Emerging dermatological symptoms in coronavirus pandemic.

Dear Editor,

COVID‐19 (coronavirus disease 2019) is a fatal disease that could lead to a serious respiratory illness. It is caused by SARS‐CoV‐2 virus. In December 2019, the first of human cases were identified in China and the infection spread quickly around the world. The World Health Organisation (WHO) declared the disease, a global pandemic on March 11, 2020, even as COVID‐19 rapidly spread across the world. According to clinical reports, fever, headache, cough, and myalgia are common clinical symptoms. Many symptoms also occur, such as sputum formation, hemoptysis, and diarrhea. ,

Scientists have recently discovered new dermatological symptoms of COVID‐19 on skin, which accompanies the other common symptoms, namely fever and dry cough. It was observed recently that several COVID‐19‐infected patients reported severe itchy hives and rashes, whereas others indicated a burning sensation on their skin. French dermatologist union, Le Syndicat National des Dermatologues‐Vénéréologues (SNDV), revealed the potential new symptoms in a press release that was released on April 6, 2020, after the SNDV communicated to a group of over 400 dermatologists that they identified signs of skin lesions, both associated with and not associated with COVID‐19. According to them, these include the appearance of pseudo‐frostbite of the extremities, sudden appearance of persistent redness, and sometimes painful, temporary, hive‐like lesions. Analysis of a number of cases reported to the SNDV shows that these signs may be associated with COVID‐19. The rashes have appeared in different shapes and sizes and have manifested anywhere on the body. One of the related reports described that the changes in the skin architecture were seen in majority of patients with COVID‐19, who received treatment at the Alessandro Manzoni Hospital, in the Northern Italy. There were 88 patients who were admitted at the hospital. Approximately, 18 of those patients, who were under treatment, exhibited severe dermatological issues. Dermatological eruption or inflammation was observed in 8 of the patients during the onset of the symptoms. Furthermore, similar observations were reported in the remaining 10 patients after they were hospitalized. Inflammatory rashes were observed in 14 patients, 1 had inflammatory vesicle and 3 of them were found to exhibit urticaria. Among all the body areas, trunk was the worst affected area in the patients. In addition, there was mild scarring of the skin. However, these lesions dried up after a certain period of time. Mild itching was observed in few patients. Interestingly, the presented dermatological issues did not match with the severity of the disease. A separate study conducted in Thailand, where the first incidence of the disease was reported outside China, stated that dermatological manifestations might heavily interfere with the diagnosis of the disease. In their report, they explained this using a COVID‐19 case admitted at a hospital in Bangkok, who was misdiagnosed as a dengue case. The reasons for this, as written by the authors, were the obvious presence of rashes on the skin, along with several red spots, that looked like bleeding into the skin. To add further confusion, the platelet count of the patient was lower than usual. To the doctors, this was an obvious case of dengue. However, the authors of the report concluded that there is a high probability for a COVID‐19 subject to present with skin manifestations, which may lead to misleading diagnosis. Therefore, it is imperative that these exceptions may be considered first, before strategizing the treatment.