Carnicelli G, DiFraia M, Chello C, Furlan C, Muharremi R, et al. Toxic erythema and eosinophilia associated with tocilizumab therapy in a COVID-19 patient. J Eur Acad Dermatol Venereol. 2020;34(8):368-70.
Test ER, Vezzoli P, Carugno A, Raponi F, Gianatti A, Rongioletti F, et al. Acute generalized exanthematous pustulosis with erythema multiforme-like lesions induced by Hydroxychloroquine in a woman with coronavirus disease 2019 (COVID-19). J Eur Acad Dermatol Venereol. 2020;34(9):457-9.
DeGiorgi V, Grazzini M, Alfaioli B, Savarese I, Corciova S, Guerriero G, et al. Cutaneous manifestations of breast carcinoma. Dermatol Ther. 2010;23:581-9.
Kumar T. Dermatological manifestations of COVID-19: a review based on existing reports. Int J Cur Res Rev. 2020;12(13):65-8.
Bai Y, Yao L, Wei T. Presumed asymptomatic carrier transmission of COVID-19. J Am Assoc. 2020;323:1406-14.