Al- Anbar Medical Journal

Dermatological Manifestations of Patients with COVID 19: A Cross-sectional study

Document Type : Original articles

Authors

1 Department of Medicine/Dermatology, College of Medicine, Al-Nahrain University. Baghdad, Iraq.

2 Department of Medicine/Dermatology, College of Medicine, Kerbala University, Kerbala, Iraq.

3 Al Hur Sector, Karbala Health Directorate, Kerbala, Iraq.

4 Department of Pathology/ Molecular Pathology, College of Medicine, University of Babylon, Babylon, Iraq.

5 Department of Medicine/Dermatology, Al-Husseini Medical City, Kerbala, Iraq.

Abstract

Background: A global pandemic “Coronavirus disease-19 (COVID-19)” caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). It was isolated in December 2019 in Wuhan (China). Skin manifestations of COVID-19 disease are overlooked in the clinical approach to those suspected of this virus focusing on the pulmonary findings.
Objectives: This study aimed to describe the dermatological manifestations of COVID-19 in Iraqi patients.
Materials and Methods: A cross-sectional study was carried out at general hospitals, primary care centers, and private clinics in three Iraqi cities Baghdad, Babil, and Karbala. The study covered the period from October 2020 – to February 2021. Data regarding the demographic and clinical characteristics of each participant were registered. A thorough physical examination by a dermatologist was conducted for every subject. The data were entered and analyzed using SPSS version 25.
Results: One hundred COVID-19 patients with cutaneous manifestations were enrolled in this study. There were 59 females. Their ages ranged from 19-62 years. Most of the patients were from the age group ≤ 40 years (68). Just above half of the participants were non-healthcare workers. The highest blood group of the patients was A (45) and the least AB (11). Half of the subjects were presented within the first 7 days from the onset of the disease. Fifty-one cases were with mild disease form. In 54 patients, dermatological manifestations have appeared in the active stage of the disease. Hair loss was the commonest manifestation (30), all of them in the age group ≤ 40 years, and the majority of the cases (26) was affecting the female. While the least manifestation was acrocyanosis in 2 patients, both of them were male and from the age group > 40 years. There were highly statistically significant differences between the skin manifestations and the age and gender (P-value = 0.000).
Conclusion: Most of the patients were from the age group ≤ 40 years and female. Hair loss was the commonest skin abnormality due to COVID-19.  The majority of cutaneous manifestations were started in the active phase of the infection. The age and gender determined the type of dermatological manifestations.

