Pityriasis rosea as a leading manifestation of COVID-19 infection.

To the Editor

Reported cutaneous manifestation incidence during COVID‐19 infection varied between countries, and a recent review showed a worldwide mean incidence of 1.7%. These manifestations are polymorphic and vary dependently on the disease severity. Few pityriasis rosea (PR) and PR‐like eruptions have been reported during COVID‐19 infection. ,

Herein, we report a case of PR‐like eruption as a leading manifestation of COVID‐19.

A 26‐year‐old woman with no previous medical history presented to our dermatology clinic for 1‐week history of erythematous scaly annular and oval papules over the trunk in a ‘Christmas tree’ like pattern (Fig. 1a). The eruption was preceded with a herald annular plaque with a peripheral scaling collaret on her right thigh (Fig. 1b). The patient developed fever, cough and myalgia 48 h later. She underwent a PCR test for COVID‐19, which came back positive.

Figure. 1

(a) Erythematous and scaly papules over the trunk, and (b) typical herald patch with the peripheral scaling collaret.

In this case, PR may be directly linked to COVID‐19 infection or to viral reactivation (e.g. HHV6, HHV7 and EBV) as previously reported .

To our knowledge, reports on cutaneous manifestations that precede respiratory symptoms in COVID 19 are scarce. Dermatologists should be aware that cutaneous manifestations can be the presenting complaint of COVID‐19 patients.

Conflicts of interest

Dr. Merhy, Dr Sarkis and Dr Stephan have nothing to disclose.

Funding source

None.