Can skin affection be a clue to COVID-19? results from a dermatology outpatient clinic in Egypt

Abstract

Background Coronavirus disease 2019 (COVID-19)-infected individuals can be asymptomatic or have mild symptoms. Cutaneous affection with COVID-19 is a unique presentation. Objective To describe the clinical presentations of skin affection in COVID-19-confirmed patients attending a dermatology outpatient clinic. Patients and methods A retrospective analysis was performed on the medical records of a single dermatology outpatient clinic described cutaneous presentations associated with COVID-19 infection in patients attending in the period from October 2020 to December 2020. Results A total of 44 COVID-19-positive patients presented with skin affection. The most common presentation was urticaria (24, 54.5%), followed by herpes simplex (seven, 15.9%), herpes zoster (four, 9.1%), papulosquamous (three, 6.9%), papulovesicular (two, 4.6%), acral lesions (two, 4.6%), leukocytoclastic vasculitis (one, 2.3%), and Kawasaki-like disease (one, 2.3%). Nine (20.5%) patients had asymptomatic COVID-19 infection, 24 (54.5%) patients had mild COVID-19, nine (20.5%) patients had moderate COVID-19, and two (4.5%) patients had severe COVID-19. Among patients with COVID-19 symptoms (35, 79.5%), seven (20%) patients presented with the cutaneous presentation before the onset of COVID-19 symptoms, whereas in the rest of the patients, cutaneous affection was simultaneous with COVID-19 symptoms (28, 80%). Conclusion Cutaneous affection can be the striking presentation for COVID-19 requiring dermatological consultation. Awareness and early recognition of skin affection associated with COVID-19 are required. Dermatologists should follow all of the precautions and use adequate personal protective equipment during their outpatient practices. Skin presentations, notably urticaria, can precede the systemic and respiratory symptoms of COVID-19. Severe mucocutaneous herpes simplex can occur with COVID-19 and require prompt medical treatment.