Keywords

Main Subjects

References
[1]        A. L. Phelan, R. Katz, and L. O. Gostin, “The novel coronavirus originating in Wuhan, China: challenges for global health governance,” Jama, vol. 323, no. 8, pp. 709–710, 2020.
[2]        X. Li, M. Geng, Y. Peng, L. Meng, and S. Lu, “Molecular immune pathogenesis and diagnosis of COVID-19,” J. Pharm. Anal., vol. 10, no. 2, pp. 102–108, 2020.
[3]        R. M. Al-Ani, “Smell and Taste Abnormalities due to COVID-19,” Al-Anbar Med. J., vol. 16, no. 1, pp. 1–2, 2020.
[4]        H. Ghazzay, R. M. Al-Ani, M. A. Khalil, and A. F. Hammad, “Socio-clinical characteristics of COVID-19 disease in Anbar Governorate, Iraq,” J. Emerg. Med. Trauma Acute Care, vol. 2021, no. 1, p. 8, 2021.
[5]        C. E. M. Griffiths, J. Barker, T. O. Bleiker, R. Chalmers, and D. Creamer, Rook’s textbook of dermatology, 4 volume set, vol. 1. John Wiley & Sons, 2016.
[6]        I. Hamming, W. Timens, and M. L. Bulthuis, “Lely. AT, Navis, GJ, and van Goor, H.(2004) Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis,” J Pathol, vol. 203, no. 2, pp. 631–637.
[7]        C. Huang et al., “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China,” Lancet, vol. 395, no. 10223, pp. 497–506, 2020.
[8]        V. De Giorgi et al., “Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): A prospective study from China and Italy,” J. Am. Acad. Dermatol., vol. 83, no. 2, pp. 674–675, 2020.
[9]        O. Askin, R. N. Altunkalem, D. D. Altinisik, T. K. Uzuncakmak, U. Tursen, and Z. Kutlubay, “Cutaneous manifestations in hospitalized patients diagnosed as COVID‐19,” Dermatol. Ther., vol. 33, no. 6, p. e13896, 2020.
[10]      S. A. Bdaiwi and R. H. Abdul-saheb, “Mucocutaneous Manifestations of COVID-19 among Iraqi Patients in Al Diwaniyah Province , Iraq : Case Series Study,” vol. 2, no. 239, pp. 239–244, 2022.
[11]      R. Fölster‐Holst and H. W. Kreth, “Viral exanthems in childhood. Part 3: Parainfectious exanthems and those associated with virus‐drug interactions,” JDDG J. der Dtsch. Dermatologischen Gesellschaft, vol. 7, no. 6, pp. 506–510, 2009.
[12]      S. A. Castillo, A. K. Pham, and J. G. Dinulos, “Cutaneous manifestations of systemic viral diseases in neonates: an update,” Curr. Opin. Pediatr., vol. 29, no. 2, pp. 240–248, 2017.
[13]      S. Recalcati, “Cutaneous manifestations in COVID-19: a first perspective [published online March 26, 2020],” J Eur Acad Dermatol Venereol. doi, vol. 10.
[14]      D. Turkmen, N. Altunisik, S. Sener, and C. Colak, “Evaluation of the effects of COVID‐19 pandemic on hair diseases through a web‐based questionnaire,” Dermatol. Ther., vol. 33, no. 6, p. e13923, 2020.
[15]      A. Goren et al., “A preliminary observation: Male pattern hair loss among hospitalized COVID-19 patients in Spain-A potential clue to the role of androgens in COVID-19 severity.,” 2020.
[16]      G. J. Nuovo, D. Suster, E. Tili, H. Awad, and C. Magro, “A Standardization Protocol for the In Situ Detection of SARS-CoV2 RNA and Proteins,” Appl. Immunohistochem. Mol. Morphol., vol. 30, no. 2, pp. 83–90, 2022.
[17]      T. P. Habif, Clinical dermatology E-book. Elsevier Health Sciences, 2015.
[18]      Z. Zhou et al., “Heightened innate immune responses in the respiratory tract of COVID-19 patients,” Cell Host Microbe, vol. 27, no. 6, pp. 883–890, 2020.
[19]      G. Kaya, A. Kaya, and J.-H. Saurat, “Clinical and histopathological features and potential pathological mechanisms of skin lesions in COVID-19: review of the literature,” Dermatopathology, vol. 7, no. 1, pp. 3–16, 2020.
[20]      P. Suchonwanit, K. Leerunyakul, and C. Kositkuljorn, “Cutaneous manifestations in COVID-19: lessons learned from current evidence,” J. Am. Acad. Dermatol., vol. 83, no. 1, pp. e57–e60, 2020.
[21]      C.-Y. Chu, “Drug eruptions: Great imitators,” Clin. Dermatol., vol. 38, no. 2, pp. 193–207, 2020.
[22]      C. Galván Casas et al., “Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases,” Br. J. Dermatol., vol. 183, no. 1, pp. 71–77, 2020.
[23]      U. Wollina, A. S. Karadağ, C. Rowland‐Payne, A. Chiriac, and T. Lotti, “Cutaneous signs in COVID‐19 patients: a review,” Dermatol. Ther., vol. 33, no. 5, p. e13549, 2020.
[24]      J. M. Carrascosa, V. Morillas, I. Bielsa, and M. Munera-Campos, “Cutaneous manifestations in the context of SARS-CoV-2 infection (COVID-19),” Actas Dermo-Sifiliográficas (English Ed., vol. 111, no. 9, pp. 734–742, 2020.
[25]      R. Gianotti et al., “Cutaneous clinico-pathological findings in three COVID-19-positive patients observed in the metropolitan area of Milan, Italy,” 2020.
[26]      T. King, B. Hewitt, B. Crammond, G. Sutherland, H. Maheen, and A. Kavanagh, “Reordering gender systems: can COVID-19 lead to improved gender equality and health?,” Lancet, vol. 396, no. 10244, pp. 80–81, 2020.
[27]      O. Wu, N. Bayoumi, M. A. Vickers, and P. Clark, “ABO (H) blood groups and vascular disease: a systematic review and meta‐analysis,” J. Thromb. Haemost., vol. 6, no. 1, pp. 62–69, 2008.
[28]      G. Paré et al., “Novel association of ABO histo-blood group antigen with soluble ICAM-1: results of a genome-wide association study of 6,578 women,” PLoS Genet., vol. 4, no. 7, p. e1000118, 2008.
[29]      J. G. Ray, M. J. Schull, M. J. Vermeulen, and A. L. Park, “Association between ABO and Rh blood groups and SARS-CoV-2 infection or severe COVID-19 illness: a population-based cohort study,” Ann. Intern. Med., vol. 174, no. 3, pp. 308–315, 2021.
[30]      J. Zhao et al., “Relationship between the ABO blood group and the coronavirus disease 2019 (COVID-19) susceptibility,” Clin. Infect. Dis., vol. 73, no. 2, pp. 328–331, 2021.
[31]      D. McGonagle, J. S. O’Donnell, K. Sharif, P. Emery, and C. Bridgewood, “Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia,” Lancet Rheumatol., vol. 2, no. 7, pp. e437–e445, 2020.
Al- Anbar Medical Journal
Volume 18, Issue 1
June 2022
Page 43-47
Files
Share
Export Citation
Statistics