key: cord-1024106-7s3fldf8
authors: Ramezani Darmian, P.; Memarzadeh, Z.; Aryan, R.; Nahidi, Y.; Mehri, Z.; Taghipour, A.; Samimi, N.; Amini, M.; Layegh, P.
title: Cutaneous manifestations of patients hospitalized with coronavirus disease 2019 (COVID‐19)
date: 2021-08-11
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.17557
sha: c234dfdc23363780e5b2099ebaf0471a08318aee
doc_id: 1024106
cord_uid: 7s3fldf8

In December 2019 a new member of the coronavirus family emerged in Wuhan city in Hubei Province of China, and rapidly spread all over the world causing a pandemic.1, 2 A recent Cochrane review categorized different presentations of COVID-19 into four groups; respiratory, systemic, cardiovascular and gastrointestinal (GI). However, some bizarre manifestations like olfactory problems,3 thrombotic events,4 and even mental problems5 may exist with this infection. One of these rare presentations, is skin involvement that can even be the first presentation of the disease.

In December 2019, a new member of the coronavirus family emerged in Wuhan city in Hubei Province of China, and rapidly spread all over the world causing a pandemic. 1,2 A recent Cochrane review categorized different presentations of coronavirus disease 2019 (COVID-19) into four groups: respiratory, systemic, cardiovascular and gastrointestinal. However, some bizarre manifestations like olfactory problems, 3 thrombotic events 4 and even mental problems 5 may exist with this infection. One of these rare presentations is skin involvement that can even be the first presentation of the disease. 6 Dermatologic signs and symptoms of COVID-19 are diverse and still need investigation to be completed. We conducted a study between September and October 2020 on 387 COVID-19 hospitalized patients in Imam Reza Hospital of Mashhad, Iran. All COVID-19 cases were confirmed according to the diagnosis of pulmonologists and infectious disease specialists based on polymerase chain reaction test or high-resolution computed tomography of the chest. All patients were visited by an academic dermatologist and a volunteer resident of dermatology at the patients' hospital beds.

Initially, the preliminary data including age, gender, demographic information, past medical history, drug history, clinical and laboratory findings of each patient were extracted from their medical files. Then, cooperative patients were asked about the history of any dermatologic lesion from a few weeks before clinical signs and symptoms of COVID-19 appear up to this point. Those with a positive history of these lesions were examined to define the distribution of the lesion. Furthermore, a full history regarding their dermatologic symptoms, any past medical history or family history of a skin problem was taken. For ill patients, physical examination of the skin was performed by a dermatologist. Photographs were also taken of all the patients' lesions. Additionally, we followed up each patient by telephone calls 2 weeks after each visit in order to detect further skin involvements. All the lesions' photographs were reviewed by three academic dermatologists and the final diagnosis was made based on their consensus. Skin biopsies were conducted in some cases that seemed necessary. The study protocol was approved by the Institutional Ethics Board of Mashhad University of Medical Sciences (IR.MUMS.-REC.1399.175). Written informed consent was signed by all patients or their legal guardians for those with very severe or unconscious conditions. P-value < 0.05 was considered statistically significant. All analyses were performed using SPSS software version 11.5 (SPSS Inc., Chicago, IL, USA).

A total of 387 patients including 205 males and 182 females were enrolled in this study. The details of demographic and baseline data of the patients are presented in Table 1 .

The most prevalent accompanying disease was dyslipidaemia (214 cases; 55.3%) followed by hypertension (190 cases; 49.1%). Respiratory symptoms were present in 294 patients (76%); 167 ) and the diagnoses of our cases included livedo reticularis/racemosa, pityrasis rosea like, herpes labialis, herpes zoster, maculopapular viral exanthema, urticarial viral rash, acral peeling, contact dermatitis and drug reaction in which the most common were livedo reticularis/racemosa (four cases; 1.0%) and acral peeling (four cases; 1.0%). There was no significant difference regarding age, gender, underlying diseases, CRP and lymphocyte levels, ICU admission and outcome of the disease in patients with different cutaneous diagnoses. (Table 2 ). Further studies are needed to complete these results. 

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

SARS-CoV-2 seroprevalence worldwide: a systematic review and meta-analysis

Smell and taste dysfunction in patients with COVID-19

Venous thromboembolism among hospitalized patients with COVID-19 undergoing thromboprophylaxis: a systematic review and meta-analysis

A case with psychotic disorder as a clinical presentation of COVID-19

Two cases of COVID-19 presenting with a clinical picture resembling chilblains: first report from the Middle East

The authors would like to express their gratitude to the staff of Cutaneous Leishmaniasis Research Center of Mashhad University of Medical Sciences.

The authors declare no conflict of interest.