Dermatological manifestations, and drug-induced reactions in COVID-19 patients: an observational study from İstanbul, Turkiye

Year 2024, , 555 - 563, 27.09.2024

Gökhan Kaya , Didem Dizman , Özlem Su Küçük

https://doi.org/10.32322/jhsm.1508495

Abstract

Aims: The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID-19) include fever, cough, sneezing, sore throat, rhinitis, dyspnoea, chest pain, malaise, fatigue, anorexia, and headache. Moreover, cutaneous manifestations have been observed in 0.2% to 20.4% of cases. This investigation further explores the dermatological manifestations associated with COVID-19 and reactions induced by its pharmacological treatments. Conducted at a university hospital, the study examined 841 patients and identified skin manifestations in 1.5% of cases. It differentiates between symptoms directly attributed to the viral infection and those arising from treatment, highlighting the need for clinical vigilance and adaptability in managing these manifestations. COVID-19 has been linked to a wide range of clinical symptoms, extending beyond the well-known respiratory effects to include various dermatological manifestations. These manifestations, which range from mild rashes to severe conditions like vasculitis, may complicate diagnosis and management, particularly when similar symptoms are induced by therapeutic drugs used in COVID-19 treatment.
Methods: This cross-sectional study included 841 patients treated in the COVID-19 outpatient and inpatient units of the university hospital between March and May 2020. The assessment involved clinical examinations and telemedicine consultations, focusing on differentiating between viral and drug-induced dermatological reactions.
Results: Dermatological manifestations were observed in 1.5% of the 841 patients. Direct virus-related skin changes were noted in 1% (n=8) of patients, including maculopapular eruptions (50%, n=4) on the face and trunk, trunk-localized urticaria (25%, n=2), and purpuric lesions (12.5%, n=1) on the lower extremities. Drug-induced dermatological reactions were identified in 0.5% (n=5) of patients, featuring conditions such as bullous drug reactions, psoriasiform drug eruptions, hypertrichosis, and urticaria.
Conclusion: These findings highlight the complex interplay between COVID-19 and its treatment, where both the virus and pharmacological agents can trigger significant dermatological reactions. The need for healthcare providers to consider both viral and drug-induced factors in the diagnosis and management of skin manifestations in COVID-19 patients is underscored. Further studies are essential to refine treatment protocols and reduce adverse dermatological outcomes.

Keywords

COVID-19, SARS-CoV-2, cutaneous manifestations, dermatology, pharmacological treatments, skin reactions

References

• Marzano AV, Cassano N, Genovese G, Moltrasio C, Vena GA. Cutaneous manifestations in patients with COVID-19: a preliminary review of an emerging issue. Br J Dermatol. 2020;183(3):431-442. doi:10.1111/bjd.19264
• Genovese G, Moltrasio C, Berti E, Marzano AV. Skin manifestations associated with COVID-19: Current knowledge and future perspectives. Dermatology. 2021;237(1):1-12. doi:10. 1159/000512932
• Singh H, Kaur H, Singh K, Sen CK. Cutaneous manifestations of COVID-19: A systematic review. Adv Wound Care. 2021;10(2):51-80. doi:10.1089/wound.2020.1309
• Sameni F, Hajikhani B, Yaslianifard S, et al. COVID-19 and skin manifestations: An overview of case reports/case series and meta-analysis of prevalence studies. Front Med. 2020;7: 573188. doi:10.3389/fmed.2020.573188
• Freeman EE, McMahon DE, Lipoff JB, et al. The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries. J Am Acad Dermatol. 2020;83(4):1118-1129. doi:10.1016/j.jaad.2020.06. 1015
• Panda M, Dash S, Behera B, Sil A. Dermatological manifestations associated with COVID-19 infection. Indian J Dermatol. 2021; 66(3):237-245. doi:10.4103/ijd.ijd_464_21
• Ring J. COVID-19 and its implications for dermatology and venereology. J Eur Acad Dermatol Venereol. 2020;34(5):914. doi: 10.1111/jdv.16414
• Atzori L, Cuenca-Barrales C, Montero-Vilchez T, Molina-Leyva A, Arias-Santiago S. Review of adverse cutaneous reactions of pharmacologic interventions for COVID-19: a guide for the dermatologist. J Am Acad Dermatol. 2020;83(6):1738-1748. doi: 10.1016/j.jaad.2020.08.006
• Najar Nobari N, Seirafianpour F, Mashayekhi F, Goodarzi A. A systematic review on treatment-related mucocutaneous reactions in COVID-19 patients. Dermatol Ther. 2021;34(1):e14662. doi:10. 1111/dth.14662
• Kalikyan ZG. Antibiotics hypersensitivity reactions during COVID-19 pandemic. Immunol Infektsionnye Bolezni. 2023; 13(3):586-590. doi:10.15789/2220-7619-AHR-8062
• Suchonwanit P, Leerunyakul K, Kositkuljorn C. Diagnostic and prognostic values of cutaneous manifestations in COVID-19. Dermatol Ther. 2020;33(4):e13650. doi:10.1111/dth.13650
• Bassetti M, Massone C, Vena A, et al. Skin manifestations in patients with coronavirus disease 2019. Curr Opin Infect Dis. 2022;35(2):88-94. doi:10.1097/QCO.0000000000000816
• Nakashima C, Kato M, Otsuka A. Cutaneous manifestations of COVID-19 and COVID-19 vaccination. J Dermatol. 2023;50(3): 280-289. doi:10.1111/1346-8138.16651
• McMahon DE, Gallman AE, Hruza GJ, et al. Long COVID in the skin: a registry analysis of COVID-19 dermatological duration. Lancet. 2021;21(3):313-314. doi:10.1016/S1473-3099(20)30986-5
• Litaiem N, Hajlaoui K, Karray M, Slouma M, Zeglaoui F. Acute generalized exanthematous pustulosis after COVID-19 treatment with hydroxychloroquine. Dermatol Ther. 2020;33(4):e13565. doi:10.1111/dth.13565
• Rostey R, Fontes C. Proposal for clinical classification of cutaneous manifestations in Covid-19 and in post vaccination against Sars-Cov-2: an observational study. Arch Clin Infect Dis. 2023. doi:10.5812/archcid-137498
• Gelincik A, Brockow K, Celik G, et al. Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: an EAACI Position Paper. Allergy. 2020;75:2775-2793. doi:10. 1111/all.14439
• Niebel D, Novak N, Wilhelmi J, et al. Cutaneous adverse reactions to COVID-19 vaccines: insights from an immuno dermatological perspective. Vaccines (Basel). 2021;9(9):944. doi: 10.3390/vaccines9090944
• Prasad S, Galvan Casas C, Strahan AG, et al. A dermatologic assessment of 101 mpox (monkeypox) cases from 13 countries during the 2022 outbreak: skin lesion morphology, clinical course, and scarring. J Am Acad Dermatol. 2023;88(5): 1066-1073. doi:10.1016/j.jaad.2022.12.035