Dermatological Manifestations of COVID-19: Data from a tertiary care hospital of Pakistan dedicated for COVID-19 Patients
Background: Cutaneous manifestations of COVID-19 disease are poorly characterized around the globe. Data from Pakistan is lacking.
Objective: To describe the cutaneous manifestations of COVID-19 disease in Pakistani population.
Introduction: SARS-CoV-2 virus has rapidly spread reaching the level of a pandemic disease. COVID-19 can affect different organ systems including the skin. There is a wide variety of descriptions of the cutaneous manifestations of COVID-19. However, cutaneous manifestations of COVID-19 disease are poorly characterized around the globe. The data from Pakistan is especially lacking. Our study was aimed at describing the cutaneous manifestations of COVID-19 disease in Pakistani population.
Materials and Methods: This cross sectional study was carried out at Benazir Bhutto Hospital from March 2020 till December 2020. A total of 150 patients were screened by senior dermatology postgraduate trainees who were deployed for the care of COVID-19 patients. The demographics, rash if any along with its complete history and description and laboratory investigations were noted on a preformed performa. The pictures of the rash were taken after verbal consent of patient or surrogate. The pictures were then discussed with the consultant for appropriate categorization.
Results: A total of 150 patients with the diagnosis of COVID-19 were screened. The mean age of the subjects was 51.9 ± 17.2 years. There were 94 (62.7%) males and 56 (37.3%) females. The mean duration of illness at the time of screening was 12.5 ± 9.7 days. Only 7 (4.7%) COVID-19 patients showed skin lesions. These included generalized bullous pemphigoid like (1 patient), urticarial lesions (1 patient), vesicular eruption (1 patient), skin necrosis (1 patient) and maculopapular rash (3 patients). The average duration of illness at the time of dermatological manifestation of COVID-19 was 6.31 ± 2.3 days. Skin necrosis was associated with severe disease.
Conclusion: The skin manifestations of COVID-19 patients in Pakistan are less as compared to reports and data from western world. However, they are in accordance with the data reported from few Asian countries. Regardless of this, the type, distribution and association of skin lesions with COVID-19 appear to be universal. This difference of frequency can be attributed to the racial differences or the variety of COVID-19 viral strains predominant in different countries. However, further studies are required to prove this association.
Key Words: COVID-19, Dermatology, Skin Manifestations, Cutaneous Manifestations
1. Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for global health governance. JAMA. 2020 Feb 25;323(8):709-10.
2. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KS, Lau EH, Wong JY, Xing X. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. New England Journal of Medicine. 2020 Jan 29.
3. Recalcati S. Cutaneous manifestations in COVID‐19: a first perspective. Journal of the European Academy of Dermatology and Venereology. 2020 Feb 21.
4. Marzano AV, Genovese G, Moltrasio C, Gaspari V, Vezzoli P, Maione V, Misciali C, Sena P, Patrizi A, Offidani A, Quaglino P. The clinical spectrum of COVID-19–associated cutaneous manifestations: An Italian multicenter study of 200 adult patients. Journal of the American Academy of Dermatology. 2021 Jan 18.
5. Fernandez‐Nieto D, Ortega‐Quijano D, Segurado‐Miravalles G, Pindado‐Ortega C, Prieto‐Barrios M, Jimenez‐Cauhe J. Comment on: Cutaneous manifestations in COVID‐19: a first perspective. Safety concerns of clinical images and skin biopsies. Journal of the European Academy of Dermatology and Venereology. 2020 Apr 15.
6. Editorial. COVID-19: Learning from exercise. Lancet. 2020; 395: 1011.
7. Sharma S, Raby E, Prasad Kumarasinghe S. Cutaneous manifestations and dermatological sequelae of Covid‐19 infection compared to those from other viruses. Australasian Journal of Dermatology. 2021 Feb 17.
8. Lavery MJ, Bouvier CA, Thompson B. Cutaneous manifestations of COVID-19 in children (and adults): A virus that does not discriminate. Clinics in Dermatology. 2020 Nov 1.
9. Rekhtman S, Tannenbaum R, Strunk A, Birabaharan M, Wright S, Grbic N, Joseph A, Lin SK, Zhang AC, Lee EC, Rivera E. Eruptions and related clinical course among 296 hospitalized adults with confirmed COVID-19. Journal of the American Academy of Dermatology. 2021 Apr 1;84(4):946-52.
10. Wollina U, Karadağ AS, Rowland‐Payne C, Chiriac A, Lotti T. Cutaneous signs in COVID‐19 patients: a review. Dermatologic therapy. 2020 Sep;33(5):e13549.
11. Cassius C, Frumholtz L, de Masson A, Dadzie O, Petit A, Saint‐Louis CORE (COvid Research) group. Under‐representation of people of African ancestry in publications on the cutaneous manifestations of COVID‐19: coincidence or physiology?Journal of the European Academy of Dermatology and Venereology. 2021 Apr 18.
12. Tan SW, Tam YC, Oh CC. Skin manifestations of COVID-19: a worldwide review. JAAD international. 2020 Dec 16.
13. Jamshidi P, Hajikhani B, Mirsaeidi M, Vahidnezhad H, Dadashi M, Nasiri MJ. Skin manifestations in COVID-19 patients: Are they indicators for disease severity? A systematic review. Frontiers in Medicine. 2021;8:15.
14. Tan SW, Tam YC, Oh CC. Skin manifestations of COVID-19: a worldwide review. JAAD international. 2020 Dec 16.
15. Visconti A, Bataille V, Rossi N, Kluk J, Murphy R, Puig S, Nambi R, Bowyer RC, Murray B, Bournot A, Wolf J. Diagnostic value of cutaneous manifestation of SARS‐CoV‐2 infection. British Journal of Dermatology. 2020 Jan 1.
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