Skin Manifestations Among Patients Admitted with COVID-19: A Cross-Sectional Study at a University-Based Tertiary Hospital in Jordan

Abstract

Background COVID-19 pandemic hit the entire world with severe health and economic consequences. Although the infection primarily affected the respiratory system, it was soon recognized that COVID-19 has a multi-systemic component with various manifestations including cutaneous involvement. Objective The main objective of this study is to assess the incidence and patterns of cutaneous manifestations among moderate-to-severe COVID-19 patients who required hospitalization and whether there was a prognostic indication for cutaneous involvement and the outcome in terms of recovery or death. Methods This is a cross-sectional observational study that included inpatients who were diagnosed with a moderate or severe COVID-19 infection. The demographic and clinical data of patients were assessed including age, sex, smoking, and comorbidities. All patients were examined clinically for the presence of skin manifestations. Patients were followed for the outcome of COVID-19 infection. Results A total of 821 patients (356 females and 465 males) aged 4–95 years were included. More than half of patients (54.6%) aged >60 years. A total of 678 patients (82.6%) had at least one comorbid condition, mostly hypertension and diabetes mellitus. Sixty-two patients (7.55%) developed rashes; 5.24% cutaneous and 2.31% oral. The rashes were then grouped into five major types: group A, Exanthema: morbilliform, papulovesicular, varicella-like. Group B, Vascular: Chilblain-like lesions, purpuric/petechial, livedoid lesions. Group C, Reactive erythemas: Urticaria, Erythema multiforme. Group D, other skin rashes including flare-up of pre-existing disease, and O for oral involvement. Most patients (70%) developed rash after admission. The most frequent skin rashes were reactive erythema (23.3%), followed by vascular (20.9%), exanthema (16.3%), and other rashes with flare-ups of pre-existing diseases (39.5%). Smoking and loss of taste were associated with the appearance of various skin rashes. However, no prognostic implications were found between cutaneous manifestations and outcome. Conclusion COVID-19 infection may present with various skin manifestations including worsening of pre-existing skin diseases.

Post-COVID Kawasaki-like Multisystem Inflammatory Syndrome Complicated by Herpes Simplex Virus-1 in a Two-Year-Old Child

“…One predisposing risk factor is low vitamin D levels, which was shown to be predictive factor of a psoriatic flare post COVID-19 vaccination [18]. Furthermore, a recent study by Alshiyab et al, 2023, found a significant association between smoking and the development of skin eruptions during an acute COVID-19 infection [19]. Pertinent to our patient, as described above, second-hand smoke exposure is also associated with COVID-19-related skin eruptions, but this usually occurs in the context of a severe COVID-19 infection.…”

Urticaria and mimickers of urticaria

“…The emergence of the novel Coronavirus disease-19 (COVID-19) infection has seen cases of EM being reported as a cutaneous complication, either to the infection itself or to the vaccine ( 14 , 15 ). EM due to COVID-19 vaccination occurred most often after the first dose, most commonly with mRNA vaccines in one study ( 15 ).…”