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Skin manifestations observed in Covid-19 patients

Doctors in both Italy and Thailand have discovered skin manifestations in Covid-19 patients, a finding that suggests coronavirus cases may initially present with a skin rash.

At the Alessandro Manzoni Hospital in Lecco, Italy, dermatologists observed the skin of 88 Covid-19 inpatients and published their findings online ahead of print in the Journal of the European Academy of Dermatology and Venereology (Mar. 26, 2020).

Of the Covid-19 patients observed, 20.5% developed skin manifestations. Additionally, 44% of patients had skin eruptions at symptom onset and the rest after hospitalization. Fourteen had red rashes, three had widespread urticaria and one had chickenpox-like vesicles.

The most commonly affected area was the trunk. Itching was mild or absent and lesions healed in a few days, the doctors observed. Most importantly, the investigators noted, skin manifestations did not correlate with disease severity.

“Analyzing these data, we may speculate that skin manifestations are similar to cutaneous involvement occurring during common viral infections,” wrote Dr. Sebastiano Recalati, a corresponding author of the study and member of the department of dermatology at Alessandro Manzoni Hospital in Lecco, Italy, in the report.

In Thailand, where the first case of the coronavirus outside of China was reported, authors of another report suggest Covid-19 skin manifestations can potentially cloud the diagnosis.

Doctors at a Bangkok hospital identified a case of Covid-19 that mimicked dengue fever. The patient presented with only a skin rash, petechiae, and low platelet count.

According to a report published online ahead of print in the Journal of the American Academy of Dermatology (Mar. 17, 2020), the patient was diagnosed with dengue, based on the symptoms.

The correct Covid-19 diagnosis was made at a tertiary care centre after the patient was admitted with respiratory problems.

“There is a possibility that a Covid-19 patient might initially present with a skin rash that can be misdiagnosed as another common disease,” wrote the authors of the report in a letter to the editor of the journal. “Additionally, some of these patients are afebrile initially. The practitioner should recognize the possibility that the patient might have only a skin rash and think of this disease to prevent transmission.”

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